Pulmonary hypertension screening
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Pulmonary Hypertension Microchapters |
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Pulmonary hypertension screening On the Web |
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American Roentgen Ray Society Images of Pulmonary hypertension screening |
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Risk calculators and risk factors for Pulmonary hypertension screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assistant Editor(s)-in-Chief: Ralph Matar
Overview
Patients with a known BMPR2 mutation, scleroderma, and portal hypertension undergoing evaluation for liver transplantation should receive periodic screening through a thorough assessment of the presence of symptoms, physical examination, chestX ray, as well as elctrocardiography. Patients with HIV infection should not be screened for PH in the absence of any suggestive findings.[1]
Screening
Patients who are considered at high risk for the development of pulmonary hypertension and require periodic screening include:
| Recommended screening | |
| Known BMPR2 mutation | Echocardiogram (yearly) |
| BMPR2 mutation in a first degree relative | Genetic counseling BMPR2 genotyping |
| Family history for PAH in 2 or more relatives | Genetic counseling BMPR2 genotyping |
| Systemic sclerosis | Echocardiogram (yearly) |
| Portal hypertension | Echocardiogram if orthotopic liver transplantation is in consideration |
| Sickle cell disease | Echocardiogram (yearly) |
| Previous use of fenfluramine | Echocardiogram in case of symptoms |
| Congenital heart disease | Echocardiogram at the time of diagnosis |
These are the parameters that should be evaluated on Echocardiogram:
- Right atrial and right ventricular enlargement.
- Reduced right ventricular function.
- Displacement of the interventricular septum.
- Tricuspid regurgitation(TR).
- Tei index or myocardial performance index (measured by Doppler ultrasound).
- Pericardial effusion (presence also indicates a higher mortality rate).
The Tei index is an index of combined right ventricular systolic and diastolic function obtained by dividing the sum of both isovolumetric contraction and relaxation intervals by the ejection time.
References
- ↑ ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension