Pulmonary Hypertension: Difference between revisions

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Pulmonary hypertension is a rare cause of high blood pressure ( hypertension ) in the pulmonary artery ( pulmonary artery ) . When the blood vessels of the lungs may be damaged , such as in pulmonary arterial hypertension, this allows for thickening and stiffening of the pulmonary artery walls , and this may cause deviations in the vessel wall. The consequence of this is that the pressure in the pulmonary artery rises and also in the RV. PH is a pressure load on the right heart . Click here to see an animation about PH .
Pulmonary hypertension is a rare cause of high blood pressure(hypertension) in the pulmonary artery(pulmonary artery). When the blood vessels of the lungs becomes damaged, such as in pulmonary arterial hypertension, the thickening and stiffening of the pulmonary artery walls occur which causes deviations in the vessel wall. The consequence of this is that the pressure in the pulmonary artery rises and also in the RV. PH is a pressure load on the right heart. Click [http://www.youtube.com/watch?v=ROz1XSWwxR4 '''here'''] to see an animation about PH.


WHO classification
==WHO classification==
Pulmonary hypertension is classified by the World Health Organization (WHO ) to the place where the obstruction is .
Pulmonary hypertension is classified by the World Health Organization (WHO) as the place where the obstruction lies.


classification subcategories
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"
Pulmonary Arterial Hypertension ( PAH )
|-
 
!Classification
Idiopathic PAH ( unknown cause )
!Subcategories
Familial PAH ( genetic cause)
|-
PAH by underlying causes as , connective tissue diseases , congenital heart disease , portal hypertension , HIV infection , drugs , drugs , toxins , and other factors .
!Pulmonary Arterial Hypertension(PAH)
PAH with significant venous and / or capillary involvement
|
Persistent pulmonary hypertension of newborn
*Idiopathic PAH(unknown cause)
*Familial PAH(genetic cause)
*PAH by underlying causes as, connective tissue diseases, congenital heart disease, portal hypertension, HIV infection, drugs, drugs, toxins, and other factors.
*PAH with significant venous and / or capillary involvement
*Persistent pulmonary hypertension of newborn


Pulmonary hypertension with left heart disease
Pulmonary hypertension with left heart disease


In disorders of left atrium and ventricle
*In disorders of left atrium and ventricle
of the heart
of the heart


With Valvular
*With Valvular


Pulmonary hypertension in pulmonary disease and / or hypoxemia
Pulmonary hypertension in pulmonary disease and / or hypoxemia


Chronic obstructive pulmonary disease ( COPD )
*Chronic obstructive pulmonary disease(COPD)
Interstitial lung disease
*Interstitial lung disease
Sleep disorders , alveolar hypoventilation ;
*Sleep disorders, alveolar hypoventilation ;
chronic exposure to high altitude
chronic exposure to high altitude


Congenital malformations / developmental
*Congenital malformations / developmental
Pulmonary hypertension due to chronic thrombotic and / or embolic processes
Pulmonary hypertension due to chronic thrombotic and / or embolic processes


Thromboembolic obstruction of proximal pulmonary arteries
*Thromboembolic obstruction of proximal pulmonary arteries
Thromboembolic obstruction of distal pulmonary arteries
*Thromboembolic obstruction of distal pulmonary arteries
embolism of the lung ( eg tumor , parasites , foreign body , bone marrow )
*embolism of the lung(eg tumor, parasites, foreign body, bone marrow)


Pulmonary hypertension as a result of other diseases and disorders
Pulmonary hypertension as a result of other diseases and disorders


Sarcoidosis
*Sarcoidosis
Histiocytosis X
*Histiocytosis X
Lymfangioleiomyomatose
*Lymfangioleiomyomatose
Sickle Cells
*Sickle Cells
Compression of the pulmonary vessels from outside ( eg by lymphadenopathy , tumor , fibrosing mediastinitis )
*Compression of the pulmonary vessels from outside(eg by lymphadenopathy, tumor, fibrosing mediastinitis)
 
• storage disorders


*storage disorders
|}
 
 
Evidence of pulmonary hypertension
Evidence of pulmonary hypertension
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TR Vmax < 2.8 m / s 2.9-3.4 m / s > 3.4 m / s
TR Vmax < 2.8 m / s 2.9-3.4 m / s > 3.4 m / s
Acct > 120 ms 120-60 ms <60 ms
Acct > 120 ms 120-60 ms <60 ms
RV MPI ( TCO-ET/ET ) < 0.36
RV MPI(TCO-ET/ET) < 0.36
RV MPI ( TDI ) < 0:50
RV MPI(TDI) < 0:50
 
 
Calculations for estimating pressure in the pulmonary artery
Calculations for estimating pressure in the pulmonary artery
 formula
 formula
Systolic PA pressure 4 x ( TR Vmax ) ² + estimated RA pressure
Systolic PA pressure 4 x(TR Vmax) ² + estimated RA pressure
Diastolic PA pressure 4 x ( PR Ved ) ² + estimated RA pressure
Diastolic PA pressure 4 x(PR Ved) ² + estimated RA pressure
Mean PA pressure 0.3 x systolic PA pressure + 0.6 x diastolic PA pressure
Mean PA pressure 0.3 x systolic PA pressure + 0.6 x diastolic PA pressure
90 - (0.62 x ACCT ) if Acct < 120ms
90 - (0.62 x ACCT) if Acct < 120ms
4 x ( PR Vmax ) ² + estimated RA pressure
4 x(PR Vmax) ² + estimated RA pressure
TR PGmean + estimated RA pressure
TR PGmean + estimated RA pressure
 
 
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Short acct with "systolic notch" Flattened septum
Short acct with "systolic notch" Flattened septum


Increased Systolic PA pressure Increased MPI , extension of isovolumetric times .
Increased Systolic PA pressure Increased MPI, extension of isovolumetric times.
Source : Eur Respir Rev 2012 ; 21: 125 , 239-248
Source : Eur Respir Rev 2012 ; 21: 125, 239-248
 
==References==
<biblio>
#1 pmid=20223755
</biblio>
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