临床医师如何处理肺动脉高压程显声课件.ppt

Case report Patient male 51 years old, was found cardiac murmur in1985. He underwent mitral valve replacement in 1988, in post-operation his symptoms disappeared and excise tolerance was normal. He regularly took warfarin, metoprolol and digoxin . In 2005 the patient recurred exertional dyspnea, extremitas edema, that were alleviative after treatment. He was admitted to hospital with hemoptysis and nocturnal dyspnea for three days. Physical exam: T36℃, P97bpm, Bp140/100mm Hg. Sitting position, numerous rales in lungs, HR130bpm, irregular rhythm, 2/6SM in TV area, heptomegaly, no edema in low extremity. Echocardiography estimated SPAP=102mm Hg, ECG and chest X-ray film see next slide. Diagnosis: chronic rheumatic heart disease, post-MV replacement, heart failure, secondary PH. Pre-treatment Post-treatment ECG: E-axis to right，RVH? Questions: 1. What is the pathogenesis of the PH? 2. How to evaluate the pulmonary vascular lesion? 3. What is the impact of the secondary PH on prognosis of the patient? 4. How to prevent and treat the pattern of PH? Whether to can use target therapy? 7.Current PAH Treatment Guidelines WHO-Venice Proceedings: - A - to –Z ( Pathobiology, Genetics, Endpoints Diagnosis, Treatment ); (JACC 2004) ACCP(US) Consensus Guidelines: - Screening, Early Detection, Diagnosis; (CHEST 2004) - Treatments; CHEST 2004, 200 ESC(EU) Consensus Guidelines: - Diagnosis and Treatment; (Eur Heart J 2004 ) ACCF/AHA (– 1st Presented at JACC; March, 2009) (1)Symptomatic PAH Combination Therapy? Prostanoid Bosentan Sildenafil General Treatment Measure Acute Vasoreactivity Testing (A IPAH,E/C for other PAH) Positive Negative Oral CCB [B for IPAH, E/B for other PAH] Sustained Response? yes No FCⅡ F