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CHEST 2024 Pulmonary and Critical Care Medicine (P ...
PH Review for Pulmonary Artery Catheter Waveforms ...
PH Review for Pulmonary Artery Catheter Waveforms and Interpretation
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Pdf Summary
The CHEST Fellows' Course on October 5, 2024, led by Dr. Talal Dahhan, provided an in-depth review of pulmonary hypertension (PH). Pulmonary arterial hypertension (PAH) diagnosis is determined by a mean pulmonary artery pressure (mPAP) ≥20 mmHg, a pulmonary capillary wedge pressure (PCWP) ≤15 mmHg, and pulmonary vascular resistance (PVR) ≥2 Wood units (WU). Critical points include cardiac output (CO) or cardiac index (CI) below 2 L/min indicating severe disease and differentiations based on PCWP values. Exercise right heart catheterization (RHC) can further identify precapillary disease.<br /><br />General management includes cardiopulmonary rehabilitation, salt and fluid restriction, and careful diuretic use. Diuretics help with symptoms like hepatic congestion and peripheral edema, while anticoagulation is considered for Group I patients on maximum therapies. Correcting anemia is also essential to prevent RV ischemia.<br /><br />Specific pharmacological treatments for PAH encompass diverse pathways and medications:<br /><br />1. **NO-based pathway**: Includes iNO and PDE-V inhibitors such as Sildenafil (Revatio) and Tadalafil (Adcirca), which help by inhibiting metabolism; however, they can cause side effects like headaches and systemic hypotension.<br />2. **Endothelin Receptor Antagonists**: Drugs like Bosentan (Tracleer), Ambrisentan (Letairis), and Macitentan (Opsumit) manage symptoms with some side effects.<br />3. **Prostacyclin Analogues**: Available in various forms like inhaled (Iloprost), oral (Treprostinil), subcutaneous (Treprostinil), and intravenous (Epoprostenol), these help but may have significant side effects.<br />4. **Soluble Guanylate Cyclase (sGC) Stimulators**: Riociguat (Adempas) is approved for Group I and Group IV patients and shares side effects with PDE-V inhibitors.<br /><br />For chronic thromboembolic pulmonary hypertension (CTEPH), the initial screening test is a ventilation-perfusion scan (VQ scan). Thromboendarterectomy surgery offers a potential cure, while balloon pulmonary angioplasty and Riociguat can aid in inoperable cases.<br /><br />References from leading journals and studies underpin the guidelines provided.
Keywords
pulmonary hypertension
PH
PAH diagnosis
cardiac output
right heart catheterization
cardiopulmonary rehabilitation
pharmacological treatments
NO-based pathway
Endothelin Receptor Antagonists
Prostacyclin Analogues
CTEPH
Pulmonary Hypertension
PH
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