This document provides an overview of pulmonary hypertension (PH), including its history, clinical findings, investigations, classification, pathophysiology, and management. Some key points:
- PH can be caused by various underlying conditions and diseases. A thorough workup is needed to determine the specific type and cause.
- Common presenting symptoms are dyspnea and fatigue. Physical exam may reveal signs of right heart failure as disease progresses.
- Initial screening tests include echocardiogram, ECG, CXR. Right heart catheterization is the gold standard for diagnosis and assessing severity.
- PH is classified into 5 types based on underlying pathophysiology. The main types are PAH, PH related to lung/
This document provides an overview of pulmonary hypertension (PH), including its classification, pathophysiology, clinical presentation, diagnostic evaluation, and treatment. PH is classified into 5 groups depending on its underlying cause. It results from increased pulmonary vascular resistance leading to right heart strain. Patients typically present with dyspnea and signs of right heart failure. Diagnosis requires right heart catheterization. Treatment focuses on supporting right ventricular function, optimizing volume status, decreasing afterload, and treating the underlying cause.
Heart failure is a clinical syndrome where the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions that reduce the heart's ability to contract or fill properly and common symptoms include dyspnea, fatigue, and edema. Upon presentation, patients exhibiting signs of congestion such as elevated jugular pressure, rales, and edema are treated with diuretics, while those with low blood pressure or organ dysfunction may require inotropic support or mechanical circulatory support.
The document provides information on pulmonary hypertension and pulmonary circulation. It discusses:
1) The pulmonary circulation begins at the right ventricle and ends at the left atrium, transporting the entire cardiac output to the lungs. It has low resistance and high compliance.
2) Pulmonary artery pressures are normally lower than systemic pressures, with mean pulmonary artery pressure around 10-12 mmHg.
3) Pulmonary vascular resistance is low due to a balance of vasodilator and vasoconstrictor prostaglandins. Resistance primarily occurs in small arteries and arterioles.
4) Pulmonary hypertension is defined as a mean pulmonary artery pressure over 25 mmHg at rest. Its causes
The document discusses pulmonary hypertension and the pulmonary circulation. It provides details on:
1) The anatomy and physiology of the pulmonary circulation and how it differs from the systemic circulation with lower pressures and resistance.
2) The pathophysiology of pulmonary hypertension including abnormalities in the endothelium, smooth muscle cells, and vascular remodeling in different types.
3) Clinical definitions of pulmonary hypertension, pulmonary arterial hypertension, and evaluation tools like echocardiogram, CT, right heart catheterization.
4) Treatment involves vasodilators, diuretics, calcium channel blockers and general measures depending on the severity and type of pulmonary hypertension.
This document summarizes pulmonary vascular lesions and pulmonary hypertension. It discusses the anatomy of the pulmonary vasculature and provides a histological classification of pulmonary vascular lesions. It also covers pulmonary hypertension, describing definitions, clinical features, investigations including right heart catheterization, and management strategies such as supportive therapy, advanced drug therapies, atrial septostomy, and lung transplantation.
This document discusses pulmonary vascular lesions and pulmonary hypertension. It begins with an overview of pulmonary vascular anatomy and classifications of pulmonary hypertension and vascular lesions. It then covers topics like the pathogenesis of pulmonary hypertension, clinical presentation, investigations including echocardiography and right heart catheterization, and management strategies. In particular, it focuses on current and emerging drug therapies for pulmonary arterial hypertension including endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids.
1) A 55-year-old woman presented with shortness of breath and was found to have right ventricular hypertrophy on ECG. Echocardiogram showed an atrial septal defect with pulmonary hypertension.
2) A 35-year-old woman with shortness of breath for 3 years was found to have mitral stenosis and pulmonary hypertension on echocardiogram.
3) A pregnant 25-year-old woman had severe pulmonary hypertension found on echocardiogram.
