Portopulmonary hypertension other diagnostic studies: Difference between revisions
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==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
In general, PPH is diagnosed 4-7 years after the patient is diagnosed with [[portal hypertension]]<ref> Hadengue et al. PH complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528</ref> and in roughly 65% of cases, the diagnosis is actually made at the time of invasive [[hemodynamic]] monitoring following [[anesthesia]] induction prior to [[liver transplantation]].<ref> Hadengue et al. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528</ref> | In general, PPH is diagnosed 4-7 years after the patient is diagnosed with [[portal hypertension]]<ref> Hadengue et al. PH complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528</ref> and in roughly 65% of cases, the diagnosis is actually made at the time of invasive [[hemodynamic]] monitoring following [[anesthesia]] induction prior to [[liver transplantation]].<ref> Hadengue et al. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528</ref> | ||
After the initial [[echocardiography]], patients are referred for [[pulmonary artery catheterization]]. | |||
The limitations of echocardiography are related to the derivative nature of non-invasive [[PAP]] estimation. The measurement of PAP by echocardiogram is made using a simplified [[Bernoulli equation]]. The speed of a fluid through a narrow orifice is proportional to the difference of the pressures on either side – in this case, the right atrium and ventricle. Therefore the velocity of [[tricuspid regurgitation]] (which occurs at a measurable but normal level in the vast majority of humans) is squared, multiplied by four and added to the estimated [[right atrial pressure]]. Right atrial pressure is a derivative value, found by examining the [[inferior vena cava]] in the following sense: If, on inspiration, it should collapse roughly 50%, then the right atrial pressure is roughly 5mm_Hg; some collapse gives a right atrial pressure of 10 mm_Hg and no collapse, pressure of 15 mm_Hg. High [[cardiac index]] and [[pulmonary capillary wedge pressure]]s, however, may lead to false positives by this standard. By one institution’s evaluation, the correlation (simple [[linear regression]]) between estimated systolic PAP and directly measured PAP was poor, 0.49.<ref> Tapper EB, unpublished data</ref> For these reasons, right heart catheterization is needed to confirm the diagnosis. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other Diagnostic Studies
In general, PPH is diagnosed 4-7 years after the patient is diagnosed with portal hypertension[1] and in roughly 65% of cases, the diagnosis is actually made at the time of invasive hemodynamic monitoring following anesthesia induction prior to liver transplantation.[2]
After the initial echocardiography, patients are referred for pulmonary artery catheterization.
The limitations of echocardiography are related to the derivative nature of non-invasive PAP estimation. The measurement of PAP by echocardiogram is made using a simplified Bernoulli equation. The speed of a fluid through a narrow orifice is proportional to the difference of the pressures on either side – in this case, the right atrium and ventricle. Therefore the velocity of tricuspid regurgitation (which occurs at a measurable but normal level in the vast majority of humans) is squared, multiplied by four and added to the estimated right atrial pressure. Right atrial pressure is a derivative value, found by examining the inferior vena cava in the following sense: If, on inspiration, it should collapse roughly 50%, then the right atrial pressure is roughly 5mm_Hg; some collapse gives a right atrial pressure of 10 mm_Hg and no collapse, pressure of 15 mm_Hg. High cardiac index and pulmonary capillary wedge pressures, however, may lead to false positives by this standard. By one institution’s evaluation, the correlation (simple linear regression) between estimated systolic PAP and directly measured PAP was poor, 0.49.[3] For these reasons, right heart catheterization is needed to confirm the diagnosis.
References
- ↑ Hadengue et al. PH complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528
- ↑ Hadengue et al. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-528
- ↑ Tapper EB, unpublished data