Pulmonary Hypertension: Beyond the Swan Ganz Catheter

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Action of PHTN TherapiesTXA2Pre‐ProEndotheliumEndothelin‐1SerotoninETa ETbProliferation andVasoconstricionArachadonicPathwayL‐arginineSSRI/SERTPGI2Nitric OxidecAMPcGMPVasodilation& ApoptosisVascular EndotheliumVascular Smooth MuscleAdapted from Zamanian et al., 2002
Serotonin and PHTN• Synthesized in pulmonary endothelium– Rate limiting step is activity of tryptophan hydroxylase1(Tph1)• Serotonin can– pass into the underlying pulmonary smooth muscle cellsthrough the serotonin transporter (SERT) to initiateproliferation– activate serotonin receptors on pulmonary smooth musclecells to evoke proliferation and contraction– mediates pulmonary fibroblast proliferation via the SERTand serotonin receptors
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Pulmonary Hypertension:Beyond the S
Page 4 and 5:
What is the Big Deal?• Patients w
Page 6 and 7:
Independent Predictor of Mortality
Page 8 and 9:
Etiology• Noxious stimuli exposur
Page 10 and 11:
Components
Page 12 and 13:
Pathways Implicated in PHTNTXA2Pre
Page 14 and 15:
Components• Prostacyclin- Prostag
Page 16 and 17:
Abnormalities in CoagulationPlatele
Page 18 and 19:
Pathophysiology• Increased flow-
Page 20 and 21:
Pathophysiology• Low resistance,
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Pathophysiology ProgressionDeath
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ClassificationARTERIAL• Idopathic
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ARTERIAL HYPERTENSION
Page 28 and 29:
Pulmonary Arterial Hypertension•
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Collagen Vascular Disease• Sclero
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Portopulmonary HTN• Portal HTN +
Page 34 and 35:
Methamphetamine• Amphetamine, met
Page 36 and 37:
VENOUS HYPERTENSION
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Left Heart Disease• LV systolic d
Page 40 and 41:
LV Pressure‐Volume Curvehttp://ww
Page 42 and 43:
Congenital Heart Disease• Systemi
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PHTN associated with lungdisease/hy
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Thromboembolic Disease• Thromboem
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Miscellaneous• Sarcoidosis• His
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SYMPTOMSAnd then I felttired…
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Signs and Symptoms• Dyspnea- Most
Page 54 and 55: Physical Exam• Prominent, split,
Page 56 and 57: ECG Changes• Right‐axis deviati
Page 58 and 59: CXRwww.emedicine.com/RADIO/topic583
Page 60 and 61: V/Q Scanwww.emedicine/RADIO/topic58
Page 62 and 63: Echohttp://www.emedicine.com/med/im
Page 64 and 65: DIAGNOSIS
Page 66 and 67: Diagnostic Tests• BNP- Increased
Page 68 and 69: Vasoreactivity Testing• RHC• Va
Page 70 and 71: Management Goals• Improve functio
Page 72 and 73: Nocturnal Desaturationwww.rnceus.co
Page 74 and 75: Digoxin• Controversial- No mortal
Page 76 and 77: Specific Concerns with Anticoagulat
Page 78 and 79: Treatment For LV sided Heart Diseas
Page 80 and 81: Action of Current PHTN TherapiesTXA
Page 82 and 83: Survival and Prostacyclin• 162 pa
Page 84 and 85: The ‘Other’ Prostacyclin Analog
Page 86 and 87: Phosphodiesterase Inhibitors• Inh
Page 88 and 89: Action of Current PHTN TherapiesPre
Page 90 and 91: Endothelin Receptor Antagonists•
Page 92 and 93: Nitric Oxide• Increases intracell
Page 94 and 95: Nitric Oxide• Vascular effects- D
Page 96 and 97: Weaning Nitric Oxide• Case Study
Page 98 and 99: Surgical Options• Pulmonary Endar
Page 100 and 101: Pulmonary Endartectomywww.emedicine
Page 102 and 103: FUTURE THERAPIES
Page 106 and 107: Serotonin Antagonists• “Treatme
Page 108 and 109: More Hope…• Perhaps the inhibit
Page 110 and 111: You knew this next one was coming
Page 112 and 113: CONCLUSIONSThe End
Page 114 and 115: WorkUp• Autoantibody tests, HIV t
Page 116 and 117: One More Thought…• …most of t
Page 118 and 119: References• Herve, P., Launay, J.
Page 120: References• Nagaya, N., Nishikimi
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Pulmonary Hypertension: Beyond the Swan Ganz Catheter

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