Cor pulmonale is right heart failure caused by chronic pulmonary hypertension. It is often caused by lung diseases like COPD and asthma, or pulmonary vascular diseases like pulmonary embolism. Symptoms include dyspnea, fatigue and syncope. Signs include elevated jugular venous pressure, heart murmurs, hepatomegaly and edema. Investigations show signs of pulmonary hypertension and right heart strain on tests like chest x-ray and ECG. Management focuses on treating the underlying cause, respiratory failure with oxygen, and cardiac failure with diuretics. The prognosis is generally poor with 50% of patients dying within 5 years.
Este documento define cor pulmonale como una alteración estructural y funcional del ventrículo derecho resultado de hipertensión pulmonar asociada con enfermedades pulmonares, vasculares o de la pared torácica. Describe los factores de riesgo, etiología, fisiopatología, síntomas, exploración física, diagnóstico, tratamiento y pronóstico de cor pulmonale.
El cor pulmonale se define como la hipertrofia y dilatación del ventrículo derecho secundarias al aumento de la presión pulmonar. Se produce por enfermedades del parénquima pulmonar o la vasculatura pulmonar que aumentan la resistencia al flujo sanguíneo. El diagnóstico incluye exploración física, radiografía de tórax, electrocardiograma, ecocardiograma y cateterismo cardiaco. El tratamiento se enfoca en reducir la presión pulmonar a través de oxígeno suplementario,
The document summarizes the echocardiographic evaluation of mitral regurgitation. It discusses the anatomy of the mitral valve, etiologies of mitral regurgitation, physiology of acute and chronic mitral regurgitation, treatment indications, and techniques for evaluating mitral regurgitation severity including 2D and Doppler echocardiography. Key aspects covered include quantifying regurgitant volume and regurgitant orifice area using proximal isovelocity surface area (PISA) method and establishing severity based on an integrated approach.
La hipertensión arterial pulmonar resulta de enfermedades pulmonares que causan daño estructural o disfunción y conducen al crecimiento del ventrículo derecho. A largo plazo puede causar insuficiencia cardíaca derecha. El tratamiento se enfoca en combatir la hipertensión arterial pulmonar y reducir la carga de trabajo del ventrículo derecho a través de oxigenación, broncodilatadores, diuréticos e inhibidores de la agregación plaquetaria. El pronóstico depende de la gravedad de la en
Este documento define el cor pulmonar y describe su epidemiología, fisiopatología, etiología, signos y síntomas, pruebas paraclínicas y tratamiento. El cor pulmonar se produce por una sobrecarga del ventrículo derecho debido a alteraciones pulmonares que conducen a hipertensión pulmonar. Los principales tratamientos incluyen diuréticos, oxígeno, vasodilatadores y terapias dirigidas a la enfermedad subyacente como EPOC.
Cor pulmonale is right heart failure caused by chronic pulmonary hypertension. It is often caused by lung diseases like COPD and asthma, or pulmonary vascular diseases like pulmonary embolism. Symptoms include dyspnea, fatigue and syncope. Signs include elevated jugular venous pressure, heart murmurs, hepatomegaly and edema. Investigations show signs of pulmonary hypertension and right heart strain on tests like chest x-ray and ECG. Management focuses on treating the underlying cause, respiratory failure with oxygen, and cardiac failure with diuretics. The prognosis is generally poor with 50% of patients dying within 5 years.
Este documento define cor pulmonale como una alteración estructural y funcional del ventrículo derecho resultado de hipertensión pulmonar asociada con enfermedades pulmonares, vasculares o de la pared torácica. Describe los factores de riesgo, etiología, fisiopatología, síntomas, exploración física, diagnóstico, tratamiento y pronóstico de cor pulmonale.
