Hemodynamic classification of pulmonary hypertension
Three categories of PH:
pre-capillary (Pre-PH),
combined pre-and-post capillary (Cpc-PH),
and isolated post-capillary (Ipc-PH).unexplained dyspnea or signs/symptoms suggesting PH .3 different drug classes
Nitric Oxide Pathway( PDE-5is and sGCs ).PAH (without cardiopulmonary comorbidities and non-vasoresponders
Endothelin Pathway( ERA )
Prostacyclin Pathway( PCA & PRA )Comprehensive risk assessment in PAH
Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure > 25 mmHg. It is classified into 5 groups, including pulmonary arterial hypertension (PAH), PH due to left heart disease, PH due to lung diseases/hypoxia, chronic thromboembolic PH, and PH with unclear mechanisms. Clinical symptoms include dyspnea, fatigue, chest pain, syncope, edema, and cough. Diagnostic tests involve echocardiogram, chest X-ray, ECG, and right heart catheterization. Management includes supportive therapies, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostacyclins, and transplantation.
Treatment strategies for pulmonary hypertensionSarfraz Saleemi
There is currently no cure for pulmonary hypertension (PAH). Treatment aims to alleviate symptoms, improve quality of life, and delay disease progression. Initial treatment involves lifestyle modifications and medications such as prostacyclins, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors. Combination therapy and newer treatments targeting cellular processes show promise. Ongoing monitoring assesses treatment response through physical exams, functional tests, labs, and imaging to optimize therapy.
1) Pulmonary hypertension (PH) is defined as elevated pulmonary artery pressure, while pulmonary arterial hypertension (PAH) is a subtype caused by constriction and remodeling of small pulmonary arteries.
2) PAH is a progressive disease that involves proliferation of cells in the pulmonary arteries leading to increased pulmonary vascular resistance and right heart failure if left untreated.
3) The document reviews classification of PH, diagnostic testing and evaluation algorithms, goals of treatment, and approved therapies for PAH.
Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure >20 mm Hg at rest. It can be caused by various conditions and is classified into 5 groups. Symptoms include dyspnea, fatigue, edema and syncope. Diagnosis involves ECG, echocardiogram, cardiac MRI and right heart catheterization. Treatment includes diuretics, oxygen therapy, calcium channel blockers, endothelin receptor antagonists, PDE5 inhibitors, prostacyclin analogs and lung transplantation in severe cases. Portopulmonary hypertension (POPH) occurs in 5% of cirrhosis patients and is treated similarly to PH but CCBs are generally avoided due to risk of worsening symptoms.
Nick H. Kim, MD, Richard N. Channick, MD, and Vallerie V. McLaughlin, MD, prepared useful Practice Aids pertaining to pulmonary hypertension for this CME activity titled "Pulmonary Hypertension at the Crossroads of Current Clinical Challenges and Novel Therapeutic Strategies." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2O9QbOh. CME credit will be available until July 30, 2019.
This document summarizes key information about pulmonary hypertension (PH) management including: median survival rates; clinical presentation; diagnostic testing including echocardiogram, right heart catheterization, and biomarkers; risk assessment; and therapy. Median survival is 2.8 years for adults and 10 months for pediatric patients with PH. Clinical presentation includes symptoms of exertional shortness of breath, fatigue, and right ventricular failure. Diagnostic testing is aimed at confirming the diagnosis, assessing severity, and identifying the cause of PH. Risk assessment evaluates factors like functional capacity, right ventricular function, and complications to determine low, intermediate, or high risk status. Therapy involves general measures, PH-specific drug therapy, and interventional procedures in advanced cases.
Current diagnosis and management of PAH from cardiologist point of view財團法人風濕病基金會台灣抗風濕病聯盟
1. Pulmonary arterial hypertension (PAH) is often misdiagnosed or diagnosed late due to non-specific symptoms. Right heart catheterization is the gold standard diagnostic test.
2. PAH can be classified into 5 groups, with Group 1 including idiopathic PAH and PAH associated with conditions like connective tissue diseases.
3. PAH progresses from a reversible stage of endothelial dysfunction and vasoconstriction to an irreversible stage involving structural changes to the pulmonary vasculature. This leads to increased pulmonary vascular resistance and pressures over time.
Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure > 25 mmHg. It is classified into 5 groups, including pulmonary arterial hypertension (PAH), PH due to left heart disease, PH due to lung diseases/hypoxia, chronic thromboembolic PH, and PH with unclear mechanisms. Clinical symptoms include dyspnea, fatigue, chest pain, syncope, edema, and cough. Diagnostic tests involve echocardiogram, chest X-ray, ECG, and right heart catheterization. Management includes supportive therapies, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase inhibitors, prostacyclins, and transplantation.
