Normal<unk>  (left) and right ventricular hypertrophy (right) Investigations available to determine the cause of cor pulmonale include the following: * Chest x-ray – right ventricular hypertrophy, right atrial dilatation, prominent<unk>  artery * ECG – right ventricular hypertrophy, dysrhythmia, P pulmonale (characteristic peaked P wave) * Thrombophilia screen- to detect chronic venous thromboembolism (proteins C and S, antithrombin III, homocysteine levels) P pulmonale Differential diagnosis The diagnosis of<unk>  is not easy as both lung and<unk><unk>  can produce similar symptoms. Therefore, the differential diagnosis (DDx) should assess: * Atrial myxoma * Congestive<unk>  failure * Constrictive pericarditis * Infiltrative cardiomyopathies * Right<unk>  failure (right ventricular infarction) * Ventricular septal defect
Pulmonary heart disease
Asthma
Obstructive lung disease
Bronchopulmonary dysplasia
Chronic obstructive pulmonary disease
Pulmonary hypertension
Restrictive lung disease
Vocal cord dysfunction