Pulmonary Hypertension: Beyond the Swan Ganz Catheter

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WorkUp• Autoantibody tests, HIV test, CBC, liver function tests, BNP– Antinuclear antibody (ANA), rheumatoid factor (RF), and antineutrophilcytoplasmic antibody (ANCA)• Electrocardiography• Chest radiography• Pulmonary function tests• Echocardiography• Ventilation‐perfusion (V/Q) scanning• Computed tomographic pulmonary angiography (CTPA)• Pulmonary angiography• Cardiac catheterization• Magnetic resonance imaging (MRI)• Exercise testing (6 min walk)
At Risk Patients and ScreeningRiskSclerodermaCREST syndromeLupus, RAOther connectivetissue disordersFamilialPortal HTNHIVPrior IVDAPrior appetitesuppressant useRecommendationsTTE annually (even without symptoms)TTE with onset of new symptomsTTE with presence of symptomsTTE with presence of symptomsTTE in 1 st degree relatives at time of patient’s diagnosisWith onset of new symptomsEvery 3‐5 yearsTeach 1 st degree relatives clinical symptomsTTE if evaluated for liver transplantTTE with presence of symptomsTTE with presence of symptomsTTE with presence of symptoms
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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
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Abnormalities in CoagulationPlatele
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Pathophysiology• Increased flow-
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Pathophysiology• Low resistance,
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Pathophysiology ProgressionDeath
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ClassificationARTERIAL• Idopathic
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ARTERIAL HYPERTENSION
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Pulmonary Arterial Hypertension•
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Collagen Vascular Disease• Sclero
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Portopulmonary HTN• Portal HTN +
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Methamphetamine• Amphetamine, met
Page 36 and 37:
VENOUS HYPERTENSION
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Left Heart Disease• LV systolic d
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LV Pressure‐Volume Curvehttp://ww
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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
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Physical Exam• Prominent, split,
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ECG Changes• Right‐axis deviati
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CXRwww.emedicine.com/RADIO/topic583
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V/Q Scanwww.emedicine/RADIO/topic58
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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 104 and 105: Action of PHTN TherapiesTXA2Pre‐P
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 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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