El cor pulmonale se define como la hipertrofia y dilatación del ventrículo derecho secundarias al aumento de la presión pulmonar. Se produce por enfermedades del parénquima pulmonar o la vasculatura pulmonar que aumentan la resistencia al flujo sanguíneo. El diagnóstico incluye exploración física, radiografía de tórax, electrocardiograma, ecocardiograma y cateterismo cardiaco. El tratamiento se enfoca en reducir la presión pulmonar a través de oxígeno suplementario,
The document summarizes the echocardiographic evaluation of mitral regurgitation. It discusses the anatomy of the mitral valve, etiologies of mitral regurgitation, physiology of acute and chronic mitral regurgitation, treatment indications, and techniques for evaluating mitral regurgitation severity including 2D and Doppler echocardiography. Key aspects covered include quantifying regurgitant volume and regurgitant orifice area using proximal isovelocity surface area (PISA) method and establishing severity based on an integrated approach.
La hipertensión arterial pulmonar resulta de enfermedades pulmonares que causan daño estructural o disfunción y conducen al crecimiento del ventrículo derecho. A largo plazo puede causar insuficiencia cardíaca derecha. El tratamiento se enfoca en combatir la hipertensión arterial pulmonar y reducir la carga de trabajo del ventrículo derecho a través de oxigenación, broncodilatadores, diuréticos e inhibidores de la agregación plaquetaria. El pronóstico depende de la gravedad de la en
Este documento define el cor pulmonar y describe su epidemiología, fisiopatología, etiología, signos y síntomas, pruebas paraclínicas y tratamiento. El cor pulmonar se produce por una sobrecarga del ventrículo derecho debido a alteraciones pulmonares que conducen a hipertensión pulmonar. Los principales tratamientos incluyen diuréticos, oxígeno, vasodilatadores y terapias dirigidas a la enfermedad subyacente como EPOC.
A presentation by Jacob Greisen at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
1. Yes, the patient meets the criteria for home oxygen therapy with a PO2 <7.3 kPa at rest.
2. Portable oxygen for mobile hypoxemic patients is intended to:
- Increase hours on oxygen
- Increase daily activity
3. Studies have found no effect of adding ambulatory oxygen to pulmonary rehabilitation programs. Ambulatory oxygen alone does not improve exercise tolerance long-term.
1) Home oxygen therapy (HOT) improves survival in patients with hypoxemia, though adherence to guidelines and follow-up is only about 50% in many countries.
2) Continuous oxygen therapy (COT) given for over 15 hours daily increases survival by 2-4 years in COPD patients with low oxygen levels. Portable oxygen allows more activity but devices are still heavy.
3) International guidelines recommend COT for patients with oxygen levels below 7.3 kPa, but adherence varies, from 35-81% of eligible patients receiving treatment across different countries. Follow-up after starting COT is also inconsistent.
This document discusses home oxygen therapy (HOT) in various countries. It provides an overview of the types of HOT, including continuous oxygen therapy (COT), short-term oxygen therapy (STOT), and nocturnal oxygen therapy (NOT). Clinical trials show that COT improves survival in COPD patients with low oxygen levels. Guidelines for COT recommend a minimum daily usage of 15 hours and follow-up every 3-6 months. Adherence to HOT varies significantly between countries, from 60% in Denmark to rates as low as 27% in some studies. Portable oxygen improves mobility and activity levels but is underutilized in many patients.
This document summarizes findings from the Danish Oxygen Register regarding long-term oxygen therapy (LTOT) in Denmark from 1994-2000. Some key findings include:
- The prevalence and incidence of COPD patients on LTOT increased and reached a plateau around 25 and 40 per 100,000 respectively.
- There was an increase in the proportion of cancer patients, older patients, and those using mobile oxygen units starting LTOT. The percentage treated over 15 hours daily and after hospital admission also rose.
- Around 20-25% of COPD patients on LTOT were still smoking despite the therapy.
- Survival rates improved over the period, however remained lower than other countries due to higher 6-
This document discusses home oxygen treatment. It provides an overview of the scientific evidence for indications and effects of oxygen therapy. It also reviews prevalence, devices, side effects, and practical considerations for home oxygen treatment in Denmark. A case study is presented on whether a 65-year-old woman with COPD exacerbation should start chronic oxygen therapy. Guidelines for initiating oxygen are outlined. Survival rates on oxygen are compared between countries.