Treatment strategies for pulmonary hypertensionSarfraz Saleemi
There is currently no cure for pulmonary hypertension (PAH). Treatment aims to alleviate symptoms, improve quality of life, and delay disease progression. Initial treatment involves lifestyle modifications and medications such as prostacyclins, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors. Combination therapy and newer treatments targeting cellular processes show promise. Ongoing monitoring assesses treatment response through physical exams, functional tests, labs, and imaging to optimize therapy.
1) Pulmonary hypertension (PH) is defined as elevated pulmonary artery pressure, while pulmonary arterial hypertension (PAH) is a subtype caused by constriction and remodeling of small pulmonary arteries.
2) PAH is a progressive disease that involves proliferation of cells in the pulmonary arteries leading to increased pulmonary vascular resistance and right heart failure if left untreated.
3) The document reviews classification of PH, diagnostic testing and evaluation algorithms, goals of treatment, and approved therapies for PAH.
Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure >20 mm Hg at rest. It can be caused by various conditions and is classified into 5 groups. Symptoms include dyspnea, fatigue, edema and syncope. Diagnosis involves ECG, echocardiogram, cardiac MRI and right heart catheterization. Treatment includes diuretics, oxygen therapy, calcium channel blockers, endothelin receptor antagonists, PDE5 inhibitors, prostacyclin analogs and lung transplantation in severe cases. Portopulmonary hypertension (POPH) occurs in 5% of cirrhosis patients and is treated similarly to PH but CCBs are generally avoided due to risk of worsening symptoms.
Nick H. Kim, MD, Richard N. Channick, MD, and Vallerie V. McLaughlin, MD, prepared useful Practice Aids pertaining to pulmonary hypertension for this CME activity titled "Pulmonary Hypertension at the Crossroads of Current Clinical Challenges and Novel Therapeutic Strategies." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2O9QbOh. CME credit will be available until July 30, 2019.
This document summarizes key information about pulmonary hypertension (PH) management including: median survival rates; clinical presentation; diagnostic testing including echocardiogram, right heart catheterization, and biomarkers; risk assessment; and therapy. Median survival is 2.8 years for adults and 10 months for pediatric patients with PH. Clinical presentation includes symptoms of exertional shortness of breath, fatigue, and right ventricular failure. Diagnostic testing is aimed at confirming the diagnosis, assessing severity, and identifying the cause of PH. Risk assessment evaluates factors like functional capacity, right ventricular function, and complications to determine low, intermediate, or high risk status. Therapy involves general measures, PH-specific drug therapy, and interventional procedures in advanced cases.
Current diagnosis and management of PAH from cardiologist point of view財團法人風濕病基金會台灣抗風濕病聯盟
1. Pulmonary arterial hypertension (PAH) is often misdiagnosed or diagnosed late due to non-specific symptoms. Right heart catheterization is the gold standard diagnostic test.
2. PAH can be classified into 5 groups, with Group 1 including idiopathic PAH and PAH associated with conditions like connective tissue diseases.
3. PAH progresses from a reversible stage of endothelial dysfunction and vasoconstriction to an irreversible stage involving structural changes to the pulmonary vasculature. This leads to increased pulmonary vascular resistance and pressures over time.
1. Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure ≥ 25 mmHg at rest as assessed by right heart catheterization.
2. PH can be classified as pre-capillary or post-capillary based on pulmonary wedge pressure and pulmonary vascular resistance.
3. Treatment for PH targets three main pathways - nitric oxide-soluble guanylate cyclase-cGMP pathway, endothelin-1 pathway, and prostacyclin pathway. Medications include phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, prostacyclin analogs, and riociguat.
Dr. Nannika Pradhan presented on pulmonary hypertension (PH). The key points discussed include:
1. PH is defined as a mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization.
2. PH is classified clinically into 5 groups based on etiology.
3. Clinical features include dyspnea, chest pain, syncope, signs of right heart failure. Diagnosis involves echocardiogram, CT scan, ventilation-perfusion scan and right heart catheterization.
4. Treatment depends on disease severity and involves diuretics, oxygen supplementation, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostano
This ppt is prepared from content of braunwald, and some latest international journals. In account it make more clear concept about pulmonary hypertension.
it also contain latest ESC 2022 guidelines of pulmonary hypertension.
This document discusses pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnosis, and management in intensive care patients. It defines PH as a mean pulmonary artery pressure >25 mmHg and outlines the various causes classified under five groups. The pathophysiology of PH involves vasoconstriction, vascular remodeling, thrombosis and endothelial dysfunction. Diagnosis involves history, physical exam, imaging like chest X-ray and ECG, as well as right heart catheterization. Management focuses on treating the underlying cause, using vasodilators, inotropes to support the right ventricle, diuretics, oxygen therapy and potentially surgery in refractory cases. PH increases mortality and deteriorations can be rapid
Pulmonary hypertension with cardiac shunt determinationDr. Rajesh Das
Pulmonary hypertension (PH) can be caused by cardiac shunts. The document discusses PH, including definitions, pathogenesis, classification, diagnosis, and cardiac shunt determination. It provides details on evaluating PH associated with cardiac shunts, such as estimating shunt size using oxygen saturation measurements from different chambers (oximetric method) during cardiac catheterization. The oximetric method involves obtaining blood samples from various locations to measure oxygen content and identify significant step-ups indicating the direction and location of shunts.
