CHEST 2023 Pulmonary and Critical Care Medicine (PCCM) Fellows Course-Pulmonary Hypertension Review

Pulmonary Hypertension Review

Pdf Summary

Dr. Talal Dahhan's presentation at the CHEST Fellows’ Course on October 7, 2023, covered essential aspects of pulmonary hypertension (PH), with a focus on definitions, diagnostic points, general measures, and management options.<br /><br />**Diagnostic Criteria:**<br />- Pulmonary Hypertension (PH) is defined by mean Pulmonary Artery Pressure (mPAP) ≥ 20 mmHg on right heart catheterization.<br />- Pulmonary Arterial Hypertension (PAH) is specified as mPAP ≥ 20 mmHg, Pulmonary Capillary Wedge Pressure (PCWP) ≤ 15 mmHg, and Pulmonary Vascular Resistance (PVR) ≥ 2 Wood units.<br />- Cardiac Output (CO) or Cardiac Index (CI) is crucial in determining disease severity.<br />- PCWP helps differentiate between pre-capillary and pulmonary venous hypertension, indicative of Group II PH.<br />- Transpulmonary Gradient (TPG) and Diastolic Pulmonary Gradient contribute to determining the type of PH.<br /><br />**General Measures and Non-Specific Management:**<br />- Cardiopulmonary rehabilitation is recommended for improving symptoms and reducing markers of inflammation in PAH patients.<br />- Salt and fluid restriction, as well as diuretics, manage symptoms such as hepatic congestion and peripheral edema, successfully lowering the risk of end-organ damage.<br />- Anticoagulation is considered for patients in Group I and those on combination therapies to manage PH.<br />- Anemia, if present, should be corrected to avoid exacerbating right ventricular ischemia.<br /><br />**Specific Pharmacologic Management:**<br />- NO-based therapies like Sildenafil and Tadalafil are used but with careful monitoring of side effects.<br />- Endothelin Receptor Antagonists (Bosentan, Ambrisentan, and Macitentan) and Prostacyclin Analogues present various administration routes with specific side effects.<br />- Soluble Guanylate Cyclase Stimulators like Riociguat are key for Group I and IV patients.<br />- Emerging treatments like Sotatercept show promise in reducing PVR in PAH patients.<br /><br />**Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH):**<br />- It requires a Ventilation-Perfusion (VQ) scan for initial diagnosis.<br />- Thromboendoarterectomy surgery can potentially cure CTEPH, while inoperable cases might benefit from balloon pulmonary angioplasty and Riociguat initiation.<br /><br />The detailed references underscore the evidence-based approach underlying these guidelines.

Keywords

Pulmonary Hypertension

Pulmonary Arterial Hypertension

Cardiac Output

Cardiopulmonary Rehabilitation

Anticoagulation

Endothelin Receptor Antagonists

Prostacyclin Analogues

Soluble Guanylate Cyclase Stimulators

Chronic Thrombo-Embolic Pulmonary Hypertension

Thromboendoarterectomy

Pulmonary Hypertension