The Treatment of Chronic Cor Pulmonale

Abstract

In this presentation stress has been laid upon the concept that the treatment, as well as the prognosis of chronic cor pulmonale depend upon the underlying pulmonary disease. It has long been known that the chief causes of chronic cor pulmonale are chronic obstructive pulmonary emphysema and various forms of fibrosis, particularly the pneumoconioses. An understanding of the difference between these diseases, both as to their pulmonary dysfunction and their circulatory complications, is crucial to success in therapy. Management of the patient with chronic pulmonary emphysema and (or pulmoniale is quite different from that of the subject with fibrosis and right heart involxemenit. Unfortuniately, little as yet is known about the circulation in the pulmonary fibroses. In patients with pulmonary fibrosis as well as those with granulomas of the lung it would appear that the anatomic pulmonary lesion is chiefly responsible for the pulmonary hypertension, in contradistinction to the patients with emphysema. Inasmuch as the anatomic lesions are for the most part irreversible, so is the pulmonary hypertension. This has limited our therapeutic approach in this form of chronic cor pulmonale to rigorous restriction of physical activity directed at minimizing exacerbations of pulmonary hypertension. While emphasis has been placed upon the difference in management of the patient with emphysema or fibrosis and cor pulmonale, nonetheless it should be remembered that in any individual patient these two conditions may coexist. In that event, intensive therapy directed at the sequellae of emphysema may be very rewarding.