Human: Thank you for the summary. Can you provide a more concise summary in 2 sentences or less?
The document describes a case of a 35-year-old female admitted with complaints of breathlessness, swelling of the legs, and abdominal distension. On examination, she had elevated jugular venous pressure, enlarged liver, edema, and signs of right heart failure. Tests showed pulmonary hypertension, right ventricular dilatation, and cardiomegaly. She was diagnosed with severe pulmonary hypertension of unknown cause.
Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 25 mmHg. It is classified based on whether the elevation in pressure is pre-capillary or post-capillary. The pathogenesis involves various changes in the pulmonary vasculature that lead to increased pulmonary vascular resistance. Diagnosis involves symptoms, physical exam findings, imaging like echocardiogram, and right heart catheterization. Treatment aims to improve hemodynamics and symptoms through pulmonary vasodilators and diuretics. Anesthetic management of pulmonary hypertension patients requires optimizing preload, afterload, and contractility while avoiding triggers of pulmonary hypertension. Close monitoring is important both intraoperatively and postoperatively.
1) HFpEF is the most common form of heart failure, affecting over 70% of heart failure patients over age 65. It is associated with substantial morbidity and mortality.
2) HFpEF is challenging to diagnose because ejection fraction is normal and cardiac congestion is difficult to evaluate non-invasively. It is defined hemodynamically as a clinical syndrome associated with a lack of capacity of the heart to pump blood adequately without elevated cardiac filling pressures.
3) There is currently no effective pharmacological treatment for HFpEF. Treatment focuses on controlling congestion through diuretics, managing comorbidities, and promoting exercise. Future efforts to better characterize HFpEF phenotypes may allow individualized therapies
This document discusses heart failure with preserved ejection fraction (HFpEF). It begins by defining HFpEF and noting that approximately half of heart failure patients have normal or near-normal ejection fractions. The document then reviews various classification systems for HF, diagnostic criteria, echocardiographic assessment of HFpEF, risk factors, and challenges in diagnosing and treating HFpEF. It concludes by discussing current and potential future treatment approaches for HFpEF, including drugs targeting comorbid conditions that are common in HFpEF patients.
Update on the Management of Pulmonary HypertensionSarfraz Saleemi
This document provides an overview of treatment for pulmonary hypertension (PH), including:
- Currently there is no cure, but earlier treatment leads to better outcomes.
- Screening high-risk groups allows for earlier diagnosis.
- Initial treatment involves general measures, supportive therapy, and testing for vasoreactivity.
- Vasoreactive patients may be treated with calcium channel blockers, while others receive PH-specific drugs.
- Combination therapy provides greater improvements in symptoms and hemodynamics than monotherapy, though it also carries higher risk of side effects.
- Over time, treatment advances have significantly improved survival rates for PH patients.
This document discusses pulmonary hypertension (PH), defining it as a mean pulmonary artery pressure of ≥20 mmHg. PH is classified into 5 groups. Group 1 is pulmonary arterial hypertension, Group 2 is PH due to left heart disease, Group 3 is PH due to lung diseases/hypoxemia, Group 4 is chronic thromboembolic PH, and Group 5 is PH with unclear multifactorial mechanisms. The pathophysiology of PH involves vasoconstriction, vascular remodeling, and thrombosis in small pulmonary vessels. Clinical evaluation includes patient history, physical exam, ECG, echocardiogram, right heart catheterization, and treatment of underlying conditions.
The document summarizes guidelines for the treatment of heart failure. Key points include:
- The 2022 guidelines recommend the use of sacubitril/valsartan (ARNi) as initial treatment for HFrEF, and suggest SGLT2 inhibitors may also be used as initial treatment.
- For HFpEF, SGLT2 inhibitors are recommended based on evidence that empagliflozin reduces hospitalizations. Other medications like ARNi, MRAs, and BB may also be considered but require further study.
- Treatment focuses on guideline-directed medical therapy including ACEi/ARB, BB, MRAs, and diuretics, with addition of other drugs like SGLT2
Samir Morcos Rafla is an emeritus professor of cardiology at Alexandria University who has published guidelines on acute heart failure. Heart failure can be chronic or acute, with acute heart failure defined as a rapid onset of symptoms requiring urgent therapy. It is classified based on systolic blood pressure into normotensive, hypertensive, non-hypertensive, and hypotensive subtypes. Acute heart failure is a global public health problem associated with high rates of hospitalization and mortality.
