Pulmonary Hypertension: Beyond the Swan Ganz Catheter

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ClassificationARTERIAL• Idopathic• Familial• Associated– Collagen vascular disease– Congenital systemic to pulmonaryshunts– Portal hypertension– HIV– Drugs and toxins– Thyroid disorders, glycogen storagedisease, Gaucher disease, herditaryhemorrhagic telangiectasia,hemoglobinopathies,myeloproliferative disorders,splenectomyVENOUS• <strong>Pulmonary</strong> veno‐occlusive disease• <strong>Pulmonary</strong> capillaryhemangiomatosis• Left sided atrial/ventricular heartdisease• Left sided valvular heart disease• COPD/ILD• Sleep disordered breathing• Alveolar hypoventilation disorders• Chronic exposure to high altitudes• Developmental abnormalities• Chronic thrombotic/embolic disease• Miscellaneous– Sarcoidosis, histiocytosis X,Lymphangiomatosis, pulmonary vesselcompression
Classification Divisions• PAH– Familial/Medical Conditions/Risk Factors• PHTN r/t Left Heart Disease– Valvular/myocardial disease• PHTN r/t Lung Disease/hypoxemia– Inadequate oxygenation• Chronic (thrombotic/embolic) pulmonary embolism• Miscellaneous– Sarcoidosis, shistosomiasis
Page 1: 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,
Page 22 and 23: Pathophysiology ProgressionDeath
Page 26 and 27: ARTERIAL HYPERTENSION
Page 28 and 29: Pulmonary Arterial Hypertension•
Page 30 and 31: Collagen Vascular Disease• Sclero
Page 32 and 33: Portopulmonary HTN• Portal HTN +
Page 34 and 35: Methamphetamine• Amphetamine, met
Page 36 and 37: VENOUS HYPERTENSION
Page 38 and 39: Left Heart Disease• LV systolic d
Page 40 and 41: LV Pressure‐Volume Curvehttp://ww
Page 42 and 43: Congenital Heart Disease• Systemi
Page 44 and 45: PHTN associated with lungdisease/hy
Page 46 and 47: Thromboembolic Disease• Thromboem
Page 48 and 49: Miscellaneous• Sarcoidosis• His
Page 50 and 51: SYMPTOMSAnd then I felttired…
Page 52 and 53: 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 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 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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