Pulmonary Hypertension PPT | Pulmonary Hypertension | Pulmonary Hypertension E medicine | Pulmonary Hypertension Symptoms | Treatment For Pulmonary Hypertension: SlideWorld Medical PPT Search Engine

Pulmonary Hypertension

Rating :

Rate It:

Send This

Download

Comment

Favourite

more

Notes

Show Notes

Slide 1 :

47 y/o F w/ 3 yr hx of progressive dyspnea, recently began having RUQ fullness, and peripheral edema. Her quality of life had been reduced to mostly revolving around activities at home due to easy fatigability. She was hospitalized last week due to a couple of episodes of exertional syncope.

Slide 2 :

On exam: she was found to have sx of R sided HF: (periph edema, ruq fullnes, abd distension) Additional findings: prominent P2, R sided s4, RV heave, PA flow murmur +JVP EKG: rad, rbbb Pfts done in clinic before hospitalization: decreased dco, mild restrictive pattern. ECHO: R sided pressure overload If she would have had a cardiac cath, the findings would have been: inc RA, RV and PA pressures;

Slide 3 :

Pulmonary Hypertension Daily Report Jafer Jeelani

Slide 4 :

Pulmonary Hypertension Pulmonary hypertension is when there is elevated pressure in the pulmonary system: arterial pressure; Definition: mean pulmonary artery pressure (measured by right heart catheterization): Resting: > 25mmHg Exercise: > 30mmHg Previous definition: PASP > 40; Prevalence unknown but if untreated the prognosis is poor mean age of onset 36; F:M 1.7-2.5:1

Slide 5 :

Annual number of hospitalizations among persons with pulmonary hypertension, United States, 1980–2002 Source: CDC, National Hospital Discharge Survey.

Slide 6 :

COPD: Leads to pulm HTN w/ effect on outcome.

Slide 7 :

Former classification: idiopathic pulmonary arterial hypertension (primary pulmonary hypertension) or secondary PH. World Health Organization (WHO) classifies Pulmonary Hypertension into 5 groups.

Slide 8 :

Group 1 PAH — Pulmonary arterial hypertension (PAH) Group 2 PH — Pulmonary venous hypertension Group 3 PH — Pulmonary hypertension associated with disorders of the respiratory system or hypoxemia Group 4 PH — Pulmonary hypertension caused by chronic thrombotic or embolic disease Group 5 PH — PH caused by inflammation, obstruction, or compression of pulmonary vasculature

Slide 9 :

Group 1 PAH — Pulmonary arterial hypertension (PAH): sporadic IPAH familial IPAH diseases affecting small pulm arterioles: collagen vascular diseases congenital systemic-to-pulmonary shunts (eg, congenital heart disease) portal hypertension human immunodeficiency virus specific characteristics: Mean pulmonary artery pressure (mPAP) >25 mmHg at rest or >30 mmHg with exercise, AND Pulmonary capillary wedge pressure (PCWP) <15 mmHg, AND Pulmonary vascular resistance (PVR) >120 dynes/sec/cm5, AND Transpulmonary gradient >10 mmHg, defined as the difference between the mean pulmonary arterial pressure and the pulmonary capillary wedge pressure

Slide 10 :

Group 2 PH — "Pulmonary venous hypertension". PH due to left atrial, left ventricular, or left valvular heart disease. Group 3 PH — "Pulmonary hypertension associated with disorders of the respiratory system or hypoxemia". interstitial lung disease chronic obstructive pulmonary disease sleep-disordered breathing alveolar hypoventilation disorders other causes of hypoxemia.

Slide 11 :

Group 4 PH — "Pulmonary hypertension caused by chronic thrombotic or embolic disease". Chronic PE Non thrombotic PE: schistosomiasis. Group 5 PH — PH caused by inflammation, obstruction, or compression of pulmonary vasculature Sarcoidosis histiocytosis X fibrosing mediastinitis

Slide 12 :

exact prevalence in general population unknown. specific populations: review of 8 studies of pts w/ OSA estimates 12-20% prevalence of mild Pulm HTN.

Slide 13 :

Pathophysiology: hemodynamic components that are involved in pulmonary artery pressure can be described as: Ppa (mean pulm art pressure) = Q (right-sided cardiac output) x PVR + Ppv (mean pulm venous pressure) Ppv can be estimated by right heart cath: ~PCWP Therefore, by looking at what factors change these variables allows us to come up with different medical conditions that give rise to Pulm hypertension.

