Pulmonary hypertension resident survival guide

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

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 .

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

No

Oral Calcium channel blocker

Lower risk

Higher risk

Sustained response

ERAs or PDE-5 Is ((Oral)
Epoprostenol or Treprostinil (IV)
Illoprost (inhaled)
Treprostinil (SC)

Do's

Don'ts

^[1]

References

↑ 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.

[pmid19332472-1] 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.

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