Pulmonary Arterial Hypertension

Pulmonary Arterial Hypertension

1. PREVALENCE

   • Congenital Heart Disease
   • Sickle Cell Anemics
   • Ethnic groups
     • Aboriginals
     • Africans Americans
   • Age
     • More prevelant in women after age 55
     • More prevalent in men before the age of 55

2. PATHOPHYSIOLOGY

   • Prolonged hypertension
     • Remodeling of intimal lining of arteries
     • Decrease in coronary perfusion pressure
     • Increased myocardial oxygen consumption
     • Reduced alveolar-capillary surface area
     • Increase in pulmonary vascular resistance
       • Right ventricular hypertrophy
       • Occasional right ventricular failure

3. CLINICAL MANIFESTATIONS

   • Fatigue
   • Dizzines
   • Palpations
   • Dyspnea
   • Peripheral edema
   • Angina
   • Frequently asymptomatic
   • Cyanosis

4. COMPLICATIONS

   • Hypertensive Heart disease
     • Coronary artery disease
     • Right ventricular hypertrophy
     • Right-sided heart failure (Cor Pulmonale)
   • Arrythmias
   • Peripheral vascular disease
   • Hemorrhage

5. PATIENT TEACHING

   • Weight loss
   • Reduced alcohol & sodium intake
   • Regular physical activity
   • Smoking cessation
   • Changes in diet
     • DASH diet
       • 2-3 servings of low-dairy
       • 8-10 servings of fruits and vegetables
       • 2.4mg of sodium
       • Low in saturated fats
   • Side effects of medication

6. INTERDISCIPLINARY CARE

   • Physician
     • Overview of Pulmonary Arterial Hypertension
   • Dietitian
     • Dietary Approaches to Stop Hypertension (DASH) Diet
   • Physiotherapist
     • Benefits of physical activity & examples of exercises
   • Pharmacist
     • Pharmacological treatment options & potential side effects

7. TREATMENT

   • Medications
     • Diuretics
     • Adrenergic inhibitors
     • Angiotensin inhibitors
     • Potent vasodilators
     • Anticoagulants
   • Surgical Intervention
     • Atrial septostomy
     • Heart transplantation
     • Lung transplantation
   • Oxygen Therapy

8. DIAGNOSTIC STUDIES

   • Past medical history
   • Cardiopulmonary Exercise Test
   • CT (Computed Tomography) Scan
   • Right-sided Catheterization
   • CBC/Serum Electrolyes
     • B-type Natriuretic Peptide, Basic Metabolic Panel, Complete Metabolic Pane
   • Pulmonary function test
   • Echocardiogram

9. DEFINITION

   • Mean pulmonary arterial pressure (MPAP) is ≥ 25 mmHg at rest
   • MPAP ≥ 30 mmHg during exercise by cardiac catheterisation
   • Pulmonary arterioles and capillaries are narrowed
     • Decrease blood to flow through your lungs
     • Increase pressure within your lungs' arteries
   • Blood Pressure = Cardiac Output x Systemic Vascular Resistance
   • Systolic PAP is ≥ 40 mmHg by echocardiography