Transcript of πνευμονικη υπερταση
- 1. - . . .
- 2. () () . . ...(PVR) . ...(PVR) P.A.P., () . PVR=TPPG/CO
=25/8mmHg =15+/-3mmHg
- 3. A /PASPNORMAL OR GRADE 1: 27+/-7GRADE 2: 38+/-7GRADE 3-4:
64+/-15 MAYO CLINIC 2008
- 4. 4,2%GROUP I79%GROUP II 10%GROUP III0,6%GROUP IV 7%GROUP
V
- 5. E.ROMBERG: . , /& . 1951,39 DrD.T.DRESDALE 1967 1973 10
.. . REXFUMARATE, ()
- 6. Regulation of pulmonary arterial tone
- 7. PAH The term PAH represents truepulmonary
ateriopathy,characterized by: In situ microthrombosis Plexiform
lesion formationLeads to progressive increasein pulmonary
vascularresistance and culminates inright heart failure and
deathThree key pathogeneses: Relative decrease in bioavailability
of NO Relative increase in serum endothelin-1 Relative deficieny of
PGI2/excess of thromboxane A2The term PH representsincreased PAP
but not due tointrinsic vascular disease
- 8. HistopathologyMain vascular changes ofPAH Vasoconstriction
SMC and endothelial-cellproliferation fibrosis thrombosis
intimamedia1.Severe concentric laminar intimal fibrosis2. Medial
hypertrophy3.in situ thrombosis of the small residual lumen
- 9. The Progression of PAH
- 10. Symptoms of PAH Dyspnea60% Fatigue19% Near syncope/syncope
13% Chest pain 7% Palpitations 5% LE edema 3%
- 11. CXR-PA viewEnlargement of the main pulmonary artery and its
major branches,with marked tapering of peripheral arteries .
- 12. CXR-lateral viewEncroachment of the retrosternal air space
-- right ventricularenlargement/hypertrophy
- 13. CXR-PA viewThe right ventricle and atrium may also be
enlarged.
- 14. CTEPH
- 15. ECGHighly specific butnot very sensitive. Right axis
deviation Right atrial and rightventricularenlargement.Right
bundlebranch blockST and T wavechanges in theanterior
precordialleads.
- 16. Echocardiogram FindingsIncreased sPAP / TR jetRight atrial
and ventricular hypertrophyFlattening of interventricular
septumSmall LV dimensionDilated PAPericardial effusion Poor
prognostic sign RA pressure so high it impedes normal drainage from
pericardium Do not drain, usually does not induce tamponade since
RV under high-pressure and non-collapsible
- 17. Representation of Echocardiographic findings
- 18. EchocardiogramRight atrial and ventricularenlargement
andflattening of theintraventricular septum --parasternal short
axisview (a) and four chamberview (b).
- 19. A Word about HemodynamicsThe right heart catheterization is
crucial.Diagnosis and/or treatment choices shouldalmost never be
made based uponechocardiography alone, it is a screening
tool.Exercise and volume challenges are helpfulduring RHC to refine
your diagnosisUseful calculations:mPAP = 1/3 sPAP + 2/3 dPAPPVR =
mPAP PCWP / C.O.