(精编)【高血压英文教学精品课件】 Pulmonary Hypertension.pptVIP

* * * * Diagnostic Tests Pulmonary angiography - should be done if segmental or larger defect on V/Q scan. Caution in pulmonary hypertension as can lead to hemodynamic collapse; use low osmolar agents, subselective angiograms. Lung biopsy not recommended * * * * World Health Organization Classification of Functional Status of Patients with PH Class I - patients with PH who experience no limitation of usual physical activity; ordinary physical activity does not cause increased dyspnea, fatigue, chest pain or presyncope Class II - patients with PH who have mild limitation of physical activity. There is no discomfort at rest, but normal physical activity causes increased dyspnea, fatigue, chest pain or presyncope Class III - patients with PH who have marked limitation of physical activity. There is no discomfort at rest, but less than ordinary activity causes increased dyspnea, fatigue, chest pain, or presyncope Class IV - patients with PH who are unable to perform any physical activity at rest and who may have signs of right ventricular failure. Dyspnea and/or fatigue may be present at rest, and symptoms are increased by almost any physical activity * * Tx of Pulmonary HTN Treat the cause! Phosphodiesterase inhibitors (sildenafil) Revatio Prosanoids (prostacyclin analogues) Flolan, Iloprost Endothelin receptor antagonists Bosentan Vasodilators L-arginine? Coumadin * * Tx of Pulmonary HTN Phosphodiesterase inhibitors (sildenafil) Revatio Nitric oxide stimulation of endothelium increases cGMP resulting in vasorelaxation Phosphodiesterase breaks down cGMP * * Tx of Pulmonary HTN Prosanoids (prostacyclin analogues) Flolan, Iloprost Prostacyclin is a potent vasodilator produced in the vascular endothelium . Also inhibits growth of smooth muscle cells * * Tx of Pulmonary HTN Endothelin receptor antagonists Bosentan Endothelan-1 is a potent vasoconstrictor, induces fibosis and leads to proliferation of smooth-muscle cells * * Tx of Pulm HTN Treatment of heart f