0.18 सीएमई

फुफ्फुसीय उच्च रक्तचाप: एक केस-आधारित दृष्टिकोण

वक्ता: डॉ. एमवी रामचंद्र

Consultant PulmonologistKauvery Hospitals.

लॉगिन करें प्रारंभ करें

विवरण

Pulmonary hypertension is a progressive and debilitating condition characterized by elevated blood pressure in the pulmonary arteries, leading to impaired functioning of the heart and lungs. This case-based approach focuses on individual patient scenarios to understand the diverse causes, clinical presentations, and management strategies for pulmonary hypertension. Diagnostic tools such as echocardiography, right heart catheterization, and pulmonary function tests play crucial roles in establishing the diagnosis and determining the severity of pulmonary hypertension. Regular follow-up and monitoring of patients are essential to evaluate treatment response, adjust therapy if needed, and address potential complications associated with pulmonary hypertension. Supportive care, including exercise training, supplemental oxygen, and psychological support, plays a crucial role in improving quality of life for patients with pulmonary hypertension. Case discussions also focus on the multidisciplinary approach involving pulmonologists, cardiologists, rheumatologists, obstetricians, and other specialists to provide comprehensive care for patients with pulmonary hypertension. Treatment approaches for pulmonary hypertension include vasodilator therapy, diuretics, anticoagulation, and in advanced cases, lung transplantation. Case-based management involves tailoring treatment to the specific underlying cause, assessing disease severity, and considering individual patient factors such as age, comorbidities, and response to therapy. Research and advancements in the understanding of pulmonary hypertension have led to the development of targeted therapies, such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclin analogs, offering new treatment options.

सारांश

  • The mean pulmonary artery pressure is normally 14 plus or minus 3, and pulmonary hypertension is defined as a mean pulmonary artery pressure greater than 20, according to current European Respiratory Society guidelines. This measurement is ideally obtained via right heart catheterization, considered the gold standard, though it's not routinely performed on all patients. Pulmonary hypertension is classified into five groups, with Group 1 specifically termed "pulmonary arterial hypertension" and including idiopathic, heritable, drug/toxin-induced, and associated conditions like connective tissue disorders, HIV, portal hypertension, congenital heart disease (specifically shunting types), pulmonary veno-occlusive disease, and persistent pulmonary hypertension of the newborn.
  • Group 2 pulmonary hypertension is caused by left heart diseases (post-capillary), including valve diseases and acquired cardiac conditions causing obstruction. Group 3 includes lung diseases such as COPD, ILD, and conditions causing hypoxia without lung disease, like sleep apnea. Group 4 is pulmonary hypertension due to chronic thromboembolism or pulmonary artery tumors, while Group 5 encompasses miscellaneous causes like hematological disorders, systemic diseases, and conditions like sarcoidosis or fibrosing mediastinitis.
  • Diagnosing pulmonary hypertension involves recognizing symptoms like breathlessness, cough, chest pain, hoarseness, and hemoptysis. Clinical examination may reveal murmurs, thrills, and signs of connective tissue disorders. Signs like cyanosis and peripheral edema may be present. Investigations are key to diagnosis.
  • Diagnostic testing includes pulmonary function tests (PFTs), overnight oximetry for sleep apnea, arterial blood gases (ABGs), ECG, echocardiography with possible cardiac MRI, and blood tests for connective tissue disorders and genetic studies. Imaging begins with chest x-rays, which can show cardiomegaly or signs of pulmonary embolism like Westermark's sign and Hampton's hump. CT scans and CT pulmonary angiograms (CTPA) provide further detail, and VQ scans are useful for detecting chronic thromboembolism.
  • Echocardiography assesses right ventricular size and function, and tricuspid regurgitation jet velocity (TRJ), indicating pulmonary hypertension. CT thorax can reveal lung diseases or congenital cardiac abnormalities associated with pulmonary hypertension, and allows measurements of the pulmonary artery diameter relative to the aorta. VQ scans are particularly useful for detecting VQ mismatch in chronic thromboembolic disease, even at the subsegmental level. Right heart catheterization is the definitive diagnostic tool, used to measure pulmonary pressures and pulmonary wedge pressure.

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