• Useful Facts:
  1. Venous Blood Gas: Useful to screen for hypercarbia (not hypoxemia). If elevated, will need an ABG.
  2. RVSP on TTE: Estimation is with large S.E. - need RHC to formally evaluate
  3. If RVSP >50 unlikely acute process since this degree of elevation in pressures acutely would cause RV failure and HD compromise
  4. Shunt Physiology: Increasing FiO2 will only result in minimal improvement in PaO2. With serial ABGs on different O2 settings can actually calculate shunt fraction.  
     • Intrapulmonary Shunt Examples:
       • Hepatopulmonary Shunt
       • Hereditary hemorrhagic telangiectasia
  
  

  Posted 07/25/16 02:16:36 PM by Adam Faye

• Pulm HTN Groups:
  1. PAH (idiopathic, connective tissue disorders, drugs and toxins)
  2. Secondary to Left Heart Disease
  3. Secondary to chronic lung disease and/or hypoxemia
  4. CTEPH
  5. Multifactorial
  
  

  Posted 07/25/16 02:22:35 PM by Adam Faye

• Vasoreactivity Test:
  • Group 1 PAH - administer inhaled NO. See if Mean PA decreases by >10mmHg to a value less than 40 mmHg. If positive trial a calcium channel blocker - untreated median survival of 2-3 years
    • Treatment- 
  
  CTEPH:
  • V/Q scan for diagnosis (more distal emboli which CTA can have difficulty picking up).
  
  

  Posted 07/25/16 02:24:34 PM by Adam Faye

• Treatment of Pulmonary Arterial Hypertension
  
  

  Posted 07/25/16 02:31:07 PM by Adam Faye

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