[Therapeutic principles in pulmonary heart disease and right heart insufficiency]

Until now the pathomechanism of pulmonary heart disease is insufficiently elucidated. Therefore, at present, rational therapeutical concepts are possible only in chronic obstructive lung diseases. Without any modification, the principle of comprehensive treatment of the basic pulmonary disease remains valid. In the symptomatic therapy of the pulmonary heart disease, in first place the long-term oxygen therapy becomes mandatory. Treatment with vasodilatory drugs remains in the long-term activity disappointing. Reasonable expectations are directed to clinical trials of angiotensin-converting-enzyme-inhibitors. Cardiac glycosides remain reserved for manifest cardiac failure. The stabilization of the acid-base-balance is of great importance for the efficacy of treatment. The decision on the use of additives depends upon a critical evaluation of the actual clinical state and upon the consideration of the risks from polymorbidity.