The document discusses pulmonary hypertension (PH) due to lung disorders. It defines PH and classifies it based on its underlying causes. PH due to lung diseases and hypoxia (group 3 PH) is associated with obstructive lung diseases like COPD, restrictive lung diseases, mixed lung diseases, and hypoxia without lung disease. Symptoms include dyspnea, fatigue, and signs of right heart failure as PH progresses. Imaging like echocardiogram and right heart catheterization are used to diagnose and assess severity of PH. Treatment involves managing the underlying lung condition, supportive therapies, and in severe cases, pulmonary arterial hypertension therapies may be considered though data is limited in group 3 PH. Prognosis is typically progressive with increased mortality
This document provides an overview of pulmonary hypertension (PH), including its classification, pathophysiology, clinical presentation, diagnostic evaluation, and treatment. PH is classified into 5 groups depending on its underlying cause. It results from increased pulmonary vascular resistance leading to right heart strain. Patients typically present with dyspnea and signs of right heart failure. Diagnosis requires right heart catheterization. Treatment focuses on supporting right ventricular function, optimizing volume status, decreasing afterload, and treating the underlying cause.
Heart failure is a clinical syndrome where the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions that reduce the heart's ability to contract or fill properly and common symptoms include dyspnea, fatigue, and edema. Upon presentation, patients exhibiting signs of congestion such as elevated jugular pressure, rales, and edema are treated with diuretics, while those with low blood pressure or organ dysfunction may require inotropic support or mechanical circulatory support.
The document provides information on pulmonary hypertension and pulmonary circulation. It discusses:
1) The pulmonary circulation begins at the right ventricle and ends at the left atrium, transporting the entire cardiac output to the lungs. It has low resistance and high compliance.
2) Pulmonary artery pressures are normally lower than systemic pressures, with mean pulmonary artery pressure around 10-12 mmHg.
3) Pulmonary vascular resistance is low due to a balance of vasodilator and vasoconstrictor prostaglandins. Resistance primarily occurs in small arteries and arterioles.
4) Pulmonary hypertension is defined as a mean pulmonary artery pressure over 25 mmHg at rest. Its causes
The document discusses pulmonary hypertension and the pulmonary circulation. It provides details on:
1) The anatomy and physiology of the pulmonary circulation and how it differs from the systemic circulation with lower pressures and resistance.
2) The pathophysiology of pulmonary hypertension including abnormalities in the endothelium, smooth muscle cells, and vascular remodeling in different types.
3) Clinical definitions of pulmonary hypertension, pulmonary arterial hypertension, and evaluation tools like echocardiogram, CT, right heart catheterization.
4) Treatment involves vasodilators, diuretics, calcium channel blockers and general measures depending on the severity and type of pulmonary hypertension.
This document summarizes pulmonary vascular lesions and pulmonary hypertension. It discusses the anatomy of the pulmonary vasculature and provides a histological classification of pulmonary vascular lesions. It also covers pulmonary hypertension, describing definitions, clinical features, investigations including right heart catheterization, and management strategies such as supportive therapy, advanced drug therapies, atrial septostomy, and lung transplantation.
This document discusses pulmonary vascular lesions and pulmonary hypertension. It begins with an overview of pulmonary vascular anatomy and classifications of pulmonary hypertension and vascular lesions. It then covers topics like the pathogenesis of pulmonary hypertension, clinical presentation, investigations including echocardiography and right heart catheterization, and management strategies. In particular, it focuses on current and emerging drug therapies for pulmonary arterial hypertension including endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids.
1) A 55-year-old woman presented with shortness of breath and was found to have right ventricular hypertrophy on ECG. Echocardiogram showed an atrial septal defect with pulmonary hypertension.
2) A 35-year-old woman with shortness of breath for 3 years was found to have mitral stenosis and pulmonary hypertension on echocardiogram.
3) A pregnant 25-year-old woman had severe pulmonary hypertension found on echocardiogram.
The document discusses pulmonary hypertension (PH) due to lung disorders. It defines PH and classifies it based on its underlying causes. PH due to lung diseases and hypoxia (group 3 PH) is associated with obstructive lung diseases like COPD, restrictive lung diseases, mixed lung diseases, and hypoxia without lung disease. Symptoms include dyspnea, fatigue, and signs of right heart failure as PH progresses. Imaging like echocardiogram and right heart catheterization are used to diagnose and assess severity of PH. Treatment involves managing the underlying lung condition, supportive therapies, and in severe cases, pulmonary arterial hypertension therapies may be considered though data is limited in group 3 PH. Prognosis is typically progressive with increased mortality
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.