Slide 14 :

Ppa = Q x PVR + Ppv Increase in right-sided cardiac output: Left-to-right atrial septal defects (ASD), left-to-right ventricular septal defects (VSD), and other systemic-to-pulmonary shunts increase right-sided cardiac output by increasing the right ventricular volume.

Slide 15 :

PH = Q x PVR + Ppv Increase in pulmonary vascular resistance: Conditions that decrease the area of the pulmonary vascular bed (eg, pulmonary emboli, collagen vascular diseases, interstitial lung disease) or induce hypoxic vasoconstriction (eg, chronic obstructive pulmonary disease) increase.

Slide 16 :

PH = Q x PVR + Ppv Increase pulmonary venous pressure: Mitral valve disease, left ventricular systolic or diastolic dysfunction, constrictive pericarditis, and pulmonary venous obstruction (eg, veno-occlusive disease).

Slide 17 :

PH = Q x PVR + Ppv The vicious cycle: any initial insult (from above) ? mild PH ? additional pulm vascular damage ? narrowing of vascular bed ? RVH (afterload) ? pulm artery pressure increases ? greater increase in RV afterload ? RV dilation.

Slide 18 :

Slide 19 :

Slide 20 :

Anorexigens: Appetite suppressants Fenfluramine (ingredient in Fen-Phen) Dexfenfluramine diethylpropion. All increase risk

Slide 21 :

Slide 22 :

Collagen vascular disease — Systemic sclerosis (ie, scleroderma) obliteration of alveolar capillaries & narrowing of small arteries and arterioles occur from pulmonary vascular disease & interstitial fibrosis. Rheumatoid arthritis and systemic lupus erythematosus (SLE) Fibrous destruction of the vascular bed.

Slide 23 :

Intracardiac shunts — Volume overload (pulm); since L to R shunts are most common ex VSD

Slide 24 :

Stimulants: Cocaine/amphetamines, inhaled OR intravenous one study shows that use of cocaine or amphetamine increased risk of developing PAH ~ 3x.

Slide 25 :

Human immunodeficiency virus (HIV) CD4 count >212, epoprostenol infusion and HAART (effects hemodynamics) all assoc w/ improved survival.

Slide 26 :

OSA: Assoc w/ mild Pulm HTN HTN tends to be worse when OSA is combined w/ (hypoxemia). Chronic PE Chronic process resulting in RVH Emboli may be asymptomatic and resting O2 levels (arterial) can be normal but dec w/ exercise. Get V/Q scan, if normal, no need to proceed further; If +, underestimate proximal emboli. Therefore, pulm angiography is needed to check involvement;

Slide 27 :

Heart failure: Left Atrial LA HTN from LV dysfunction, valvular dz, constrictive/restrictive heart disease. LA HTN causes PASP to become increased in order to maintain pressure gradient across vasculature. One study: 26% of 108 pts w/ dilated cardiomyopathy has PASP > 40mmHg. Mitral insufficiency: 41 pts w/ isolated sever MR; 76% had Pulm HTN.

Slide 28 :

Pulmonary venous obstruction (rare): fibrosing mediastinitis, venous stenosis after ablation of atrial fibrillation pulmonary veno-occlusive disease.

Slide 29 :

Slide 30 :

Slide 31 :

Possible Treatments for Pulmonary Hypertension Correct underlying cause: Surgical treatment of mitral stenosis, left to right shunt or accessible chronic thromboemboli Afterload reduction, digoxin (Lanoxin) and diuretics for left ventricular dysfunction Prevention and treatment of respiratory infection Avoidance of anorectic agents Decrease pulmonary vascular resistance: Vasodilators Oxygen Calcium channel blockers such as diltiazem (Cardizem) or nifed

There is no comments now for this Slide.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

1 Favorites

rajanke, favourited this 23 Hours ago.

	SlidesOnline 1 Years ago. Category: other

Tags:	other

1600 Views, 1 favourite
collagen vascular diseases; congenital systemic-to-pulmonary shunts (eg, congenital heart disease); more collagen vascular diseases; congenital systemic-to-pulmonary shunts (eg, congenital heart disease); portal hypertension; human immunodeficiency virus ... less

SWINE Flu

Why do women live longer then men? Humor

History of Medicine

Yoga and Medicine

How to be a Successful Interventional Fellow size 50 MB

Cardiac Pathology

Hypertension: New Concepts, Guidelines, and Clinical Management

Diabetes Pathology