This document discusses long-term oxygen therapy (LTOT) and home oxygen therapy. It provides an overview of the terminology, scientific background, equipment, indications, and practical considerations of LTOT. It also includes two case studies examining whether a patient should start or continue LTOT. The document summarizes the effects of LTOT including improved survival, decreased hospitalizations, and improved quality of life for COPD patients. It addresses portable oxygen therapy and the prevalence of home oxygen therapy in different countries.
This document discusses long-term oxygen therapy (LTOT). It provides an overview of the terminology, scientific background, equipment, indications, and quality of LTOT treatment. Specifically:
1) It defines various types of home oxygen therapy including LTOT, short-term oxygen therapy (STOT), ambulatory oxygen therapy, and oxygen used for palliation of attacks of dyspnea.
2) It reviews studies showing the effects of LTOT on survival, health outcomes, and hospitalizations for COPD patients. LTOT is shown to increase survival by 2-4 years and decrease hospitalizations by 25% for qualifying patients.
3) It discusses considerations for starting, controlling, and ensuring quality of LT
A presentation by Jacob Greisen at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
1. Yes, the patient meets the criteria for home oxygen therapy with a PO2 <7.3 kPa at rest.
2. Portable oxygen for mobile hypoxemic patients is intended to:
- Increase hours on oxygen
- Increase daily activity
3. Studies have found no effect of adding ambulatory oxygen to pulmonary rehabilitation programs. Ambulatory oxygen alone does not improve exercise tolerance long-term.
1) Home oxygen therapy (HOT) improves survival in patients with hypoxemia, though adherence to guidelines and follow-up is only about 50% in many countries.
2) Continuous oxygen therapy (COT) given for over 15 hours daily increases survival by 2-4 years in COPD patients with low oxygen levels. Portable oxygen allows more activity but devices are still heavy.
3) International guidelines recommend COT for patients with oxygen levels below 7.3 kPa, but adherence varies, from 35-81% of eligible patients receiving treatment across different countries. Follow-up after starting COT is also inconsistent.
This document discusses home oxygen therapy (HOT) in various countries. It provides an overview of the types of HOT, including continuous oxygen therapy (COT), short-term oxygen therapy (STOT), and nocturnal oxygen therapy (NOT). Clinical trials show that COT improves survival in COPD patients with low oxygen levels. Guidelines for COT recommend a minimum daily usage of 15 hours and follow-up every 3-6 months. Adherence to HOT varies significantly between countries, from 60% in Denmark to rates as low as 27% in some studies. Portable oxygen improves mobility and activity levels but is underutilized in many patients.
This document summarizes findings from the Danish Oxygen Register regarding long-term oxygen therapy (LTOT) in Denmark from 1994-2000. Some key findings include:
- The prevalence and incidence of COPD patients on LTOT increased and reached a plateau around 25 and 40 per 100,000 respectively.
- There was an increase in the proportion of cancer patients, older patients, and those using mobile oxygen units starting LTOT. The percentage treated over 15 hours daily and after hospital admission also rose.
- Around 20-25% of COPD patients on LTOT were still smoking despite the therapy.
- Survival rates improved over the period, however remained lower than other countries due to higher 6-
This document discusses home oxygen treatment. It provides an overview of the scientific evidence for indications and effects of oxygen therapy. It also reviews prevalence, devices, side effects, and practical considerations for home oxygen treatment in Denmark. A case study is presented on whether a 65-year-old woman with COPD exacerbation should start chronic oxygen therapy. Guidelines for initiating oxygen are outlined. Survival rates on oxygen are compared between countries.
This document discusses long-term oxygen therapy (LTOT) and home oxygen therapy. It provides an overview of the terminology, scientific background, equipment, indications, and practical considerations of LTOT. It also includes two case studies examining whether a patient should start or continue LTOT. The document summarizes the effects of LTOT including improved survival, decreased hospitalizations, and improved quality of life for COPD patients. It addresses portable oxygen therapy and the prevalence of home oxygen therapy in different countries.