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 provides an overview of pulmonary hypertension (PH), including its definition, classification, mechanisms, pathology, clinical presentation, diagnosis, treatment, and prognosis. PH is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest. It is classified into 5 groups based on etiology. Common mechanisms include vasoconstriction, vascular obstruction, increased blood flow, and loss of pulmonary vascular bed. Pathology often involves remodeling of small pulmonary arteries and arterioles. Presentation is usually nonspecific symptoms like dyspnea. Diagnosis involves echocardiogram, cardiac catheterization, and ruling out other causes. Treatment includes vasodilators, anticoagulation, diuretics, oxygen supplementation and sometimes
Pulmonary hypertension (2014) dr.tinku josephDr.Tinku Joseph
This document provides information on pulmonary hypertension (PH), including its definition, classification, pathogenesis, diagnosis, and treatment. It begins with defining PH as a mean pulmonary arterial pressure greater than 25 mmHg at rest based on right heart catheterization. PH is classified into 5 groups. The pathogenesis and pathology of each group is described. Diagnostic workup includes labs, imaging like CXR, echocardiogram and right heart catheterization. Treatment involves general measures, diuretics, anticoagulants, oxygen, and PAH-specific therapies like endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and calcium channel blockers in some cases. Prognostic factors and goals of treatment are also discussed.
This document provides an overview of pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnostic workup, and treatment. PH is defined as a mean pulmonary arterial pressure over 25 mmHg at rest. It is classified into 5 groups, with Group 1 being pulmonary arterial hypertension. The pathophysiology involves vasoconstriction, endothelial dysfunction, and vascular remodeling. Diagnosis involves echocardiogram, right heart catheterization, and ruling out other causes. Treatment includes diuretics, anticoagulants, oxygen, and PAH-specific therapies, with the goal of improving functional status and survival.
- Pulmonary artery hypertension (PAH) is defined as a mean pulmonary artery pressure of ≥25 mmHg at rest. It is characterized by pre-capillary pulmonary hypertension with a pulmonary wedge pressure <15 mmHg and a pulmonary vascular resistance >3 Wood units.
- The pathophysiology involves sustained vasoconstriction, vascular remodeling, in situ thrombosis, and increased arterial stiffness. Genetic factors like BMPR2 mutations also contribute to PAH development.
- Clinical features range from mild breathlessness to signs of right heart failure. Diagnostic tests include echocardiography, CT scans, V/Q scans, right heart catheterization and lab tests.
- Treatment involves oxygen therapy, diure
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.
The document discusses pulmonary hypertension and the pulmonary circulation. It covers:
1) The anatomy of the pulmonary circulation including the pulmonary arterial and bronchial circulations.
2) The physiology of the low pressure pulmonary system and how blood flow is regulated.
3) The classifications, causes, signs and symptoms, and imaging manifestations of various types of pulmonary hypertension including pulmonary arterial hypertension, pulmonary hypertension due to lung/hypoxic diseases, chronic thromboembolic pulmonary hypertension, and pulmonary hypertension related to left heart disease.
4) The pathophysiology and histopathological changes seen in different forms of pulmonary hypertension.
1. Acyanotic congenital heart defects like ventricular septal defects (VSD), atrial septal defects (ASD), and atrioventricular septal defects involve left-to-right shunting that can cause pulmonary overcirculation and congestion over time.
2. During anesthesia for repairs of these defects, careful attention must be paid to balancing systemic and pulmonary vascular resistances to avoid increasing or decreasing the shunt. Inhalational induction is relatively contraindicated due to risk of shunt reversal and cyanosis.
3. Intravenous induction with ketamine or etomidate is preferred for acyanotic left-to-right shunt defects to gradually control hemodynamics
Pulmonary Arterial Hypertension Overview
Michael J. Cuttica MD Assistant Professor of Medicine Northwestern Pulmonary Hypertension Program
Northwestern University
Pulmonary hypertension is abnormal elevation of pulmonary artery pressure that can be caused by several factors. It occurs when the arteries in the lungs become narrowed, blocking blood flow and overworking the heart. There are five groups of pulmonary hypertension distinguished by their causes, which include left heart disease, lung diseases that cause hypoxia, chronic thromboembolic pulmonary hypertension, rare diseases with unclear causes, and pulmonary arterial hypertension. The latter involves thickening of pulmonary arteries and is the most severe form, sometimes caused by genetic mutations. Symptoms include shortness of breath and right heart failure over time if left untreated.
