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For all patients, consider:
For patients with New York Heart Association (NYHA) class IV symptoms inspite of calcium-channel antagonists, consider:
- Prostaglandins, such as iloprost, treprostinil, or epoprostenol.
- Endothelin receptor antagonists such as bosentan.
Pulmonary hypertensive crisis, also called acute right heart syndrome, may happen when the pulmonary artery pressure is over a mean of 40 mm Hg. If the systemic blood pressure falls below the pulmonary artery pressure, perfusion of the right ventricle may be reduced leading to myocardial ischemia and dilitation of the right ventricle which may lead to systemic hypotension and acidosis.
- Electrocardiogram right-axis deviation and right-ventricular hypertrophy
- history of pulmonary embolism
- A ratio of right-ventricular to systemic systolic pressure > 0.66
- Anonymous (2015), Pulmonary hypertension (English). Medical Subject Headings. U.S. National Library of Medicine.
- Fisher MR, Forfia PR, Chamera E, et al (April 2009). "Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension". Am. J. Respir. Crit. Care Med. 179 (7): 615–21. DOI:10.1164/rccm.200811-1691OC. PMID 19164700. Research Blogging.
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