This document discusses long-term oxygen therapy (LTOT). It provides an overview of the terminology, scientific background, equipment, indications, and quality of LTOT treatment. Specifically:
1) It defines various types of home oxygen therapy including LTOT, short-term oxygen therapy (STOT), ambulatory oxygen therapy, and oxygen used for palliation of attacks of dyspnea.
2) It reviews studies showing the effects of LTOT on survival, health outcomes, and hospitalizations for COPD patients. LTOT is shown to increase survival by 2-4 years and decrease hospitalizations by 25% for qualifying patients.
3) It discusses considerations for starting, controlling, and ensuring quality of LT
The document discusses the impact of Denmark's national oxygen register on adherence to guidelines for long-term oxygen therapy (LTOT) in COPD patients. Some key findings from 1994-2000 include an increase in the prevalence and incidence of COPD patients on LTOT, more patients receiving mobile oxygen and starting LTOT after hospitalization. Documentation of hypoxemia improved but only about half of patients received follow-up and 20-25% still smoked. Survival rates increased over time but remained lower than other countries. The register data was not optimally utilized and direct feedback to doctors may help further improve LTOT guideline adherence.
2. Oversigt
CaseCase
Videnskabelige baggrund for kronisk iltbeh.Videnskabelige baggrund for kronisk iltbeh.
IltudstyrIltudstyr
Hvordan i praksis?Hvordan i praksis?
Start & kontrolStart & kontrol
Prævalens, incidens og overlevelse i DKPrævalens, incidens og overlevelse i DK
3. Case 1 (1)
65-årig kvinde m. KOL eksacerbation.65-årig kvinde m. KOL eksacerbation.
Indlagt på 5. døgn. Overvejer udskrivelse.Indlagt på 5. døgn. Overvejer udskrivelse.
Uden ilttilskud: POUden ilttilskud: PO22=6.5 & PCO=6.5 & PCO22=5.8 kPa=5.8 kPa
Skal hun starte kronisk iltbehandling?Skal hun starte kronisk iltbehandling?
Hvad gør du?Hvad gør du?
4. Case 1 (2)
Hvis JaHvis Ja:
Pt. er motiveret for brug >15 timer dagl.Pt. er motiveret for brug >15 timer dagl.
Ikke-rygerIkke-ryger
Iltflow: eleverer POIltflow: eleverer PO22 >8.0 el. min. 0.7 kPa>8.0 el. min. 0.7 kPa
Sikre sig imod betydende hyperkapniSikre sig imod betydende hyperkapni
IltsystemerIltsystemer
Inform. pt. om evt. temporær iltterapi (kontrol)Inform. pt. om evt. temporær iltterapi (kontrol)
Kontrol efter 1-3 mdr.Kontrol efter 1-3 mdr.
Hvis Nej:Hvis Nej: Kontrol efter 1-3 mdr.Kontrol efter 1-3 mdr.
5. Case 1 (3)
Ved 3-mdr.-kontrol:Ved 3-mdr.-kontrol:
POPO22=7.6 & PCO=7.6 & PCO22=5.6 kPa.=5.6 kPa.
Dyspnø ved let-moderat anstrengelse.Dyspnø ved let-moderat anstrengelse.
Angiver subjektiv effekt af iltAngiver subjektiv effekt af ilt
Skal kronisk iltterapi fortsætte?Skal kronisk iltterapi fortsætte?
