{"id":5094,"date":"2011-07-14T20:23:21","date_gmt":"2011-07-14T20:23:21","guid":{"rendered":"http:\/\/crashtext.org\/misc\/pulmonary-hypertension.htm\/"},"modified":"2013-02-03T00:04:39","modified_gmt":"2013-02-03T05:04:39","slug":"pulmonary-hypertension","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/cardiology\/pulmonary-hypertension.htm\/","title":{"rendered":"Pulmonary Hypertension"},"content":{"rendered":"<p><span style=\"font-size: 13px; line-height: 19px;\">Review Article<\/span><\/p>\n<p>best: (Crit Care Med 2007;35:2037)<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>(Clinical Pulmonary Medicine 2004;11(1):40)<\/p>\n<p>&nbsp;<\/p>\n<p>Cor pulmonale is pulmonary hypertension in the setting of respiratory disease either acute or chronic, it does not require right heart failure thought that is sometimes a sequelae<\/p>\n<p>&nbsp;<\/p>\n<p>Divided into primary, which is idiopathic (PPH or IPH) and secondary, from a cause outside of the lung vasculature.<\/p>\n<p>&nbsp;<\/p>\n<p>While acute disease may be reversible, vascular remodeling in chronic disease may be permanent<\/p>\n<p>&nbsp;<\/p>\n<p>PPH<\/p>\n<p>unknown etiology, there have been associations with amphetamine diet aids, contaminated rapeseed oil, and contaminated l-tryptophan.<\/p>\n<p>&nbsp;<\/p>\n<p>Patients present with substernal chest pain or pressure, exertional dyspnea, fatigue, and possibly syncope.<\/p>\n<p>Diagnostics<\/p>\n<p>Chest x-ray will show prominent pulmonary arterial vasculature<\/p>\n<p>ECG will may show right ventricular hypertrophy<\/p>\n<p>&nbsp;<\/p>\n<p>High resolution CT, Perfusion nuclear scanning, MRI, and angiography may all be useful.\u00a0 Cardiac cath may be needed as well.\u00a0 Lung biopsy may be a final, necessary step to make a diagnosis of cause for PH.<\/p>\n<p>&nbsp;<\/p>\n<p>Therapy<\/p>\n<p>Correct hypoxemia<\/p>\n<p>PaO2&lt;55 or PaO2&lt;59 with Crit&gt;55, p pulmonale, or edema should be treated with chronic supplemental O2<\/p>\n<p>CCBs, Iv nitroglycerin, IV Prostacyclin, epoprostenol (Flolan), eventual lung transplantation<\/p>\n<p>vasodilator therapy is not without risks as it can cause systemic hypotension or worsen PH b\/c if the pulmonary diameter is fixed, it will just cause decreased RH pressures without affecting pulmonary.<\/p>\n<p>&nbsp;<\/p>\n<p>at risk for venous thromboembolic disease<\/p>\n<p>chronic VTE can also be the cause of pulmonary hypertension and often the patient will have dramatic improvement if the clot is removed<\/p>\n<h3>Estimation of Mean Pulmonary Artery Pressure<\/h3>\n<p>(Chest. 2008; 133:592-593)<\/p>\n<p>An invasive study by our team1 has challenged this model by reporting that sPAP accounts for 98% of mPAP variability in resting humans studied over \u00e0 range of 10 to 78 mm Hg, and that a new formula (mPAP = 0.61 sPAP + 2) reasonably predicts mPAP, with a 0 \u00b1 2 mm Hg bias (mean \u00b1 SD). Our retrospective analysis1 of the pressure data previously published by Laskey et al2 led to similar conclusion. The principle that underlies scientific modeling cautions against favoring the complex models over the simple ones,3 and this favors the use of sPAP only to estimate mPAP, without the need to include dPAP in the model. Although initially challenged,4 our findings have been confirmed in children free of congenital heart diseases,5 and have proved useful to estimate mPAP in large-scale studies performed in both adults6 and children7 for whom only Doppler-derived sPAP data are available. Finally, a linear relationship between mPAP and sPAP has also been documented in pulmonary arterial hypertension patients performing graded, submaximal supine exercise both before and after a 6-week prostacyclin treatment.8<\/p>\n<p>&nbsp;<\/p>\n<h4>HIV<\/h4>\n<p>can cause pulmonary hypertension<\/p>\n<p>&nbsp;<\/p>\n<p>PAH associated with syncope, vasovagal, and sudden death<\/p>\n<p>&nbsp;<\/p>\n<p>hypoxemia and hypercarbia are both vasoconstrictors<\/p>\n<p>&nbsp;<\/p>\n<p>sleep apnea to pulm htn to apnea to worsening pulm htn<\/p>\n<p>&nbsp;<\/p>\n<p>coumadin o2 diuretics<\/p>\n<h4><\/h4>\n<h4><\/h4>\n<h4>Hanging Flolan using normal IV pump<\/h4>\n<p>1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Get Intervia (empty IV bag) and light proof plastic bag.<\/p>\n<p>2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mix Flolan with sterile diluent<\/p>\n<p>3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Inject Flolan into intervia<\/p>\n<p>4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Place Ice on both sides in light-proof bag<\/p>\n<p>5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Use normal IV tubing, no filter required.<\/p>\n<p>6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Convert pt\u0092s 24 hour rate to hourly rate<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>|\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[27,32],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - 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