Pulmonary hypertension risk factors: Difference between revisions

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Latest revision as of 17:20, 9 June 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Ralph Matar; Rim Halaby, M.D. [2]

Overview

Pulmonary hypertension (PH) is a multifactorial disease involving genetic and environmental risk factors. Risk factors for pulmonary arterial hypertension include BMPR2 mutation, connective tissue disease, HIV infection, portal hypertension, fenfluramine use, and congenital heart disease with a shunt. Left heart and lung diseases are risk factors for PH. Patients with a hypercoagulable state (such as the presence of lupus anticoagulant, deficiency of protein C, protein S, or antithrombin III, chronic inflammatory disorders, myeloproliferative syndromes, and splenectomy) are at an increased risk for chronic thromboembolic pulmonary hypertension.

Risk Factors

Risk factors of pulmonary hypertension are divided as follows:^[1]

Pulmonary Arterial Hypertension

Shown below is a table summarizing the list of drugs associated with PAH:

Definite risk	Possible risk	Likely risk	Unlikely risk
Aminorex Fenfluramine Dexfenfluramine Toxic rapeseed oil Benfluorex	Cocaine Phenylpropanolamine St John's wort Chemotherapy Selective serotonin reuptake inhibitors Pergolide	Amphetamine L-tryptophan Methamphetamine	Oral contraceptive Estrogen therapy Smoking

Pulmonary hypertension due to Left Heart Disease

Pulmonary Hypertension due to Lung Diseases and/or Hypoxia

Alveolar hypoventilation disorders
Chronic exposure to high altitude
Chronic obstructive pulmonary disease
Developmental abnormalities
Interstitial lung disease
Pulmonary diseases with mixed restrictive and obstructive pattern
Sleep related breathing problems

Chronic Thromboembolic Pulmonary Hypertension

Pulmonary embolism
Hypercoagulability (lupus anticoagulant, deficiency of protein C, protein S, or antithrombin III, chronic inflammatory disorders, myeloproliferative syndromes, and splenectomy)

PH with Unclear and/or Multifactorial Mechanisms

References

↑ McLaughlin, VV.; Archer, SL.; Badesch, DB.; Barst, RJ.; Farber, HW.; Lindner, JR.; Mathier, MA.; McGoon, MD.; Park, MH. (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. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[McLaughlin-2009-1] McLaughlin, VV.; Archer, SL.; Badesch, DB.; Barst, RJ.; Farber, HW.; Lindner, JR.; Mathier, MA.; McGoon, MD.; Park, MH. (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. Unknown parameter |month= ignored (help)