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
This document discusses the case of a 61-year-old female patient with a history of pulmonary tuberculosis who presented with dyspnea and edema. A physical exam found distended neck veins, crackles, thrills, and a holosystolic murmur. Testing showed severe pulmonary hypertension. The case involves group 3 pulmonary hypertension secondary to bronchiectasis from recurrent pulmonary TB. A right heart catheterization confirmed pre-capillary pulmonary hypertension. The patient was started on diuretics, aspirin, oxygen, and later sildenafil to treat her pulmonary hypertension based on current guidelines.
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.
1) The patient presented with exertional dyspnea and was found to have a pulmonary artery systolic pressure of 80 mm Hg and right ventricular enlargement on echocardiogram.
2) Further tests including right heart catheterization confirmed the diagnosis of pulmonary arterial hypertension with a mean pulmonary artery pressure of 52 mm Hg.
3) Treatment for this patient's World Health Organization functional class III pulmonary arterial hypertension will include oxygen supplementation, diuretics, anticoagulation, and advanced vasodilatory therapy targeting the underlying cause and cardiovascular effects.
Pulmonary arterial hypertension (PAH) is high blood pressure in the pulmonary arteries of the lungs. It can be caused by various conditions and is diagnosed through tests like echocardiograms, pulmonary function tests, and right heart catheterization. As PAH progresses, the increased pressure in the lungs puts strain on the right side of the heart. Treatment aims to relieve symptoms and slow disease progression through oral medications, inhaled treatments, IV therapies, and possibly lung transplantation in severe cases.
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
Pulmonary Arterial Hypertension: The Other High Blood Pressure and its association with scleroderma is presented by
Micheal J. Cuttica MD, MS, Assistant Professor of Medicine, Director; Northwestern Pulmonary Hypertension Program, Northwestern University
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!
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.
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 provides an overview of pulmonary hypertension (PH), including its definition, classification, mechanisms, pathology, clinical presentation, diagnosis, treatment, and prognosis. PH is defined as a mean pulmonary arterial pressure greater than 25 mm Hg at rest. It is classified into 5 groups based on etiology. Common mechanisms include vasoconstriction, vascular obstruction, increased blood flow, and loss of pulmonary vascular bed. Pathology often involves remodeling of small pulmonary arteries and arterioles. Presentation is usually nonspecific symptoms like dyspnea. Diagnosis involves echocardiogram, cardiac catheterization, and ruling out other causes. Treatment includes vasodilators, anticoagulation, diuretics, oxygen supplementation and sometimes
Pulmonary hypertension (2014) dr.tinku josephDr.Tinku Joseph
This document provides information on pulmonary hypertension (PH), including its definition, classification, pathogenesis, diagnosis, and treatment. It begins with defining PH as a mean pulmonary arterial pressure greater than 25 mmHg at rest based on right heart catheterization. PH is classified into 5 groups. The pathogenesis and pathology of each group is described. Diagnostic workup includes labs, imaging like CXR, echocardiogram and right heart catheterization. Treatment involves general measures, diuretics, anticoagulants, oxygen, and PAH-specific therapies like endothelin receptor antagonists, phosphodiesterase inhibitors, prostanoids, and calcium channel blockers in some cases. Prognostic factors and goals of treatment are also discussed.
This document provides an overview of pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnostic workup, and treatment. PH is defined as a mean pulmonary arterial pressure over 25 mmHg at rest. It is classified into 5 groups, with Group 1 being pulmonary arterial hypertension. The pathophysiology involves vasoconstriction, endothelial dysfunction, and vascular remodeling. Diagnosis involves echocardiogram, right heart catheterization, and ruling out other causes. Treatment includes diuretics, anticoagulants, oxygen, and PAH-specific therapies, with the goal of improving functional status and survival.
- Pulmonary artery hypertension (PAH) is defined as a mean pulmonary artery pressure of ≥25 mmHg at rest. It is characterized by pre-capillary pulmonary hypertension with a pulmonary wedge pressure <15 mmHg and a pulmonary vascular resistance >3 Wood units.
- The pathophysiology involves sustained vasoconstriction, vascular remodeling, in situ thrombosis, and increased arterial stiffness. Genetic factors like BMPR2 mutations also contribute to PAH development.