This document summarizes a presentation on pulmonary hypertension. It discusses:
1) Updates from recent pulmonary hypertension guidelines and clinical trials, including new approved drugs for PAH like riociguat, treprostinil, and selexipag.
2) Right ventricular remodeling patterns in PAH and their relationship to prognosis.
3) The distinction between pulmonary hypertension due to left heart disease versus other causes, and challenges in management.
4) The lack of evidence for using PAH therapies for pulmonary hypertension in the setting of lung diseases or hypoxemia.
5) A case presentation of a patient with hereditary hemorrhagic telangiectasia, liver masses, and signs of severe pulmonary
Evaluation and Management of pulmonary artery hypertension - dr sandeep mohan...YolaNewary1
Dr. Mohanan outlines the evaluation and management of pulmonary arterial hypertension (PAH). The diagnostic workup includes clinical exams, echocardiography, pulmonary function tests, CT scans, ventilation-perfusion scans, and right heart catheterization. Prognostic testing includes the 6-minute walk test and cardiopulmonary exercise testing. Management involves pharmacological treatments, surgical options, and follow-up monitoring. The document provides details on interpreting various diagnostic tests and determining prognosis in PAH patients.
The document provides information on the diagnosis and management of heart failure with preserved ejection fraction (HFpEF) according to ESC guidelines. It notes that HFpEF has a different epidemiological profile than heart failure with reduced ejection fraction (HFrEF), with older, female, obese, and hypertensive patients who are less likely to have coronary heart disease. The diagnosis of HFpEF is more difficult than HFrEF as other potential causes must be ruled out first. No treatments have convincingly reduced morbidity and mortality for HFpEF, though diuretics are used to control symptoms and treatment of comorbidities is important. The guidelines recommend controlling blood pressure and provide limited guidance for HFpEF management in
The document discusses updates to guidelines for defining and diagnosing pulmonary hypertension from the 5th World Symposium on Pulmonary Hypertension held in 2013. Key points include: maintaining the general definition of PH as a mPAP over 25 mm Hg, collecting more data on borderline PH cases with mPAP between 21-24 mm Hg, and not reintroducing exercise-induced PH criteria due to a lack of suitable definition. Recommendations are also provided on measuring and interpreting pulmonary vascular resistance and pulmonary artery wedge pressure during right heart catheterization.
Core curriculum h fp ef, hfref, and infiltrativerestrictive cardiomyopathiesdrucsamal
This document discusses the differences between cor pulmonale (right heart failure due to lung disease) and heart failure with preserved ejection fraction (HF-PEF), exploring the heterogeneity of clinical presentations in HF-PEF and the role of right heart catheterization in evaluating pulmonary hypertension. It reviews the etiologies and diagnostic clues for HF-PEF versus other conditions that can present similarly, including constrictive pericarditis, restrictive cardiomyopathy, and primary right heart failure.
This document summarizes pulmonary hypertension and its management. It discusses the pulmonary circulation and pressures, types and classification of pulmonary hypertension, pathogenesis involving various molecular pathways, clinical diagnosis using echocardiography, right heart catheterization, and treatment goals and strategies. The main treatment approaches discussed are calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. The goals of treatment are to palliate symptoms, improve exercise tolerance and right ventricular function, and strive to improve survival rates.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
1. Pulmonary hypertension (PH) is defined as a mean pulmonary arterial pressure ≥ 25 mmHg at rest as assessed by right heart catheterization.
2. PH can be classified as pre-capillary or post-capillary based on pulmonary wedge pressure and pulmonary vascular resistance.
3. Treatment for PH targets three main pathways - nitric oxide-soluble guanylate cyclase-cGMP pathway, endothelin-1 pathway, and prostacyclin pathway. Medications include phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, prostacyclin analogs, and riociguat.
Dr. Nannika Pradhan presented on pulmonary hypertension (PH). The key points discussed include:
1. PH is defined as a mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization.
2. PH is classified clinically into 5 groups based on etiology.
3. Clinical features include dyspnea, chest pain, syncope, signs of right heart failure. Diagnosis involves echocardiogram, CT scan, ventilation-perfusion scan and right heart catheterization.
4. Treatment depends on disease severity and involves diuretics, oxygen supplementation, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostano
This ppt is prepared from content of braunwald, and some latest international journals. In account it make more clear concept about pulmonary hypertension.
it also contain latest ESC 2022 guidelines of pulmonary hypertension.
