Pulmonary hypertension: Difference between revisions

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==Diagnosis==
==Diagnosis==
The [[echocardiogram]] may be more than 10 mm/Hg in error in half of cases.<ref name="pmid19164700">{{cite journal |author=Fisher MR, Forfia PR, Chamera E, ''et al'' |title=Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension |journal=Am. J. Respir. Crit. Care Med. |volume=179 |issue=7 |pages=615–21 |year=2009 |month=April |pmid=19164700 |doi=10.1164/rccm.200811-1691OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=19164700 |issn=}}</ref>
The [[echocardiogram]] may be more than 10 mm/Hg in error in half of cases.<ref name="pmid19164700">{{cite journal |author=Fisher MR, Forfia PR, Chamera E, ''et al'' |title=Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension |journal=Am. J. Respir. Crit. Care Med. |volume=179 |issue=7 |pages=615–21 |year=2009 |month=April |pmid=19164700 |doi=10.1164/rccm.200811-1691OC |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=19164700 |issn=}}</ref><ref name="pmid20864617">{{cite journal| author=Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S| title=Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. | journal=Chest | year= 2011 | volume= 139 | issue= 5 | pages= 988-93 | pmid=20864617 | doi=10.1378/chest.10-1269 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20864617  }} </ref>
 
A [[meta-analysis]] of [[Doppler echocardiography]] for predicting right heart catheterization reported a [[Sensitivity and specificity|sensitivity]] and [[Sensitivity and specificity|specificity]] of 88% and 56%, respectively. <ref name="pmid23227919">{{cite journal| author=Taleb M, Khuder S, Tinkel J, Khouri SJ| title=The diagnostic accuracy of Doppler echocardiography in assessment of pulmonary artery systolic pressure: a meta-analysis. | journal=Echocardiography | year= 2013 | volume= 30 | issue= 3 | pages= 258-65 | pmid=23227919 | doi=10.1111/echo.12061 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23227919 }} </ref>


==Treatment==
==Treatment==

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In medicine, pulmonary hypertension is "increased vascular resistance in the pulmonary circulation, usually secondary to heart diseases or lung diseases."[1]

Diagnosis

The echocardiogram may be more than 10 mm/Hg in error in half of cases.[2][3]

A meta-analysis of Doppler echocardiography for predicting right heart catheterization reported a sensitivity and specificity of 88% and 56%, respectively. [4]

Treatment

For all patients, consider:

For patients with New York Heart Association (NYHA) class IV symptoms inspite of calcium-channel antagonists, consider:

Perioperative care

The preoperative care and perioperative care (including intraoperative care and postoperative care) has been reviewed.[5]

Pulmonary hypertensive crisis, also called acute right heart syndrome, may happen when the pulmonary artery pressure is over a mean of 40 mm Hg. If the systemic blood pressure falls below the pulmonary artery pressure, perfusion of the right ventricle may be reduced leading to myocardial ischemia and dilitation of the right ventricle which may lead to systemic hypotension and acidosis.[5]

If the preoperative pulmonary artery systolic pressure is over 70 mm Hg, the risk of postoperative heart failure and mortality may be 10%.[6] Risk factors for operative mortality include:

References