Pulmonary hypertension resident survival guide: Difference between revisions
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Revision as of 01:11, 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 (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
{{familytree | | | | | D01 | | | | | |D01=Anticoagulation ± Diuretics ± Oxygen ± Digoxin
| Characterize the symptoms
| |||||||||||||||||||||||||||||||||||||||
| Examine the patient
| |||||||||||||||||||||||||||||||||||||||
| Consider alternative diagnosis
| |||||||||||||||||||||||||||||||||||||||
| 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
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.