University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

52

Pages:

2
Author:

Mariam A. A.

Pulmonary Hypertension Type I: Idiopathic Genetic Drugs Toxins Inflammation Type II (due to Left Heart Failure): LHF (Left Heart Failure) LV (Left Ventricle) Aortic stenosis Mitral regurgitation Type III (due to Lung Disease): COPD (Chronic Obstructive Pulmonary Disease) ILD (Interstitial Lung Disease) Pulmonary fibrosis Lung cancer Type IV (due to Chronic Blood Clotting): Recurrent PE Pulmonary embolism Downregulated: * JNO, NO, PG12 Upregulated: * Endothelin * Serotonin * Thromboxane Hemodynamics: * Increased pulmonary vascular resistance (PVR) * Increased right ventricular pressure (RV) * Increased right ventricular afterload * Right heart failure Clinical Manifestations: * Dyspnea * Fatigue * Chest pain * Syncope * Right heart failure symptoms (JVD, peripheral edema) Diagnosis: * Right heart catheterization * Measure mean PA pressure (mPAP) * Measure cardiac output (CO) * Estimate PVR Treatment: Vasodilators: Calcium channel blockers Potassium channel openers Endothelin receptor antagonists Diuretics: To manage fluid overload Oxygen therapy: For hypoxemia Sildenafil: For pulmonary vasoconstriction Diagnostic Approach to Pulmonary Hypertension Rule out: LHF (Left Heart Failure) COPD ILD (Interstitial Lung Disease) Chronic thromboembolic disease (CTE) Right Heart Catheterization: mPAP (Mean Pulmonary Artery Pressure) >25 mmHg PVR (Pulmonary Vascular Resistance) >3 Wood units Without evidence of LHF: Possible PH (Pulmonary Hypertension) Confirmed Pulmonary Hypertension Type I: Idiopathic (BMPR2 mutation) Type II: Left Heart Failure (COPD, ILD, Chronic thromboembolic disease) Type III: Lung Disease (COPD, ILD) Type IV: Chronic thromboembolic disease Type V: Multifactorial causes (sarcoidosis) Treatment of Pulmonary Hypertension Type I: Vasodilator therapy Type II: Treat underlying cause Type III: Treat underlying cause Type IV: Treat underlying cause Type V: Treat underlying cause Vasodilator Therapy Vasoreactivity test (+): Calcium channel blockers: Nifedipine Endothelin antagonists: Bosentan Prostacyclin agonists: Sildenafil Vasoreactivity test (-): Prostacyclin agonists: Epoprostenol