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قديم 12-10-2012, 05:43 PM
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Medical Management of cor pulmonale
Pharmacological
Long-term oxygen therapy (LTOT)/**cturnal Oxygen Therapy (**T) have been shown to improve quality of life and survival in patients with severe chronic hypoxia
Diuretics: such as furosemide and bumetanide
Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
Vasodilators: such as nifedipine and diltiazem
Anticoagulation: These help prevent clots from forming in the blood. Blood thinners make it more likely for you to bleed
I**tropic *****, particularly digoxin, are frequently used but there is little evidence for their efficacy in right heart failure, in contrast to their use with left ventricular failure
Methylxanthine bronchodilators such as theophylline are frequently used for their beneficial effect on bronchial tone and concomitant mild positive i**tropic effect


**n pharmacological
Limit your liquids as directed: Ask your caregiver how much liquid you should drink each day. Too much liquid can increase your risk for swelling and make your cor pulmonale worse.

 


Eat healthy foods: You may need to change what you eat to control your symptoms. Foods that are low in salt are best. Healthy foods include fruit, vegetables, whole-***** breads, low-fat dairy products, beans, lean meat, and fish.
Exercise: Talk to your caregiver about the best exercise plan for you. Exercise may help you lose weight, which will decrease stress on your heart.
Prevent pregnancy: During pregnancy, your heart needs to work harder than usual. Pregnancy may be life-threatening to both you and your baby. Talk with your caregiver about safe ways to prevent pregnancy.
Do **t drink *******: ******* can make it harder for you to breathe, and can worsen your cor pulmonale. Talk with your caregiver if you drink ******* and need help to stop

 


Do **t *****: If you *****, it is never too late to quit. ******* ***** can make your heart and lung symptoms worse. It can also cause heart and lung disease. Ask your caregiver for information if you need help to stop smoking

Surgery procedure
Venesection is used with caution in some patients who have severe secondary polycythaemia (usually defined as haematocrit >0.65) due to chronic hypoxia. It has been shown to improve symptomatology, but there is ** evidence of improved survival.[2]
Transplantation of single/double lung or heart/lung is used in some extreme cases of cor pulmonale and significantly improves outlook. The underlying cause must usually be unrelated to smoking to reduce the likelihood of other pathology that would give poorer outcomes


Medical management of cardiomyopathy
**n-pharmacological
A healthy diet and physical activity are part of a healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and *****s; half of your *****s should come from whole-***** products.
Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.
Choose and prepare foods with little sodium (salt). Too much salt can raise your risk of high blood pressure.
Choose foods and ********* that are low in added sugar. If you drink *******ic *********, do so in moderation.
Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in with the calories you use during physical activity. Be as physically active as you can.
Some people should get medical advice before starting or increasing physical activity. For example, talk with your doctor if you have a chronic (ongoing) health problem, are on medicine, or have symptoms such as chest pain, shortness of breath, or dizziness. Your doctor can suggest types and amounts of physical activity that are safe for you.
Avoiding the use of ******* and illegal *****
Getting e**ugh sleep and rest
Reducing stress
Treating underlying conditions, such as diabetes and high blood pressure
Quitting smoking

Pharmacological
Lower your blood pressure. ACE inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are examples of medicines that lower blood pressure.
Slow your heart rate. Beta blockers, calcium channel blockers, and digoxin are examples of medicines that slow the heart rate. Beta blockers and calcium channel blockers also are used to lower blood pressure.
Keep your heart beating with a **rmal rhythm. These medicines, called antiarrhythmics, help prevent arrhythmias.
Balance electrolytes in your body. Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They also help muscle and nerve tissues work properly. Ab**rmal electrolyte levels may be a sign of dehydration (lack of fluid in your body), heart failure, high blood pressure, or other disorders. Aldosterone blockers are an example of a medicine used to balance electrolytes.
Remove excess fluid and sodium from your body. Diuretics, or "water pills," are an example of a medicine that helps remove excess fluid and sodium from the body.
Prevent blood clots from forming. Anticoagulants, or "blood thinners," are an example of a medicine that prevents blood clots. Blood thinners often are used to prevent blood clots from forming in people who have dilated cardiomyopathy.
Reduce inflammation. Corticosteroids are an example of a medicine used to reduce inflammation.

Surgery
Septal Myectomy
Septal myectomy is open-heart surgery. It's used for people who have obstructive hypertrophic cardiomyopathy and severe symptoms. This surgery generally is used for younger patients and for people whose medicines aren't working well.
Surgically Implanted Devices
Surgeons can place several types of devices in the heart to help it work better. One example is a pacemaker. This is a small device that's placed under the skin of your chest or abdomen to help control arrhythmias. The device uses electrical pulses to prompt the heart to beat at a **rmal rate.
Sometimes doctors choose to use a cardiac resynchronization therapy (CRT) device. A CRT device coordinates contractions between the heart's left and right ventricles.
A left ventricular assist device (LVAD) helps the heart pump blood to the body. An LVAD can be used as a long-term therapy or as a short-term treatment for people who are waiting for a heart transplant.
An implantable cardioverter defibrillator (ICD) helps control life-threatening arrhythmias that may lead to SCA. This small device is implanted in the chest or abdomen and connected to the heart with wires.
If an ICD senses a dangerous change in heart rhythm, it will send an electric shock to the heart to restore a **rmal heartbeat.
For this surgery, a surgeon replaces a person's diseased heart with a healthy heart from a deceased do**r. A heart transplant is a last resort treatment for people who have end-stage heart failure. "End-stage" means the condition has become so severe that all treatments, other than heart transplant, have failed.
For more information about this treatment, go to the Health Topics Heart Transplant article.

**nsurgical Procedure
Doctors may use a **nsurgical procedure called ******* septal ablation to treat cardiomyopathy.
For this procedure, your doctor injects etha**l (a type of *******) through a tube into the small artery that supplies blood to the thickened area of heart muscle. The ******* kills cells, and the thickened tissue shrinks to a more **rmal size.
This procedure allows blood to flow freely through the ventricle, which improves symptoms

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