CHEST 2024 Pulmonary and Critical Care Medicine (PCCM) Fellows Course-Pulmonary Artery Catheter Waveforms and Interpretation

Pulmonary Artery Catheter Waveforms and Interpretation

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The document is a summary of the "CHEST Fellows' Course" on Pulmonary Hypertension (PH) presented by Dr. Talal Dahhan on October 5, 2024. It covers various aspects of PH, including definitions, diagnostic criteria, and management strategies.<br /><br />**Definitions and Diagnostic Criteria:**<br />- PH is identified by a mean pulmonary artery pressure (mPAP) ≥ 20 mmHg on right heart catheterization.<br />- Pulmonary Arterial Hypertension (PAH) is characterized by mPAP ≥ 20 mmHg, pulmonary capillary wedge pressure (PCWP) ≤ 15 mmHg, and pulmonary vascular resistance (PVR) ≥ 2 wood units (wu).<br />- A cardiac output (CO) or cardiac index (CI) < 2 L/min suggests severe disease.<br />- PCWP > 15 mmHg indicates high filling pressures, or Group II pulmonary venous hypertension.<br />- Diagnostic measures like transpulmonary gradient (TPG) and diastolic pulmonary gradient can help differentiate PAH.<br /><br />**Management Strategies:**<br />- Cardiopulmonary rehabilitation, including slow-paced respiration therapy, is beneficial for PAH patients.<br />- Salt and fluid restriction and diuretics are essential to manage right heart failure and reduce hepatic congestion and peripheral edema.<br />- Anticoagulation may be considered for certain PAH groups.<br />- Correction of anemia is crucial to prevent right ventricular ischemia and disease progression.<br /><br />**Specific Pharmacologic Management:**<br />- **Nitric Oxide (NO) Pathway:** Sildenafil and Tadalafil are used, but Tadalafil should be discontinued if estimated glomerular filtration rate (eGFR) < 45 ml/min or in septic patients with hypotension.<br />- **Endothelin Receptor Antagonists:** Drugs include Bosentan, Ambrisentan, and Macitentan, which can cause side effects like ankle edema and fluid retention.<br />- **Prostacyclin Analogues:** Includes inhaled (Iloprost, Treprostinil), oral (Treprostinil, Selexipag), subcutaneous (Treprostinil), and intravenous (Epoprostenol, Treprostinil) formulations.<br />- **Soluble Guanylate Cyclase Stimulators:** Riociguat is specified for Group I and inoperable Group IV CTEPH patients.<br />- **Inhaled Treprostinil:** Shows promise for patients with interstitial lung disease (ILD) and associated pre-capillary PH.<br />- **Sotatercept:** A novel protein showing positive outcomes in reducing PVR for PAH patients on background therapy.<br /><br />**Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH):**<br />- Diagnosed through VQ scans.<br />- Curable through thromboendarterectomy surgery, with alternatives like balloon pulmonary angioplasty and Riociguat for inoperable cases. <br /><br />References cited include works by Humbert, Kelley and Rabbani, and Waxman in leading medical journals like NEJM and the European Heart Journal.

Keywords

Pulmonary Hypertension

CHEST Fellows' Course

Dr. Talal Dahhan

diagnostic criteria

management strategies

Pulmonary Arterial Hypertension

pharmacologic management

Chronic Thrombo-Embolic Pulmonary Hypertension

cardiopulmonary rehabilitation

right heart failure

Pulmonary Hypertension