Which of the following therapies is indicated for the treatment of cor pulmonale in this patient?
A 73-year-old male patient of yours with longstanding chronic obstructive pulmonary disease presents to your office complaining of increased dyspnea, weakness, and fatigue. He has been experiencing these symptoms for the past few months. The symptoms have progressed despite adherence to his inhaler regimen. He also reports that he has been experiencing lower-extremity swelling for the past month. On examination, jugular venous distention, a right ventricular heave, and pitting lower-extremity edema are noted. These findings were not present before. You suspect that the patient has developed cor pulmonale.
A. A calcium channel blocker B. A prostacyclin analogue C. A diuretic D. Digitalis
A diuretic-chronic cor pulmonale develops in response to a chronic increase in pulmonary vascular resistance; the right ventricle will distend and undergo hypertrophy. when the ability of the right ventricle to compensate is overwhelmed, increases in right ventricular end-diastolic pressure and right atrial pressure occur, resulting in right heart failure. the most important approach to treatment of chronic cor pulmonale is the treatment of the underlying lung disease. in patients with hypoxemia, controlled-flow supplemental o2 should be given at rest, during exercise, and during sleep to maintain o2 saturation above 90%. diuretics are useful in reducing the edema, ascites, and liver congestion associated with cor pulmonale, but these agents must be used carefully to avoid reducing right ventricular filling pressures, which may lead to decreasing cardiac output. although vasodilator agents such as calcium channel blockers block hypoxic pulmonary vasoconstriction and cause pulmonary vasodilatation, the impairment in gas exchange in patients with chronic cor pulmonale negates any potential positive effect of these drugs. epoprostenol (prostacyclin) and other analogues have been studied in several types of chronic pulmonary hypertension and are approved for use in pulmonary arterial hypertension (pah), but they have not been studied extensively in patients with cor pulmonale. except in cases of coexistent left ventricular failure, digitalis is not indicated in patients with cor pulmonale; in addition, use of digitalis may be associated with greater toxicity. assessment of oxygenation status and the use of supplemental oxygen are also appropriate for this patient.