Pulmonary Hypertension - ECAB

Author: Haworth> Sheila Glennis  

Publisher: Elsevier Health Sciences APAC‎

Publication year: 2008

E-ISBN: 9788131231760

P-ISBN(Paperback): 9788131219768

Subject: R544.1 hypertension

Keyword: 内科学

Language: ENG

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Description

Pulmonary hypertension is defined as a mean pulmonary artery pressure (mPAP) =25 mmHg, with Pulmonary Capillary Wedge Pressure = 15 mmHg, measured by cardiac catheterization. The etiology of PH has a varied spectrum extending right from Drugs, toxins and portal hypertension to HIV, Collagen Vascular Diseases and Persistent Pulmonary Hypertension of Newborn, etc. The estimation of disease prevalence has been nearly impossible owing to the geographic distribution and economic diversity, along with significant regional variations in human development and healthcare infrastructure. A large number of patients with PH never reach the health centers capable of diagnosing the disease condition correctly. Advance pulmonary vascular disease as a result of uncorrected CHD is a major health challenge in the developing world. PH exists as a major component of many forms of cardiac and pulmonary disease. While breathlessness is the most common feature of PH, patients often also present with chest pain, syncope, fatigue, weakness and abdominal distension. The precordial signs include a right ventricular lift, accentuated pulmonary component of S2, a pansystolic murmur of Tricuspid regurgitation, a diastolic murmur of pulmonary regurgitation and a right ventricular S3. The standard diagnostic workup in developed countries includes a series of investigations to rule out the secondary causes. Additional tests are required to estimate the disease severity and plan the appropriate treatment. Th

Chapter

A Historical Perspective

Where are we Now?

The Future

Pulmonary Hypertension in India and the Developing World

Epidemiology of Pulmonary Hypertension in the Developing World

The Challenge of Managing Pulmonary Hypertension with Limited Resources

The Challenge of Early Diagnosis and Referral

Diagnostic Work-up

Specialized Clinics and Service

Management of Pulmonary Hypertension

The Impact of Newly Introduced Drugs for Pulmonary Hypertension

Addressing the Problem of Pulmonary Hypertension in the Developing World

Diagnostic Work-up

Specialized Clinics and Service

Management of Pulmonary Hypertension

The Impact of Newly Introduced Drugs for Pulmonary Hypertension

Addressing the Problem of Pulmonary Hypertensionin the Developing World

Clinical and Genetic Aspects of Pulmonary Hypertension: An Overview

Physiological and Genetic Aspects

Bone Morphogenetic Protein Receptor Type 2

Activin Receptor-Like Kinase

Serotonin Transporter

Microsatellite Markers

Expression Profiling in Human Primary Pulmonary Hypertension

Therapeutics

Conclusions

Acknowledgment

Evaluation of a Patient with Pulmonary Hypertension: What is Necessary for Diagnosis, Classification and Prognostication

Basic Studies

Electrocardiogram

Chest Radiograph

Echocardiography

Two-Dimensional Echocardiography

Doppler Evaluation to Assess Hemodynamics

Blood Tests and Biomarkers

Immunological Tests

Confirming The Diagnosis and Establishing Causality

Imaging Studies

Lung Perfusion Scan

CT Scan and CT Angiography of Pulmonary Vessels

Pulmonary Angiography

Magnetic Resonance Imaging of Heart and Pulmonary Vasculature

Pulmonary Angioscopy

Right Heart Catheterization

Lung Biopsy

Pulmonary Function Tests

Six-minute Walk Test and Cardiopulmonary Exercise Testing

Conclusion

Evidence-based Management of Pulmonary Arterial Hypertension

Calcium Channel Blockers

Prostacyclin Analogs or Prostanoids

Epoprostenol

Treprostinil

Iloprost

Beraprost

Endothelin Receptor Antagonists

Bosentan

Sitaxsentan

Ambrisentan

Phosphodiesterase-5 (PDE-5) Inhibitors

Sildenafil

Combination Therapy

Rationale for Combination Therapy35

Strategies for Combination Therapy

Drug Interactions35

Other Conventional and Supportive Therapies

Anticoagulation

Oxygen Therapy

Digoxin

Diuretics

Atrial Septostomy

Novel Treatments for the Future

Vasoactive Intestinal Polypeptide

Inhibition of Angiogenesis

Stem Cell Therapy

Disease-Targeted Therapy of Pulmonary Arterial Hypertension Based On 2007 Accp Recommendations2

Functional Class II

Functional Class III

Functional Class IV

Add-on or Combination Therapy

Conclusions

Assessment of Operability in Left to Right Shunts: Guidelines for the Practising Cardiologists

The Knowns

The Reason for Confusion

Clinical Assessment of Operability

Influence of Age

Other Factors Influencing Pulmonary Vasculature

Other Investigations

Conclusions

Pulmonary Hypertension Early After Congenital Heart Surgery: Prevention and Treatment

Pathophysiology

Right Ventricular Dysfunction, Ventricular Interdependence and Pulmonary Hypertensive Crisis

Diagnosis

Management

Sedation and Analgesia

Fluid Management

Ventilation Strategies

Right Ventricular (RV) Failure Management

Atrial Septostomy

Summary

Summary

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