- Clinical features range from mild breathlessness to signs of right heart failure. Diagnostic tests include echocardiography, CT scans, V/Q scans, right heart catheterization and lab tests.
- Treatment involves oxygen therapy, diure
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.
The document discusses pulmonary hypertension and the pulmonary circulation. It covers:
1) The anatomy of the pulmonary circulation including the pulmonary arterial and bronchial circulations.
2) The physiology of the low pressure pulmonary system and how blood flow is regulated.
3) The classifications, causes, signs and symptoms, and imaging manifestations of various types of pulmonary hypertension including pulmonary arterial hypertension, pulmonary hypertension due to lung/hypoxic diseases, chronic thromboembolic pulmonary hypertension, and pulmonary hypertension related to left heart disease.
4) The pathophysiology and histopathological changes seen in different forms of pulmonary hypertension.
1. Acyanotic congenital heart defects like ventricular septal defects (VSD), atrial septal defects (ASD), and atrioventricular septal defects involve left-to-right shunting that can cause pulmonary overcirculation and congestion over time.
2. During anesthesia for repairs of these defects, careful attention must be paid to balancing systemic and pulmonary vascular resistances to avoid increasing or decreasing the shunt. Inhalational induction is relatively contraindicated due to risk of shunt reversal and cyanosis.
3. Intravenous induction with ketamine or etomidate is preferred for acyanotic left-to-right shunt defects to gradually control hemodynamics
Pulmonary Arterial Hypertension Overview
Michael J. Cuttica MD Assistant Professor of Medicine Northwestern Pulmonary Hypertension Program
Northwestern University
Pulmonary hypertension is abnormal elevation of pulmonary artery pressure that can be caused by several factors. It occurs when the arteries in the lungs become narrowed, blocking blood flow and overworking the heart. There are five groups of pulmonary hypertension distinguished by their causes, which include left heart disease, lung diseases that cause hypoxia, chronic thromboembolic pulmonary hypertension, rare diseases with unclear causes, and pulmonary arterial hypertension. The latter involves thickening of pulmonary arteries and is the most severe form, sometimes caused by genetic mutations. Symptoms include shortness of breath and right heart failure over time if left untreated.
PowerPoint presentation describing various aspects of Pulmonary Hypertension. Please mail me your feedback on this presentation to following Email ID: tinkujoseph2010@gmail.com.
This document discusses the case of a 61-year-old female patient with a history of pulmonary tuberculosis who presented with dyspnea and edema. A physical exam found distended neck veins, crackles, thrills, and a holosystolic murmur. Testing showed severe pulmonary hypertension. The case involves group 3 pulmonary hypertension secondary to bronchiectasis from recurrent pulmonary TB. A right heart catheterization confirmed pre-capillary pulmonary hypertension. The patient was started on diuretics, aspirin, oxygen, and later sildenafil to treat her pulmonary hypertension based on current guidelines.
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.
1) The patient presented with exertional dyspnea and was found to have a pulmonary artery systolic pressure of 80 mm Hg and right ventricular enlargement on echocardiogram.
2) Further tests including right heart catheterization confirmed the diagnosis of pulmonary arterial hypertension with a mean pulmonary artery pressure of 52 mm Hg.
3) Treatment for this patient's World Health Organization functional class III pulmonary arterial hypertension will include oxygen supplementation, diuretics, anticoagulation, and advanced vasodilatory therapy targeting the underlying cause and cardiovascular effects.
Pulmonary arterial hypertension (PAH) is high blood pressure in the pulmonary arteries of the lungs. It can be caused by various conditions and is diagnosed through tests like echocardiograms, pulmonary function tests, and right heart catheterization. As PAH progresses, the increased pressure in the lungs puts strain on the right side of the heart. Treatment aims to relieve symptoms and slow disease progression through oral medications, inhaled treatments, IV therapies, and possibly lung transplantation in severe cases.
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
Pulmonary Arterial Hypertension: The Other High Blood Pressure and its association with scleroderma is presented by
Micheal J. Cuttica MD, MS, Assistant Professor of Medicine, Director; Northwestern Pulmonary Hypertension Program, Northwestern University
Similar to APPROACH TO PULMONARY HYPERTENSION.pptx (20)
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!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. • Outline
a) Introduction
b) History
c) Clinical findings
d) Investigations
e) Diagnostic algorithm
f) Discussion of PH
g) Management
3. Introduction
• Pulmonary Hypertension diagnosis is important.
