Right coronary artery flow impairment in patients with pulmonary hypertension

Wolferen, S A van; Marcus, J. Tim; Westerhof, Nico; Spreeuwenberg, Marieke; Marques, Koen M.; Bronzwaer, Jean G.F.; Henkens, Ivo R.; Gan, C. Tji-Joong; Boonstra, Anco; Postmus, Pieter E.; Vonk‐Noordegraaf, Anton

doi:10.1093/eurheartj/ehm567

Cited by 211 publications

(162 citation statements)

References 23 publications

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“…Angina is also common, likely reflecting demand ischemia from impaired coronary blood flow to a markedly hypertrophied right ventricle (RVH). 16 As cardiac output becomes fixed and eventually falls, patients may have episodes of syncope or near-syncope, an ominous symptom requiring prompt medical attention. Patients with PH related to left ventricular systolic or diastolic dysfunction, the most common cause of PH, may have orthopnea or paroxysmal nocturnal dyspnea.…”

Section: Clinical Assessment Of the Patient With Suspected Pulmonary mentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

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1820T here has been an increased recognition of pulmonary hypertension (PH) in clinical practice over the past 30 years. It is likely that this rise in PH diagnoses is attributable to multiple factors, including increased awareness by clinicians, the routine use of diagnostic tools such as Doppler echocardiography, and the availability and marketing of the many PH-specific drugs.1 Although the increased awareness of the disease should be viewed as a favorable development, the unintended consequences include overdiagnosis, misclassification, and at times indiscriminate use of expensive, PH-specific drugs. In this review, we address the epidemiology, prognosis, and updated clinical classification of PH. We then focus on the diagnostic approach to the patient with suspected PH with an emphasis placed on highlighting key pearls for the clinician to consider. Finally, we review an evolving conceptual framework of viewing the pulmonary vasculature and the right ventricle as a single, coupled cardiopulmonary unit.

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Section: Clinical Assessment Of the Patient With Suspected Pulmonary mentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

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“…RV is a thin walled chamber structured to handle a low pressure pulmonary circulation [9,10]. Unlike the normal physiology, in PH the perfusion to the RV is gradually restricted only to diastole with the progression of severity of PH resulting in progressive ischemia and failure of RV [11]. Though there may be a disparity of 10-20 mmHg of PASP measurement invasively as compared to 2D Echo, the latter is the preferred initial modality to diagnose, quantify and follow-up PH [12].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Pulmonary Hypertension Induced Thrombocytopenia - A Case Report

Dash¹,

Venugopal²,

Sahoo³

et al. 2016

J Pulm Respir Med

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“…(57). Alternatively, RV ischemia in PH may result from reduced perfusion pressure due to RV hypertension (57,58) and/or rarefaction of the microvasculature (59). Various biomarkers are associated with the maladaptive phenotype including prolongation of the QTc interval on ECG (60) and elevation of brain natriuretic peptide (61).…”

Section: Maladaptive Rv Hypertrophymentioning

confidence: 99%

An Official American Thoracic Society Statement: Pulmonary Hypertension Phenotypes

Dweik¹,

Rounds²,

Erzurum³

et al. 2014

Am J Respir Crit Care Med

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Background: Current classification of pulmonary hypertension (PH) is based on a relatively simple combination of patient characteristics and hemodynamics. This limits customization of treatment, and lacks the clarity of a more granular identification based on individual patient phenotypes. Rapid advances in mechanistic understanding of the disease, improved imaging methods, and innovative biomarkers now provide an opportunity to define PH phenotypes on the basis of biomarkers, advanced imaging, and pathobiology. This document organizes our current understanding of PH phenotypes and identifies gaps in our knowledge.

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Right coronary artery flow impairment in patients with pulmonary hypertension

Abstract: Although in controls, RCA flow is similar in systole and diastole, in PH there is systolic flow impediment, which is proportional to RV pressure and mass. In patients with severe RV hypertrophy total mean flow is reduced.

Cited by 211 publications

References 23 publications

Clinical Diagnosis of Pulmonary Hypertension

Clinical Diagnosis of Pulmonary Hypertension

Idiopathic Pulmonary Hypertension Induced Thrombocytopenia - A Case Report

An Official American Thoracic Society Statement: Pulmonary Hypertension Phenotypes

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