6. COT in COPD: effect on survival
PaO2 <7.3 kPa;7.3-8.0: EVF>55% or cor pulmonale)
Post-PaO2 >8.6 kPa; Stabile and optimal treated; Non-smokers
MRC NOTT
N 87 203
Age 58 66
Men% 76 80
FEV1% 30 30
PO2, 6.8 6.8 kPa
PCO2 7.2 6.9 kPa
Htc.% 52 47
Smoking 45% ”Yes”
Flow 2 1-3+1
Hours 13.5 17.7/12
Mobile - +/-
16. Survival rates of new COPD patients on COT from
Denmark compared to patients from other countries
0
10
20
30
40
50
60
70
80
90
100
0 3 6 9 12 15 18 21 24 27 30 33 36 39
Months
Cumulativesurvivalproportion(%)%)
Denmark (n=5659)
Sweden (n=403)
Belgium (n=270)
France (n=252)
Australia (n=505)
NOTT, COT (n=101)
Japan (n=4552)
17. Conclusions
COT improves survival in hypoxaemic
patients
Most patients started after hospitalisation
↑ incidence and prevalence
In general, poor survival
18. Prevalence and Incidence of LTOT 1994-
2000
anno 1994 anno 1995 anno 1996 anno 1997 anno 1998 anno 1999
exkl.børn & horton & diagn.?1873 2123 2370 2649 2972 3172
2121 2268 2425 2608 2985
31.12.01 31.12.02 31.12.05 31.12.06 31.12.08 31.12.09 31.12.10
exkl. Se ovenfor COPD 47 47,1 47,6 48,5 50,4 49,2 49
Cancer 7,5 6,3 7 6,5 7,6 7,7 6,8
Others 23,6 25,4 29,9 29 39,7 42,2 49,1
Missing
0
500
1000
1500
2000
2500
3000
3500
anno
1994
anno
1995
anno
1996
anno
1997
anno
1998
anno
1999
pr evalence
incidence
0
20
40
60
80
100
120
31.12.0131.12.0231.12.0531.12.0631.12.0831.12.09
per100.000
Others
Cancer
COPD
0
10
20
30
40
50
60
70
80
90
100
2001 2003
per100.000
0
10
20
30
40
50
60
70
80
90
100
2001 2003 2005 2006 2009 2010
Other s
Cancer
COPD
0
20
40
60
80
100
120
31.12.01 31.12.05 31.12.08 31.12.10
Others
Cancer
COPD
0
10
20
30
40
50
60
70
per100.000
1995 1996 1997 1998 1999 2000
Incidence
Missing
Others
Cancer
COPD
0
20
40
60
80
100
120
per100.000
31.12.01 31.12.02 31.12.05 31.12.06 31.12.08 31.12.09 31.12
Prevalence
0
20
40
60
80
100
2001 2003 2005 2006 2009
per100.000
Others
Cancer
COPD
0
10
20
30
40
50
60
70
80
90
100
2001 2003 2005 2006 2009 2010
Others
Cancer
COPD
0
20
40
60
80
100
120
per100.000
31.12.01 31.12.02 31.12.05 31.12.06 31.12.08 31.12.09 31.12.10
Prevalence
Missing
Others
Cancer
COPD
19. Indikationer (2)
PPaaOO22 <7.3 kPa (Sat. 88%)<7.3 kPa (Sat. 88%)
(7.3-8.0: EVF>55% el. cor pulmonale)(7.3-8.0: EVF>55% el. cor pulmonale)
Delta- PDelta- PaaOO22 >0.7 kPa & post-P>0.7 kPa & post-PaaOO22 >8.6 kPa>8.6 kPa
Post-arteriel-PH >7.32Post-arteriel-PH >7.32
Stabil og optimal behandletStabil og optimal behandlet
Ikke-rygerIkke-ryger
Anvende ilt minimum 15 timer dagligtAnvende ilt minimum 15 timer dagligt
Kontrol efter 3 mdr. og siden hver 6. mdr.Kontrol efter 3 mdr. og siden hver 6. mdr.
Editor's Notes
In 1994 the prevalence of COPD was about 27/100.000. I the following years, it increased by about 50% to 42/100.000
The incidence of COPD increased from 20 to 25/100.00 during 5 years
In 1994 the prevalence of COPD was about 27/100.000. I the following years, it increased by about 50% to 42/100.000
The incidence of COPD increased from 20 to 25/100.00 during 5 years
In 1994 the prevalence of COPD was about 27/100.000. I the following years, it increased by about 50% to 42/100.000
The incidence of COPD increased from 20 to 25/100.00 during 5 years