• PH is underdiagnosed.
• Different diseases cause PH.
• Numerous factors influence the management of PH patients.
• Thinking Physiologically is useful in approach to PH.
4. HISTORY
• Most patients will present with dyspnea and/or fatigue.
• Whereas edema, chest pain, presyncope, and syncope are less
common and associated with more advanced disease.
• In early phases of PAH, the physical examination is often unrevealing.
• As the disease progresses, there may be evidence of right ventricular
failure with elevated jugular venous pressure, lower extremity
edema, and ascites.
5. Clinical Findings
• Cardiovascular examination may reveal
A. Elevated JVP
B. Hypertension
C. Accentuated P2 component of the second heart sound,
D. Right-sided S3 or S4
E. Mid diastolic murmur of MS
F. Ejection systolic murmur at pulmonary area.
G. Holosystolic tricuspid regurgitant murmur.
6.
7.
8. • It is also important to seek signs of the diseases that are commonly
concurrent with PH.
• Clubbing may be seen in some chronic lung diseases (DPLD)
• Crepitations in lung field.
• Air entry
• Sclerodactyly, telangiectasia may signify scleroderma (or the limited
cutaneous form, CREST [calcinosis, Raynaud’s phenomenon,
esophageal dysmotility, sclerodactyly, and telangiectasia]),
9. Investigation
• ECG may show right ventricular hypertrophy or strain.
• CXR may reveal enlargement of pulmonary arteries and obliteration
of the retrosternal space.
• Echocardiography with agitated saline (bubble) study is the most
important initial screening test.
• Elevated estimated pulmonary artery systolic pressure (>35 mmHg)
or a hypertrophied or dilated right ventricle support the diagnosis of
PH.
10. • Important additional information can be gleaned about specific
etiologies of PH, such as
1. valvular disease,
2. left ventricular systolic and diastolic function,
3. left atrial enlargement, and
4. intracardiac shunt.
11. ECG
• Diagnostic criteria
• Right axis deviation of +110° or more.
• Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
• Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
• QRS duration < 120ms (i.e. changes not due to RBBB).
12. • Supporting criteria
• Right atrial enlargement (P pulmonale).
• Right ventricular strain pattern = ST depression / T wave inversion in
the right precordial (V1-4) and inferior (II, III, aVF) leads.
• S1 S2 S3 pattern = far right axis deviation with dominant S waves in
leads I, II and III.
• Deep S waves in the lateral leads (I, aVL, V5-V6).
13.
14.
15.
16.
17. Additional tests focusing on functional
capacity
• 6-minute walk distance (6-MWD) assessment, which also aids in
assessing prognosis.
• Cardiopulmonary exercise testing (CPET) differentiates between
cardiac and pulmonary causes of dyspnea and includes measuring
peak volume of oxygen consumption, which is an integrated
parameter of cardiopulmonary fitness and also useful in
prognosticating PH.
• Invasive hemodynamic monitoring with right heart catheterization
(RHC) is the gold standard for PH diagnosis and severity assessment.
18.
19. • PULMONARY FUNCTION AND LUNG IMAGING
a. In PAH, an isolated reduction in diffusing capacity of the lungs for
carbon monoxide (DLCO) is a classic finding.
b. HRCT- Enlargement of the main pulmonary artery, right ventricle,
and atria, as well as peripheral pruning of small vessels.
c. CT is also critical for distinguishing co-morbid interstitial lung
disease, emphysema, or overlap syndromes that include fibrosis
and obstructive pulmonary disease.
20. • SLEEP STUDIES
1. Nocturnal desaturation is a common finding in PH even in the
absence of sleep-disordered breathing.
2. Thus, all patients should undergo nocturnal oximetry screening,
regardless of whether classic symptoms of obstructive sleep apnea
or obesity-hypoventilation syndrome are present.
• ASSESSMENT OF PULMONARY ARTERIAL THROMBOSIS
• Serology for HIV screening.
21.
22. Discussion
• Pulmonary hypertension (PH) is a heterogenous disease involving
pathogenic remodeling of the pulmonary vasculature, which
increases pulmonary artery pressure and vascular resistance.
