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Showing posts from August, 2017

Getting it ‘Right’: Pulmonary Hypertension in the ED

ObjectivesDescribe the pathophysiology of Pulmonary Hypertension (PH), and how it can be dangerousWho to suspect and workup for PH in the EDDescribe the POCUS findings in PHDescribe the management of these patients and how to avoid causing harm PhysiologyDefinition Pulmonary hypertension (PH) is defined as a pulmonary artery mean pressure >25 mmHg by right heart catheterization at rest. Transthoracic echocardiography is used as a screening tool with a right ventricular systolic pressure (RVSP) > 40 being suggestive but not diagnostic of PH (1,2).
Classification PH can be divided broadly into conditions primarily affecting pulmonary arterioles (Group 1) or secondary causes that progressively lead to changes in the pulmonary arteries (Groups 2-5). 
Group 1 is pulmonary arterial hypertension that is:  idiopathicheritabledrug-induceassociated with other conditions (eg. HIV, schistosomiasis, portal hypertension) The secondary causes include:  Group 2: Left sided heart disease (eg. valvu…