This document discusses pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnosis, and management in intensive care patients. It defines PH as a mean pulmonary artery pressure >25 mmHg and outlines the various causes classified under five groups. The pathophysiology of PH involves vasoconstriction, vascular remodeling, thrombosis and endothelial dysfunction. Diagnosis involves history, physical exam, imaging like chest X-ray and ECG, as well as right heart catheterization. Management focuses on treating the underlying cause, using vasodilators, inotropes to support the right ventricle, diuretics, oxygen therapy and potentially surgery in refractory cases. PH increases mortality and deteriorations can be rapid
Pulmonary hypertension with cardiac shunt determinationDr. Rajesh Das
Pulmonary hypertension (PH) can be caused by cardiac shunts. The document discusses PH, including definitions, pathogenesis, classification, diagnosis, and cardiac shunt determination. It provides details on evaluating PH associated with cardiac shunts, such as estimating shunt size using oxygen saturation measurements from different chambers (oximetric method) during cardiac catheterization. The oximetric method involves obtaining blood samples from various locations to measure oxygen content and identify significant step-ups indicating the direction and location of shunts.
Human: Thank you for the summary. Can you provide a more concise summary in 2 sentences or less?
The document describes a case of a 35-year-old female admitted with complaints of breathlessness, swelling of the legs, and abdominal distension. On examination, she had elevated jugular venous pressure, enlarged liver, edema, and signs of right heart failure. Tests showed pulmonary hypertension, right ventricular dilatation, and cardiomegaly. She was diagnosed with severe pulmonary hypertension of unknown cause.
Pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 25 mmHg. It is classified based on whether the elevation in pressure is pre-capillary or post-capillary. The pathogenesis involves various changes in the pulmonary vasculature that lead to increased pulmonary vascular resistance. Diagnosis involves symptoms, physical exam findings, imaging like echocardiogram, and right heart catheterization. Treatment aims to improve hemodynamics and symptoms through pulmonary vasodilators and diuretics. Anesthetic management of pulmonary hypertension patients requires optimizing preload, afterload, and contractility while avoiding triggers of pulmonary hypertension. Close monitoring is important both intraoperatively and postoperatively.
1) HFpEF is the most common form of heart failure, affecting over 70% of heart failure patients over age 65. It is associated with substantial morbidity and mortality.
2) HFpEF is challenging to diagnose because ejection fraction is normal and cardiac congestion is difficult to evaluate non-invasively. It is defined hemodynamically as a clinical syndrome associated with a lack of capacity of the heart to pump blood adequately without elevated cardiac filling pressures.
3) There is currently no effective pharmacological treatment for HFpEF. Treatment focuses on controlling congestion through diuretics, managing comorbidities, and promoting exercise. Future efforts to better characterize HFpEF phenotypes may allow individualized therapies
This document discusses heart failure with preserved ejection fraction (HFpEF). It begins by defining HFpEF and noting that approximately half of heart failure patients have normal or near-normal ejection fractions. The document then reviews various classification systems for HF, diagnostic criteria, echocardiographic assessment of HFpEF, risk factors, and challenges in diagnosing and treating HFpEF. It concludes by discussing current and potential future treatment approaches for HFpEF, including drugs targeting comorbid conditions that are common in HFpEF patients.
Update on the Management of Pulmonary HypertensionSarfraz Saleemi
This document provides an overview of treatment for pulmonary hypertension (PH), including:
- Currently there is no cure, but earlier treatment leads to better outcomes.
- Screening high-risk groups allows for earlier diagnosis.
- Initial treatment involves general measures, supportive therapy, and testing for vasoreactivity.
- Vasoreactive patients may be treated with calcium channel blockers, while others receive PH-specific drugs.
- Combination therapy provides greater improvements in symptoms and hemodynamics than monotherapy, though it also carries higher risk of side effects.
- Over time, treatment advances have significantly improved survival rates for PH patients.
This document discusses pulmonary hypertension (PH), defining it as a mean pulmonary artery pressure of ≥20 mmHg. PH is classified into 5 groups. Group 1 is pulmonary arterial hypertension, Group 2 is PH due to left heart disease, Group 3 is PH due to lung diseases/hypoxemia, Group 4 is chronic thromboembolic PH, and Group 5 is PH with unclear multifactorial mechanisms. The pathophysiology of PH involves vasoconstriction, vascular remodeling, and thrombosis in small pulmonary vessels. Clinical evaluation includes patient history, physical exam, ECG, echocardiogram, right heart catheterization, and treatment of underlying conditions.
The document summarizes guidelines for the treatment of heart failure. Key points include:
- The 2022 guidelines recommend the use of sacubitril/valsartan (ARNi) as initial treatment for HFrEF, and suggest SGLT2 inhibitors may also be used as initial treatment.
- For HFpEF, SGLT2 inhibitors are recommended based on evidence that empagliflozin reduces hospitalizations. Other medications like ARNi, MRAs, and BB may also be considered but require further study.
- Treatment focuses on guideline-directed medical therapy including ACEi/ARB, BB, MRAs, and diuretics, with addition of other drugs like SGLT2
Samir Morcos Rafla is an emeritus professor of cardiology at Alexandria University who has published guidelines on acute heart failure. Heart failure can be chronic or acute, with acute heart failure defined as a rapid onset of symptoms requiring urgent therapy. It is classified based on systolic blood pressure into normotensive, hypertensive, non-hypertensive, and hypotensive subtypes. Acute heart failure is a global public health problem associated with high rates of hospitalization and mortality.
