Which finding supports cor pulmonale in a patient with COPD?

• A. Elevated PCWP
• B. Normal PCWP
• C. Increased JVP
• D. Left heart failure

Answer: (B)

Cor pulmonale is right-sided heart failure caused by pulmonary hypertension from chronic lung disease. In COPD, ongoing hypoxia causes vasoconstriction and remodeling of the pulmonary arteries, increasing afterload on the right ventricle and leading to right heart strain.

The pulmonary capillary wedge pressure (PCWP) estimates left atrial pressure. In cor pulmonale due to lung disease, left-sided pressures stay normal, so PCWP is typically normal (roughly 6–12 mmHg). This normal PCWP helps distinguish pulmonary‑vascular–driven right heart failure from left‑heart–driven causes of pulmonary hypertension, where PCWP would be elevated.

An elevated PCWP would point to left-sided heart disease as the source of pulmonary hypertension rather than cor pulmonale, and left heart failure itself isn’t the right‑sided failure process described here. Increased JVP can accompany right heart failure, but the key diagnostic clue in this context is the normal PCWP.