Pulmonary hypertension: Difference between revisions
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In [[medicine]], '''pulmonary hypertension''' is "increased vascular resistance in the pulmonary circulation, usually secondary to heart diseases or lung diseases."<ref>{{MeSH}}</ref> | In [[medicine]], '''pulmonary hypertension''' is "increased vascular resistance in the pulmonary circulation, usually secondary to heart diseases or lung diseases."<ref>{{MeSH}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
The [[echocardiogram]] may be more than 10 mm/Hg in error in half of cases.<ref name="pmid19164700">{{cite journal |author=Fisher MR, Forfia PR, Chamera E, ''et al'' |title=Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension |journal=Am. J. Respir. Crit. Care Med. |volume=179 |issue=7 |pages=615–21 |year=2009 |month=April |pmid=19164700 |doi=10.1164/rccm.200811-1691OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=19164700 |issn=}}</ref> | The [[echocardiogram]] may be more than 10 mm/Hg in error in half of cases.<ref name="pmid19164700">{{cite journal |author=Fisher MR, Forfia PR, Chamera E, ''et al'' |title=Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension |journal=Am. J. Respir. Crit. Care Med. |volume=179 |issue=7 |pages=615–21 |year=2009 |month=April |pmid=19164700 |doi=10.1164/rccm.200811-1691OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=19164700 |issn=}}</ref><ref name="pmid20864617">{{cite journal| author=Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S| title=Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. | journal=Chest | year= 2011 | volume= 139 | issue= 5 | pages= 988-93 | pmid=20864617 | doi=10.1378/chest.10-1269 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20864617 }} </ref> | ||
A [[meta-analysis]] of [[Doppler echocardiography]] for predicting right heart catheterization reported a [[Sensitivity and specificity|sensitivity]] and [[Sensitivity and specificity|specificity]] of 88% and 56%, respectively. <ref name="pmid23227919">{{cite journal| author=Taleb M, Khuder S, Tinkel J, Khouri SJ| title=The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis. | journal=Echocardiography | year= 2013 | volume= 30 | issue= 3 | pages= 258-65 | pmid=23227919 | doi=10.1111/echo.12061 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23227919 }} </ref> | |||
==Treatment== | |||
For all patients, consider: | |||
* Inhibitors of [[phosphodiesterase]] type 5 (PDE-5), such as [[sildenafil]]. | |||
For patients with New York Heart Association (NYHA) class IV symptoms inspite of calcium-channel antagonists, consider: | |||
* [[Prostaglandin]]s, such as [[iloprost]], [[treprostinil]], or [[epoprostenol]]. | |||
* [[Endothelin]] receptor antagonists such as [[bosentan]]. | |||
===Perioperative care=== | |||
The [[preoperative care]] and [[perioperative care]] (including [[intraoperative care]] and [[postoperative care]]) has been reviewed.<ref name="pmid19558745">{{cite journal| author=Hill NS, Roberts KR, Preston IR| title=Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication. | journal=Respir Care | year= 2009 | volume= 54 | issue= 7 | pages= 958-68 | pmid=19558745 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19558745 }} </ref> | |||
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.<ref name="pmid19558745">{{cite journal| author=Hill NS, Roberts KR, Preston IR| title=Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication. | journal=Respir Care | year= 2009 | volume= 54 | issue= 7 | pages= 958-68 | pmid=19558745 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19558745 }} </ref> | |||
If the preoperative pulmonary artery systolic pressure is over 70 mm Hg, the risk of postoperative [[heart failure]] and mortality may be 10%.<ref name="pmid17576968">{{cite journal| author=Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ| title=Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. | journal=Br J Anaesth | year= 2007 | volume= 99 | issue= 2 | pages= 184-90 | pmid=17576968 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=17576968 | doi=10.1093/bja/aem126 }} </ref> Risk factors for operative mortality include: | |||
* [[Electrocardiogram]] right-axis deviation and right-ventricular hypertrophy | |||
* history of [[pulmonary embolism]] | |||
* A ratio of right-ventricular to systemic systolic pressure > 0.66 | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 08:16, 6 September 2013
- The content on this page originated on Wikipedia and is yet to be significantly improved. Contributors are invited to replace and add material to make this an original article.
In medicine, pulmonary hypertension is "increased vascular resistance in the pulmonary circulation, usually secondary to heart diseases or lung diseases."[1]
Diagnosis
The echocardiogram may be more than 10 mm/Hg in error in half of cases.[2][3]
A meta-analysis of Doppler echocardiography for predicting right heart catheterization reported a sensitivity and specificity of 88% and 56%, respectively. [4]
Treatment
For all patients, consider:
- Inhibitors of phosphodiesterase type 5 (PDE-5), such as sildenafil.
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.
Perioperative care
The preoperative care and perioperative care (including intraoperative care and postoperative care) has been reviewed.[5]
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.[5]
If the preoperative pulmonary artery systolic pressure is over 70 mm Hg, the risk of postoperative heart failure and mortality may be 10%.[6] Risk factors for operative mortality include:
- Electrocardiogram right-axis deviation and right-ventricular hypertrophy
- history of pulmonary embolism
- A ratio of right-ventricular to systemic systolic pressure > 0.66
References
- ↑ Anonymous (2024), 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.
- ↑ Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S (2011). "Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice.". Chest 139 (5): 988-93. DOI:10.1378/chest.10-1269. PMID 20864617. Research Blogging.
- ↑ Taleb M, Khuder S, Tinkel J, Khouri SJ (2013). "The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis.". Echocardiography 30 (3): 258-65. DOI:10.1111/echo.12061. PMID 23227919. Research Blogging.
- ↑ 5.0 5.1 Hill NS, Roberts KR, Preston IR (2009). "Postoperative pulmonary hypertension: etiology and treatment of a dangerous complication.". Respir Care 54 (7): 958-68. PMID 19558745.
- ↑ Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ (2007). "Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery.". Br J Anaesth 99 (2): 184-90. DOI:10.1093/bja/aem126. PMID 17576968. Research Blogging.