This document summarizes a presentation on pulmonary hypertension. It discusses:
1) Updates from recent pulmonary hypertension guidelines and clinical trials, including new approved drugs for PAH like riociguat, treprostinil, and selexipag.
2) Right ventricular remodeling patterns in PAH and their relationship to prognosis.
3) The distinction between pulmonary hypertension due to left heart disease versus other causes, and challenges in management.
4) The lack of evidence for using PAH therapies for pulmonary hypertension in the setting of lung diseases or hypoxemia.
5) A case presentation of a patient with hereditary hemorrhagic telangiectasia, liver masses, and signs of severe pulmonary
Evaluation and Management of pulmonary artery hypertension - dr sandeep mohan...YolaNewary1
Dr. Mohanan outlines the evaluation and management of pulmonary arterial hypertension (PAH). The diagnostic workup includes clinical exams, echocardiography, pulmonary function tests, CT scans, ventilation-perfusion scans, and right heart catheterization. Prognostic testing includes the 6-minute walk test and cardiopulmonary exercise testing. Management involves pharmacological treatments, surgical options, and follow-up monitoring. The document provides details on interpreting various diagnostic tests and determining prognosis in PAH patients.
The document provides information on the diagnosis and management of heart failure with preserved ejection fraction (HFpEF) according to ESC guidelines. It notes that HFpEF has a different epidemiological profile than heart failure with reduced ejection fraction (HFrEF), with older, female, obese, and hypertensive patients who are less likely to have coronary heart disease. The diagnosis of HFpEF is more difficult than HFrEF as other potential causes must be ruled out first. No treatments have convincingly reduced morbidity and mortality for HFpEF, though diuretics are used to control symptoms and treatment of comorbidities is important. The guidelines recommend controlling blood pressure and provide limited guidance for HFpEF management in
The document discusses updates to guidelines for defining and diagnosing pulmonary hypertension from the 5th World Symposium on Pulmonary Hypertension held in 2013. Key points include: maintaining the general definition of PH as a mPAP over 25 mm Hg, collecting more data on borderline PH cases with mPAP between 21-24 mm Hg, and not reintroducing exercise-induced PH criteria due to a lack of suitable definition. Recommendations are also provided on measuring and interpreting pulmonary vascular resistance and pulmonary artery wedge pressure during right heart catheterization.
Core curriculum h fp ef, hfref, and infiltrativerestrictive cardiomyopathiesdrucsamal
This document discusses the differences between cor pulmonale (right heart failure due to lung disease) and heart failure with preserved ejection fraction (HF-PEF), exploring the heterogeneity of clinical presentations in HF-PEF and the role of right heart catheterization in evaluating pulmonary hypertension. It reviews the etiologies and diagnostic clues for HF-PEF versus other conditions that can present similarly, including constrictive pericarditis, restrictive cardiomyopathy, and primary right heart failure.
This document summarizes pulmonary hypertension and its management. It discusses the pulmonary circulation and pressures, types and classification of pulmonary hypertension, pathogenesis involving various molecular pathways, clinical diagnosis using echocardiography, right heart catheterization, and treatment goals and strategies. The main treatment approaches discussed are calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. The goals of treatment are to palliate symptoms, improve exercise tolerance and right ventricular function, and strive to improve survival rates.
Similar to 10 Take-home messages of the 2022 ESC/ERS Guidelines for the diagnosis and treatment of PH (20)
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
4. Pre- capillary component (↑PVR )
Post-capillary component (↑PAWP)
Pulmonary Hypertension and the Right Ventricle : Forgotten No More
PH is not a rare condition
as it affects 1% of the
global population.
5. 1.1 Idiopathic PAH
1.1.1 Nonresponders at vasoreactivity testing
1.1.1 Acute responders at vasoreactivity testing
1.2 Heritable PAH
1.3 Drug- and toxin-induced PAH
1.4 PAH associated with:
1.4.1 Connective tissue disease
1.4.2 HIV infection
1.4.3 Portal hypertension
1.4.4 Congenital heart diseases
1.4.5 Schistosomiasis
1.5 PAH with overt features of venous/capillary (PVOD/PCH) involvement
1.6 Persistent PH of the newborn syndrome
2.1 PH due to HF
2.1.1 With preserved LVEF
2.1.2 Due to HF with reduced LVEF
2.2 Valvular heart disease
2.3 Congenital/acquired cardiovascular conditions
leading to postcapillary PH
1. Pulmonary Arterial Hypertension
2. PH Associated With Left Heart Disease
3. PH Associated With Lung Diseases and/or Hypoxia
4. PH Associated With Pulmonary Artery Obstructions
5. PH With Unclear and/or Multifactorial Mechanisms
3.1 Obstructive lung disease
3.2 Restrictive lung disease
3.3 Lung disease with mixed restrictive/obstructive pattern
3.4 Hypoventilation syndromes
3.5 Hypoxia without lung disease (eg, high altitude)
3.6 Developmental lung disorders
4.1 Chronic thromboembolic PH
4.2 Other pulmonary artery obstructions
5.1 Hematological disorders
5.2 Systemic disorders
5.3 Metabolic disorders
5.4 Chronic kidney failure (+/-hemodialysis)
5.5 Pulmonary tumor thrombotic microangiopathy
5.4 Fibrosing mediastinitis
Recent ESC/ERS Updates to 6th World Symposium on PH Classification
Humbert. Eur Heart J. 2022;43:3618. Humbert. Eur Resp J. 2023;61:2200879. Simonneau. Eur Resp J. 2019;53:1801913.
