Cor pulmonale with an elevated hematocrit indicate the patient has been hypoxic from quite some time which has increased hematopoiesis. Increased blood viscosity due to the high hematocrit may worsen Cor pulmonale symptoms, but did not cause the Cor pulmonale. ARDS may cause an acute decompensation in the patient and lead to Cor pulmonale, but the hematocrit would be normal in this patient, not elevated. Although aggressive fluid resuscitation would decrease blood viscosity, it would worsen heart failure due to volume overload.