Pulmonary hypertension

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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[edit]

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[edit]

For all patients, consider:

• Inhibitors of phosphodiesterase type 5 (PDE-5), such as sildenafil.

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

• Prostaglandins, such as iloprost, treprostinil, or epoprostenol.
• Endothelin receptor antagonists such as bosentan.

Perioperative care[edit]

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:

• Electrocardiogram right-axis deviation and right-ventricular hypertrophy
• history of pulmonary embolism
• A ratio of right-ventricular to systemic systolic pressure > 0.66

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References[edit]