9. Guidelines recognize that focusing on multiple pathways
is an effective treatment strategy : 3 different drug classes
Nitric Oxide Pathway( PDE-5is and sGCs )
Endothelin Pathway( ERA )
Prostacyclin Pathway( PCA & PRA )
Pathway Class Drug
Endothelin
ERA, endothelin receptor
antagonist
Ambrisentan:oral
Bosentan:oral
Macitentan:oral
Nitric Oxide
PDE5i, phosphodiesterase
5 inhibitor
Sildenafil:oral
Tadalafil:oral
sGCs, soluble guanylate
cyclase stimulator
Riociguat:oral
Prostcyclin
PCA, prostacyclin
analogue
Epoprostenol:iv infusion
Iloprost:inhaled
Treprostinil:iv,sc,oral,inhaled
Beraprost:oral
PRA, prostacyclin receptor
agonist
Selexipag:oral
Too Much Endothelin-1
Too Little Nitric Oxide
Too Little Prostacyclin
The balance between
vasodilators and vasoconstrictors,
is disturbed in PAH
PAH Drugs
12. (1) First, how did the 2022 ESC/ERS update change from the
2018 WSPH Guidelines?
6th World Symposium
on PH 2018
2022
ESC/ERS
In the new guideline, there are minor changes in the
haemodynamic definition of PH, for example:
#The threshold of PH was lowered to a mean pulmonary
arterial pressure (mPAP) >20 mmHg*
#The threshold of pre-capillary PH was lowered to a
pulmonary vascular resistance (PVR) >2 Woods units (WU)
#The threshold of isolated post-capillary PH was lowered to a
PVR ≤2 WU
#The threshold of combined post- and pre-capillary PH was
lowered to a PVR >2 WU.
*Lowering the diagnostic threshold captures more at-risk individuals,
but it should be noted that an mPAP >20 mm Hg alone is not pathognomonic for PH.
13. (2) The clinical classification of PH distinguishes five main groups:
(i) Pulmonary arterial hypertension (PAH)
(ii) PH associated with left heart disease
(iii) PH associated with lung diseases and/or hypoxia
(iv) PH associated with pulmonary artery obstructions (mainly CTEPH)
(v) PH with unclear and/or multi-factorial mechanisms
The differential diagnosis is crucial, because the therapeutic
strategies for each of these five groups are fundamentally different.
Update of PH classification
The main changes in the classification of PH include the addition of
the subgroups ‘‘nonresponders at vasoreactivity testing’’ and ‘‘acute
responders at vasoreactivity testing’’ to the group of idiopathic PAH.
14. (3) New diagnostic algorithm aims at earlier detection & early referral
The proposed diagnostic algorithm should be considered
in patients with unexplained dyspnea or signs/symptoms suggesting PH
and includes 3 steps:
Step 1. Suspicion. Initial evaluation (first-line physicians)
Step 2: Detection. Includes noninvasive lung and cardiac testing.
Step 3. Confirmation. Patients should be referred to a PH center.
At any time, a fast-track
referral to a PH center
in case of warning signs or
when PAH and CTEPH are
suspected is recommended.
Rapidly evolving or severe
symptoms (WHO-FC III/IV),
clinical signs of RV failure,
syncope, signs of low CO
,poorly tolerated arrhythmias,
and hemodynamic instability.
#Based on the TR velocity and other echo
signs of PH, including the TAPSE/sPAP ratio
(<0.55 mm/mmHg is suggestive of PH)
#
15. (4) Initial Treatment Strategies: In patients with PAH (without cardiopulmonary
comorbidities and non-vasoresponders), risk assessment utilizing a three-strata
approach is recommended at the time of diagnosis.
For patients presenting with low or intermediate risk, initial combination therapy
with a phosphodiesterase type 5 inhibitor (PDE5i) and an endothelin receptor
antagonist (ERA) is recommended.
In patients at high risk, initial combination therapy with a PDE5i, an ERA, and
s.c./i.v. prostacyclin analogues (PCA) should be considered.
