Pulmonary hypertension resident survival guide: Difference between revisions

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==Definition==
==Definition==
Pulmonary hypertension ([[PHT]]) is defined by mean pulmonary artery pressure greater (mPAP) than '''25 mmHg''' at rest,.Other hemodynamic characteristics include pulmonary capillary wedge pressure ([[PCWP]]),left atrial pressure or left ventricle end-diastolic pressure ([[LVEDP]]) less that 15 mmHg ,and pulmonary vascular resistance greater than 3 Wood units .
Pulmonary hypertension (PH) is defined by mean pulmonary artery pressure > 25 mm Hg at rest.


==Causes==
==Causes==

Revision as of 17:03, 7 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]

Definition

Pulmonary hypertension (PH) is defined by mean pulmonary artery pressure > 25 mm Hg at rest.

Causes

Life threatening causes

Life threatening conditions which may cause death or permanent disability within 24 hours if left untreated.

  • Pulmonary veno-occlusive disease (PE)

Common causes

  • Familial
  • LA/LV systolic/diastolic dysfunction.
  • Valvular heart disease in the left heart (MR,MS).
  • Congenital heart disease with left→right shunt (ASD,VSD,PDA).
  • Connective tissue diseases(CREST,SLE,MCTD,RA).
  • Lung diseases with chronic hypoxia (COPD,ILD,sleep apnea)
  • High altitude.
  • Idiopathic

Management

 
 
 
 
Characterize the symptoms:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider alternative diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Anticoagulation ±
❑ Diuretics ±
❑ Oxygen ±
❑ Digoxin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute vasoreactivity testing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
 
 
 
Negative
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Oral Calcium channel blocker (CCB)
 
 
Lower risk
 
 
 
Higher risk
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sustained response
 
 
❑ ERAs or PDE-5 Is ((Oral)
❑ Epoprostenol or Treprostinil (IV)
❑ Illoprost (inhaled)
❑ Treprostinil (SC)
 
 
 
❑ Epoprostenol or Treprostinil (IV)
❑ Illoprost (inhaled)
❑ ERAs or PDE-5 Is ((Oral)
❑ Treprostinil (SC)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continue CCB
 
 
Reassess consider combo-therapy
 
 
 
 
Atrial septostomy
Lung transplant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Investigational protocols
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

Don'ts

[1]

References

  1. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR; et al. (2009). "ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association". Circulation. 119 (16): 2250–94. doi:10.1161/CIRCULATIONAHA.109.192230. PMID 19332472.