Acute decompensated pulmonary hypertension

Abstract

Acute right heart failure in chronic precapillary pulmonary hypertension is characterised by a rapidly progressive syndrome with systemic congestion resulting from impaired right ventricular filling and/or reduced right ventricular flow output. This clinical picture results from an imbalance between the afterload imposed on the right ventricle and its adaptation capacity. Acute decompensated pulmonary hypertension is associated with a very poor prognosis in the short term. Despite its major impact on survival, its optimal management remains very challenging for specialised centres, without specific recommendations. Identification of trigger factors, optimisation of fluid volume and pharmacological support to improve right ventricular function and perfusion pressure are the main therapeutic areas to consider in order to improve clinical condition. At the same time, specific management of pulmonary hypertension according to the aetiology is mandatory to reduce right ventricular afterload. Over the past decade, the development of extracorporeal life support in refractory right heart failure combined with urgent transplantation has probably contributed to a significant improvement in survival for selected patients. However, there remains a considerable need for further research in this field.

Acute Respiratory Failure in Interstitial Lung Disease Complicated by Pulmonary Hypertension

“…Natriuretic peptides (i.e NT-proBNP) elevation results from ventricular stretch and imply increasing right-sided pressures in patients with PH. Higher mortality is associated with elevated cardiac enzymes and lactic acidosis [55][56][57][58].…”

“…In the setting of hypervolemia, negative fluid balances reduce right ventricular preload, right-left ventricular interdependence, tricuspid regurgitation, and end organ congestion [57]. Intravenous loop diuretics are used first line and combination with thiazide-type diuretics or aldosterone antagonist may be considered to improve urinary output [9,91].…”

“…Phenylephrine should be avoided due to its effect on increasing pulmonary vascular resistance, which worsen coupling between RV function and afterload [94]. In patients with shock physiology, the mortality has been correlated with increasing vasopressor requirements [57].…”

Serum cardiac troponin elevation predicts mortality in patients with pulmonary hypertension: A meta‐analysis of eight cohort studies

“…Pulmonary hypertension is a major global health issue; it affects approximately 1% of the total population and increases up to 10% among individuals aged >65 years . Despite impressive advancements in elucidation of the pathobiology of PH and the introduction of targeted medical therapies, PH remains a life‐threatening disease with a poor prognosis, with estimated survival rates at 1 year, 2 years and 3 years of 95.6%, 87.3% and 77.0%, respectively, in Europe and North America . Thus, it is important to identify novel prognostic therapeutic targets and precise prognostic markers for this type of lung disease.…”

Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report

“…Pulmonary hypertension, a multietiological disease leading to chronic right heart failure, is such a possible comorbidity [2]. Acute decompensation of the condition can lead to rapid progression, multiorgan failure and cardiovascular collapse, with an extremely high mortality rate of 14–100% [3]. The most severe forms of the disease, including idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH), often affect young females [2, 4] and it is well known that pregnancy in these conditions carries significant additional risk.…”