Pulmonary Hypertension - New Trends of Diagnostic and Therapy

Abstract

Pulmonary hypertension is a pathophysiological state hemodynamically defined as the increase of the mean pulmonary arterial pressure above 25, or 30 mmHg at rest, measured by catheterization of the right heart. Laboratory findings usually reveals polycythemia, the ECG right ventricle hypertrophy, and x-ray characteristic of diseased branches (echocardiography and biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP hormones are potentially helpful tools in identifying PH). Echocardiography can be found the increase of the right atrium and ventricle, right ventricular hypertrophy, abnormal contraction of the interventricular septum, left ventricular diastolic dysfunction and decreased left ventricular size, with reduced volumes of systole and end diastole. Doppler confirming tricuspid regurgitation. Pharmacological therapy would represent a use: Calcium Channel Blockers, Prostacyclin Analogues, Endothelin Receptor Antagonists and Phosphodiesterase-5 Inhibitors. Alpha adrenergic antagonists, endothelial receptor subtype A (Bosentan, Tracller) with treatment of the underlying disease or anticongestive therapy, are recommended. In case of inadequate response to treatment with a specific drug, guidelines recommend the combined use of drugs from the basic three groups, using their synergism.

Left ventricular dysfunction and reversible pulmonary hypertension secondary to severe pneumonia in a background of sepsis: a case report and review of the literature

“…The main mechanisms responsible for cardiovascular complications have been linked to the patients' demographics (age, presence of comorbidities), pneumonia severity, and systemic response to infection. Hypoxia or respiratory failure causes an increase in pulmonary arterial pressure and also right ventricular afterload (12)(13)(14)(15)(16)(17). Persistent inflammation as in the case of sepsis causes depression in myocardial function and increases myocardial oxygen demand.…”

Radiomics Detection of Pulmonary Hypertension via Texture-Based Assessments of Cardiac MRI: A Machine-Learning Model Comparison—Cardiac MRI Radiomics in Pulmonary Hypertension

“…PH is defined as when resting mean arterial pressure as measured during right heart catheterization (RHC) is ≥25 mm Hg [ 2 ]; however, it was recently proposed to reduce the threshold to define PH to >20 mm Hg [ 3 ]. Patients with PH have non-specific symptoms including dyspnea, chest pain, syncope, palpitations, or reduced exercise tolerance [ 4 ]. No clinical, laboratory, or ECG marker is specific for early diagnosis of PH.…”

Evaluation of Cardiac Parameters in Bone Marrow Transplant Patients: Effect of Pulmonary Artery Pressure on Survival

“…Pulmonary hypertension (PH) is defined as pulmonary artery pressure (PAP) of more than 25 mmHg at rest. Right heart catheterization is used as the gold standard in diagnosis, but this method is not suitable for daily practical use [6]. In the past 30 years, prodigious technological improvements in echocardiography have increased its sensitivity for quantifying PAP and it is now used as a safe and available alternative to invasive catheterization [7].…”