MANAGEMENT OF PATIENTS WITH COR-PULMONALE

The successful management of cor pulmonale (pulmonary heart disease) or disordered function of the right ventricle due to lung disease depends entirely upon the detailed evaluation of the form of lung disease which has produced the cardiac dysfunction. Contrary to the common forms of heart disease - such as arteriosclerotic or rheumatic heart disease - in which the primary disorder is within the cardiac cells themselves, cor pulmonale is a secondary form of heart disease, dependent on lung disorders which occasion the development of pulmonary artery hypertension. The cardiac myocardium is normal but is called upon to work against increased pressures in the lesser circulation. It becomes immediately clear therefore that the mechanisms which produce the hemodynamic abnormality of pulmonary hypertension are key to the understanding of cor pulmonale and also should provide information which guides therapy in these patients. An attack on these mechanisms is the logical approach to prevention of cardiac complications.