Pulmonary Hypertension: Beyond the Swan Ganz Catheter

Anorectic Drugs• Etiology: Likely due to increased blood levels of serotonin– Inhibit serotonin reuptake by neurons (by inhibiting transporter), increaseserotonin release and receptor stimulation. Also inhibit serotonin transporterin platelets, endothelial cells and smooth muscle cells– Net result: increased plasma serotonin levels• Odds ratio >6:1 if take drugs for > 3 months• PAH precipitated if have other risk factors esp. collagen vascular disease• 187 patients– 62 PPH patients with history of fenfluramine use, 125 with PPH– Mean interval between onset of SOB and diet drug use was 49 months– Similar severe baseline hemodynamics– 27% of PPH patients responded to vasodilator challenges as compared to 10%of diet drug users– Overall survival was similar in the two groups with a 3‐year survival rate of50%.Simonneau, et al. (1998). Chest, 114(3 Suppl), pp. 195S‐199S.