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Pulmonary Hypertension

Pulmonary Hypertension. R. Keith Brown. Objectives. Define Pulmonary Hypertension Etiology/Incidence of Pulmonary Hypertension Clinical Manifestations of Pulmonary Hypertension Treatment of Pulmonary Hypertension. Pulmonary Hypertension.

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Pulmonary Hypertension

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  1. Pulmonary Hypertension R. Keith Brown

  2. Objectives • Define Pulmonary Hypertension • Etiology/Incidence of Pulmonary Hypertension • Clinical Manifestations of Pulmonary Hypertension • Treatment of Pulmonary Hypertension

  3. Pulmonary Hypertension • Definition= Abnormal elevation in pulmonary artery pressure, that may reflect an increase in left heart filling pressures in the presence of normal pulmonary vascular resistance, pulmonary or parenchymal disease with a elevation in pulmonary vascular resistance, or a combination of these initiating factors.

  4. Etiology • Increased pulmonary vascular resistance • Vasoconstriction (hypoxia, acidosis) • Loss of vascular tone (emphysema, lung resection) • Occlusion of the pulmonary vasculature (pulmonary embolism) • Stenosis of pulmonary vasculature (vasculitis) • Increased Pulmonary Pressures • Left Ventricular Failure or Hypertrophy • Valvular heart disease • Constrictive pericarditis • Increased Pulmonary Blood Flow • Polycythemia • Primary (idiopathic) is seen most often in young women

  5. Incidence of Pulmonary Hypertension • Secondary pulmonary hypertension is related to the incidence of the cause of pulmonary hypertension

  6. Clinical Presentation of Pulmonary Hypertension • Symptoms • Dyspnea with exertion • Related to the disease that caused the pulmonary hypertension • Substernal discomfort • Fatigue • Syncope • Examination • Splitting of second heart sound resulting in a P2 increase • Peripheral edema if right heart failure • Ascites • Lab • CBC (polycythemia) • ECG (right axis deviation) • Chest X-ray • Increased size of pulmonary arteries • Visible narrowing of the pulmonary arteries in the medial third of the lung (emphysema) • Two-dimensional echocardiogram. Cardiac catheterization to confirm Pulmonary Hypertension • Echocardiogram to rule out valve disease • Pulmonary Function Testing • Restrictive and/or obstructive disease • Primary Pulmonary hypertension is a diagnosis of exclusion

  7. Treatment of Pulmonary Hypertension • Treat the underlying disorder • COPD • CHF • OSA • Oxygen at night • Anticoagulation if risk for PE • Hematocrit >60% may require phlebotomy. Goal of 55% • Primary Pulmonary Hypertension is treated with Calcium Channel Blockers and Anticoagulation

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