[1]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Pulmonary hypertension}}
-{{CMG}}   '''Assistant Editor(s)-in-Chief:''' [[User:Ralph Matar|Ralph Matar]],
+{{CMG}}; '''Assistant Editor(s)-in-Chief:''' [[User:Ralph Matar|Ralph Matar]]; {{Rim}}
-==Risk factors for developing Pulmonary Hypertension==
+==Overview==
-Pulmonary hypertension can be diagnosed in people of all ages, races, and ethnicity. However some risk factors make some people more likely to get the disease.
+Pulmonary hypertension (PH) is a multifactorial disease involving genetic and environmental risk factors. Risk factors for pulmonary arterial hypertension include [[BMPR2]] [[mutation]], [[connective tissue disease]], [[HIV infection]], [[portal hypertension]], [[fenfluramine]] use, and [[congenital heart disease]] with a [[shunt]]. [[Left heart]] and [[lung]] diseases are risk factors for PH. Patients with a [[hypercoagulable state]] (such as the presence of [[lupus anticoagulant]], deficiency of [[protein C]], [[protein S]], or [[antithrombin III]], [[inflammation#Chronic inflammation|chronic inflammatory disorders]], [[myeloproliferative syndrome]]s, and [[splenectomy]]) are at an increased risk for chronic [[thromboembolic]] pulmonary hypertension.
-These risk factors include:
-#Gender: Females are at least two-and-a-half more likely to have idiopathic and familial pulmonary hypertension than males.
-#Family history of the condition: defined by two or more family members having a gene mutation causing pulmonary hypertension.
-#Co-morbidities: certain diseases or conditions, such as heart and [[lung diseases]], [[liver disease]], [[HIV]] infection, [[connective tissue disorders]] like [[scleroderma]] and [[lupus]] are associated with pulmonary hypertension.
-#[[Obstructive sleep apnea]] by causing a drop in oxygen level when the patient is asleep.
-#Being prone to have recurrent [[Pulmonary Embolism]].
-#The use of street drugs(such as [[cocaine]]) or certain appetite suppressors like methamphetamines and the diet drug “fen phen”.
-#Living at high altitudes for a long period of time.(hypoxemia).
-*While [[pregnancy]] in itself is not considered a risk factor for pulmonary hypertension, a female who gets pregnant and has pulmonary hypertension carries a higher risk of mortality, for this reason, pregnancy is contraindicated in patients with PAH.
+==Risk Factors==
+Risk factors of pulmonary hypertension are divided as follows:<ref name="McLaughlin-2009">{{Cite journal  | last1 = McLaughlin | first1 = VV. | last2 = Archer | first2 = SL. | last3 = Badesch | first3 = DB. | last4 = Barst | first4 = RJ. | last5 = Farber | first5 = HW. | last6 = Lindner | first6 = JR. | last7 = Mathier | first7 = MA. | last8 = McGoon | first8 = MD. | last9 = Park | first9 = MH. | title = 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. | journal = Circulation | volume = 119 | issue = 16 | pages = 2250-94 | month = Apr | year = 2009 | doi = 10.1161/CIRCULATIONAHA.109.192230 | PMID = 19332472 }}</ref>
-*If needed, birth control pills containing the lowest amount of estrogen are recommended. However, nearly half of the specialists did not advocate using birth control pills for their patients, and some actively discouraged patients from doing so because of concern over the possible role of estrogen in worsening PAH<ref>Consensus statement issued by the scientific leadership council,  birth control and hormonal therapy in pulmonary arterial hypertension.</ref>
+===Pulmonary Arterial Hypertension===
+* [[BMPR2]] gene mutation
+* [[ALK1]] gene mutation
+* [[Connective tissue disease]]
+* [[HIV]] infection
+* [[Portal hypertension]]
+* [[Congenital heart disease]]
+* [[Schistosomiasis]]
+* Chronic [[hemolytic anemia]]
+* [[Drug]]s and [[toxin]]s
+Shown below is a table summarizing the list of drugs associated with PAH:
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 25%" align="center" |Definite risk || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 25%" align="center" |Possible risk || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 25%" align="center" |Likely risk || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 25%" align="center" |Unlikely risk
+|-
+| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="left" |
+* [[Aminorex]]
+* [[Fenfluramine]]
+* [[Dexfenfluramine]]
+* Toxic rapeseed oil
+* [[Benfluorex]]
+| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="left" |
+* [[Cocaine]]
+* [[Phenylpropanolamine]]
+* [[St John's wort]]
+* [[Chemotherapy]]
+* [[Selective serotonin reuptake inhibitor]]s
+* [[Pergolide]]
+| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="left" |
+* [[Amphetamine]]
+* [[L-tryptophan]]
+* [[Methamphetamine]]
+| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="left" |
+* [[Oral contraceptive]]
+* [[Estrogen|Estrogen therapy]]
+* [[Smoking]]
+|}
+===Pulmonary hypertension due to Left Heart Disease===
+* [[Systolic dysfunction]]
+* [[Diastolic dysfunction]]
+* Left [[valvular disease]]
+===Pulmonary Hypertension due to Lung Diseases and/or Hypoxia===
+* Alveolar [[hypoventilation]] disorders
+* Chronic exposure to high altitude
+* [[Chronic obstructive pulmonary disease]]
+* Developmental abnormalities
+* [[Interstitial lung disease]]
+* Pulmonary diseases with mixed restrictive and obstructive pattern
+* Sleep related breathing problems
+===Chronic Thromboembolic Pulmonary Hypertension===
+* [[Pulmonary embolism]]
+* [[Hypercoagulability]] ([[lupus anticoagulant]], deficiency of [[protein C]], [[protein S]], or [[antithrombin III]], [[inflammation|chronic inflammatory disorder]]s, [[myeloproliferative syndrome]]s, and [[splenectomy]])
+===PH with Unclear and/or Multifactorial Mechanisms===
+* [[Myeloproliferative disease]]
+* [[Splenectomy]]
+* [[Sarcoidosis]]
+* [[Histiocytosis]]
+* [[Lymphangioleiomyomatosis]]
+* [[Neurofibromatosis]]
+* [[Vasculitis]]
+* [[Glycogen storage disease]]
+* [[Gaucher disease]]
+* [[Thyroid]] disorder
+* Obstruction by [[tumor]]
+* Fibrosing [[mediastinitis]]
+* [[Chronic renal failure]] on [[dialysis]]
 ==References==
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