Acute vasoreactivity testing
PAH :I/H/D-PAH only
Acute
responders
CCB therapy
Amlodipine/Diltiazem/Felodipine
Non-
responders
Risk (3 strata)
Dual Triple
16. Comprehensive risk
assessment in PAH
(3-strata model)
6MWD, 6-minute walking distance; BNP,
brain natriuretic peptide; CI, cardiac
index; cMRI, cardiac magnetic resonance
imaging; CPET, cardiopulmonary exercise
testing; HF, heart failure;NT-proBNP, N-
terminal pro-brain natriuretic peptide;
PAH, pulmonary arterial hypertension;
pred., predicted; RA, right atrium; RAP,
right atrial pressure; sPAP, systolic
pulmonary arterial pressure; SvO2, mixed
venous oxygen saturation; RVESVI, right
ventricular end-systolic volume index;
RVEF, right ventricular ejection fraction;
SVI, stroke volume index;TAPSE, tricuspid
annular plane systolic excursion;
VE/VCO2, ventilatory equivalents for
carbon dioxide; VO2, oxygen uptake;
WHO-FC, World Health Organization
functional class
.aOccasional syncope during heavy
exercise or occasional orthostatic syncope
in a stable patient.
bRepeated episodes of syncope even with
little or regular physical activity.
cObserve that 6MWD is dependent upon
age, height, and burden of comorbidities.
dTo harmonize with the four-strata model
shown in Table 18, the BNP and NT-
proBNP cut-off levels have been updated
from the 2015 version based on data from
the REVEAL registry,acknowledging that
the European validation studies have used
the original cut-off
levels.274,292,293,295,296,302
ecMRI parameters adapted from Section
6.2.2.2.
17. (5) Risk assessment and treatment goals in follow-up
During follow-up, PAH patients should be re-assessed using the refined four-
strata risk assessment model.
In patients at intermediate-low-risk, therapy should be intensified by adding
a prostacyclin receptor agonist (PRA), or by switching from PDE5i to a soluble
guanylate cyclase stimulator (sGCs).
For patients at intermediate- high or high risk, addition of s.c./i.v.
prostacyclin analogues(PCA) and evaluation for lung transplantation should be
considered.
F/U: Assessment Tool
18.
19. (6) In patients with ‘PAH with comorbidities’, initial monotherapy
with a PDE5i or an ERA should be considered.
For patients presenting at intermediate or high risk during follow-up,
additional PAH medications may be considered on an individual basis.
Cardiopulmonary comorbidities : These are found predominantly in elderly patients and include
risk factors such as obesity, DM,CAD, systemic HTN (left heart phenotype) or a history of chronic
smoking and low diffusing capacity =DLCO (cardiopulmonary phenotype).
These patients respond worse to PAH medication, are less likely to reach low-risk status, have a higher mortality risk
and are more likely to discontinue this medication due to efficacy failure or low tolerance.
20. (7) PH associated with left heart disease is sub-categorized into
isolated post-capillary PH (PVR ≤2 WU), and combined post- and
pre-capillary PH (PVR >2 WU).
No PH IpcPH, isolated post-capillary PH
PVR ≤ 2 WU : normal
CpcPH, combined post- and pre-capillary PH
↑PVR> 2 WU
Finally, although drugs approved for PAH are not recommended in patients with PH-left heart disease, the
guidelines do not provide any recommendation for or against using PDE5i in patients with HFpEF and
combined post- and precapillary PH. In contrast, there is clear recommendation against the use of PDE5i in
patients with HFpEF who have isolated postcapillary PH.
In patients with a severe pre- capillary component (PVR >5 WU),
an individualized approach to treatment is recommended.
21. (8) For PH associated with lung diseases and/or hypoxia, ‘severe PH’ is
defined by a PVR >5 WU.
In such patients, an individualized approach to treatment is recommended.
Inhaled treprostinil may be considered in patients with PH associated with
interstitial lung disease(ILD).
COPD= Chronic obstructive pulmonary disease
CPFE = Combined pulmonary fibrosis and emphysema
ILD =Interstitial lung disease
Hypoxemia at rest and/or during exercise
22. (9) For patients with CTEPH, a multi-modality approach to treatment is
recommended, considering pulmonary endarterectomy(PEA), balloon
pulmonary angioplasty(BPA), and medical therapy.
Overlap in treatments/multimodality approaches in chronic CTEPH
23. Collaborative team approach for the diagnosis & management of patients with PH.
(10) It is recommended for PH centres to provide care by
a multi- disciplinary team, which collaborates with patient associations, and is
involved in research, teaching, and education.
Editorial/Rev Esp Cardiol.
2023;76(5):294–300
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In addition, we would like to emphasize the need for improvement of both early diagnosis and early treatment, based on establishing an organized,collaborative team approach directly involves first-line physicians, echocardiography, and specialized PH centers