• Pulmonary arterial hypertension (PAH) is an uncommon, but distinct,
PH subtype characterized by the interplay between molecular and
genetic events that cause an obliterative arteriopathy and symptoms
of dyspnea, chest pain, and syncope.
• If left untreated, PH carries a high mortality rate, largely owing to
decompensated right heart failure.
23. Pathophysiology
• Pulmonary circulation is a low resistance, high compliance circuit.
During exercise it gets engorged and can accommodate 3times its
blood volume( high compliance)
• Ohm’s Law V=IR
• Pulmonary circulation: mPAP= (COXPVR) + LAP
• Systemic circulation: mean Aortic Pressure= (COXSVR) + RAP
• Normally LVEDP= LAP= PCWP
• As because SVR>>PVR, Mean Aortic Pressure is much more than
mPAP.
24. • In PAH the pathologic lesions involve mainly the distal pulmonary
arteries (< 500 μm in diameter).
• Characterized by
1. Medial hypertrophy, intimal proliferative and fibrotic changes
(concentric, eccentric)
2. Adventitial thickening
3. Moderate perivascular inflammatory infiltrates
4. Complex lesions (plexiform, dilated lesions)
5. Thrombotic lesions
25. • Upregulation of Endothelin pathway : vasoconstriction and
antiproliferation.
• Downregulation of NO pathway : inhibition of cGMP
• Downregulation of Prostacycline pathway : PGI2 / cAMP/
Prostacycline inhibited.
26.
27. Classification
• Type 1 PAH
• Type 2 Secondary to left heart disease. ( Increased LAP/ PCWP)
aka PVH.
• Type 3 Secondary to Lung disease and hypoxia.
• Type 4 Chronic Thrombo Embolic PH
• Type 5 Miscellaneous.
28. Hemodynamic Definition
• Normal values
I. mPAP <20 mmHg
II. PVR <3 Wood’s unit
III. LAP/ PCWP <15 mmHg
PH mPAP PVR LAP/PCWP
Type 1 >20 >3 <15
Type 3 ,, ,, ,,
Type 4 ,, ,, ,,
Type 2 >20 <3 <15
29. Type 1/ WHO group 1
• PAH
• Idiopathic PAH is the MC variety. Young Female.
• Heritable- BMPR2 gene mutation ( 70% with germline mutation), ALK
1
• Drug and Toxin induced
a) Dasatinib (TKI)
b) Anorexigens ( Fen-Phen, Aminorex)
c) Methamphetamine
30. • Disease associated-
a) CTD – MC Scleroderma ( CREST/ Limited Cutaneous), SLE
b) Congenital Heart Disease- ASD, VSD, PDA with Eissenmenger
Syndrome.
c) Portal Hypertension ( Splanchnic blood bypasses liver)
d) HIV
e) Schistosomiasis
31. Pulmonary Hypertension Associated with Left Heart
Disease
• Patients with PH due to left ventricular systolic dysfunction, aortic
and mitral valve disease, and heart failure with preserved ejection
fraction (HFpEF) are classified in WHO group 2.
• The hallmark is elevated LAP with resulting pulmonary venous
hypertension.
32. Pulmonary Hypertension Associated with
Lung Disease
• COPD, DPLD
• PH is also diagnosed in diseases of mixed obstructive/restrictive
pathophysiology: bronchiectasis, cystic fibrosis, mixed obstructive-
restrictive disease marked by fibrosis in the lower lung zones, and
emphysema predominantly in the upper lung zones.
33. Management
• General measures
1) Salt restriction <2.4 gm/d
2) Immunization for respiratory illness – Influenza and pneumonia
vaccine.
3) Minimize valsalva maneuver (cough, constipation, heavy lifting). It
can increase the risk of syncope.
4) Avoid pregnancy, as there is 30-50% maternal mortality and 15%
fetal mortality.
34. • Medical Management
i. PAH specific therapy.
ii. Oxygen: to prevent hypoxemia. As because Pulmonary circulation
reacts to hypoxia by vasoconstriction.
iii. Digoxine- shown to increase RV contraction.
iv. Anti coagulants in CTEPH
v. Diuretics ( judicious use)
• Surgical Management Atrial septostomy , Lung transplant.