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Σ. Ορφανός Β’ Κλινική Εντατικής Θεραπείας & Διακλινικό Ιατρείο Πνευμονικής Υπέρτασης Π.Γ.Ν. ΑΤΤΙΚΟΝ

Παθοφυσιολογία & Διαγνωστική Προσέγγιση της Πνευμονικής Υπέρτασης. Σ. Ορφανός Β’ Κλινική Εντατικής Θεραπείας & Διακλινικό Ιατρείο Πνευμονικής Υπέρτασης Π.Γ.Ν. ΑΤΤΙΚΟΝ. 25/0. RV. PULMONARY CIRCULATION A VASCULAR BED of LOW PRESSURES & LOW RESISTENCE. MEAN = 100. MEAN = 15. 25 / 8.

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Σ. Ορφανός Β’ Κλινική Εντατικής Θεραπείας & Διακλινικό Ιατρείο Πνευμονικής Υπέρτασης Π.Γ.Ν. ΑΤΤΙΚΟΝ

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  1. Παθοφυσιολογία & Διαγνωστική Προσέγγιση της Πνευμονικής Υπέρτασης Σ. Ορφανός Β’ Κλινική Εντατικής Θεραπείας & Διακλινικό Ιατρείο Πνευμονικής Υπέρτασης Π.Γ.Ν. ΑΤΤΙΚΟΝ

  2. 25/0 RV PULMONARY CIRCULATION A VASCULAR BED of LOW PRESSURES & LOW RESISTENCE MEAN = 100 MEAN = 15 25 / 8 120 / 80 ARTERY ARTERY 12 30 PULMONARY SYSTEMIC 120/0 LV CAP CAP 20 RA LA 2 5 8 10 VEIN VEIN

  3. PULMONARY HYPERTENSION WHAT IS IT? • ELEVATED PULMONARY ARTERIAL PRESSURE (>25 mm Hg mean, at rest )PULMONARY ARTERIAL HYPERTENSION • RESULTS FROM • ABNORMAL PULMONARY VASCULAR RESISTANCEDUE TO • PULMONARY VASCULAR REMODELLING AND CONSTRICTION

  4. Current classification & guidelines Dana Point, California meeting 2008 Dana Point, CA

  5. ERJ & EHJ 2009

  6. PAH: a disease of hyperplasia, occlusion & loss of vascular surface area Plexiform lesion Occlusion of pulmonary artery Fishman. Physiol Res 2000

  7. Progression of vascular disease

  8. Intensive Care Med 2004; 30:1702-14

  9. Intensive Care Med 2004; 30:1702-14

  10. Endothelial Cell Dysfunction in PAH NO PGI2 ET-1 • ET-1 is elevated (+) • Vasoconstriction • Cell proliferation / Hypertrophy • NO and PGI2 are reduced (-) • Vasodilation • Anti-proliferation • Anti-inflammation Spieker LE et al. J Am Coll Cardiol. 2001;37:1493-1505. Luscher TF and Barton M. Circulation. 2000;102:2434-2440. Albrecht EW et al. J Pathol. 2003;199:8-17. Hankins SR and Horn EM. Curr Cardiol Rep. 2000;2:244-251.

  11. Signs and symptoms of PAH No early symptoms of PAH Annual screening in high risk populations mandatory Disease Onset Unexplained or disproportional dyspnea Progressive dyspnea on exertion, fatigue, palpitations, chest pain, syncope, coughing First Symptoms Symptoms and signs of right heart failure Edema, ascites Endstage Symptoms Median survival is 2.8 years1 Death 1 D’Alonzo et al. Ann Internal Med 1991;115:343Harrison‘s Principles of Internal Medicine, 14th ed.

  12. Unexplained or disproportional dyspnea: TT heart echo (or BNP?)

  13. can NOT be replaced by echo!!

  14. EHJ & ERJ, 2009

  15. REVEAL Registry: Correlation of Right Heart Catheterization and Echocardiography in Patients With Pulmonary Arterial Hypertension Congestive Heart FailureVolume 17, Issue 2, pages 56-63, 27 JAN 2011 DOI: 10.1111/j.1751-7133.2010.00202.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1751-7133.2010.00202.x/full#f2 Farber H et al 2011

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