cardiovascular disorders
Cor Pulmonale
Treatment of Cor Pulmonale
Treatment of cause Treatment of cor pulmonale is difficult; it focuses on the cause (see table), particularly alleviation or moderation of hypoxia. Early identification and treatment are important before structural changes become irreversible. If peripheral edema is present, diuretics may seem appropriate, but they are helpful only if LV failure and pulmonary fluid overload are also present. Diuretics should be used cautiously because small decreases in preload often worsen cor pulmonale. Pulmonary vasodilators (eg,hydralazine, calcium channel blockers, nitrous oxide, prostacyclin, phosphodiesterase inhibitors), although beneficial in primary pulmonary hypertension, are not effective.Bosentan, an endothelin receptor blocker, also may benefit patients with primary pulmonary hypertension, but its use is not well studied in cor pulmonale.Digoxinis effective only if patients have concomitant LV dysfunction; caution is required because patients with COPD are sensitive todigoxin’s effects. Phlebotomy during hypoxic cor pulmonale has been suggested, but the benefits of decreasing blood viscosity are not likely to offset the harm of reducing oxygen-carrying capacity unless significant polycythemia is present. For patients with chronic cor pulmonale, long-term anticoagulants reduce risk of venous thromboembolism. 