Pharmacologic therapy of cor pulmonale.

Oxygen remains the mainstay for the therapy of pulmonary hypertension and right ventricular failure in patients with COPD. Oxygen selectively vasodilates the pulmonary vascular bed, increases oxygen delivery and mixed venous oxygen tension, and reduces the elevated pulmonary vascular resistance and right ventricular work. Clinically, oxygen therapy improves neurologic function, exercise performance, and survival. Digitalis therapy is indicated only in patients with biventricular failure or supraventricular tachycardia. Diuretics should be used carefully. Two investigational therapies offer promise, but are unproven. Almitrine increases arterial PO2, and vasodilators lower pulmonary vascular resistance. Despite the proper use of the drugs reviewed in this chapter, the current therapy for the treatment of right ventricular hypertrophy and failure is limited. Improved therapy will require a better understanding of the pathophysiology that causes a hypertrophied ventricle to fail.