Pulmonary artery hypertension

Points to remember about pulmonary artery hypertension

1. Pulmonary arterial hypertension (PAH) - mean pulmonary arterial pressure > 20 mm Hg and a pulmonary vascular resistance > 3 WU, with a normal capillary wedge pressure of < 15 mm Hg

2. Increased pulmonary resistance results in right ventricular overload and right heart failure

3. Mortality of at least 50% in 7 years

4. Pregnancy in women with PAH is associated with high maternal and neonatal mortality rates

5. The only therapy with a direct survival benefit is intravenous epoprostenol, a prostanoid vasodilator

6. A positive acute vasodilator response is defined by a decrease in mean PAP ≥ 10 mm Hg to reach a mean PAP < 40 mm Hg with an improved or stable cardiac output. In these patients, high-dose calcium channel blockers significantly lower PAP and vascular resistance.

7. Most common cause of death- right sided heart failure

8. Agents within the same class (including PDE-5 inhibitors and guanylate cyclase stimulators) should not be used together.

9. Riociguat, a soluble guanylate cyclase stimulator, is approved for the treatment of chronic thromboembolic pulmonary hypertension.

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ECG Quiz

Case History: A 46-year old female presents with history of palpitations. At the time of palpitations, she also had rapid neck pulsations. She presented to emergency and an ECG was done. What are the findings? What is the diagnosis? Click here to reveal the answer The ECG shows a regular narrow complex tachycardia (ventricular rate of approximately 250/min). The P waves are not clearly visible, but there is a small deflection at the end of QRS in various leads. In lead I, this is pseudo r' and in leads this is pseudo s wave. The patient was found to have AVNRT on EPS and slow pathway was ablated successfully.

ECG of Acute Pulmonary Embolism

Case 1. A 23-year old gentleman presented with history of chest pain and shortness of breath. This was the ECG at the time of presentation. What are the findings? What is the diagnosis? Answer: ECG shows Sinus tachycardia and S1Q3T3 pattern. S1Q3T3 pattern is a specific sign of acute pulmonary embolism. CTPA confirmed the diagnosis. Patient underwent thrombolysis with Tenecteplase successfully with resolution of symptoms.

Peripartum Cardiomyopathy

Peripartum Cardiomyopathy (PPCM) • Usually develops in last month of pregnancy or first 5 months post-delivery. • Presents as heart failure with reduced ejection fraction (dilated cardiomyopathy) ↳ LV EF < 45% • PPCM is a diagnosis of exclusion. • Risk factors → 1- History of Hypertension, Pre-eclampsia 2- Black women • Incidence → 1 in 2000 live births. • Management → 1. Guideline directed medical therapy for HF- Beta-blockers Hydralazine plus isosorbide dinitrate Diuretics 2. Bromocriptine 3. Low threshold for anticoagulation 4. ...

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