A population-based study in Minnesota estimated that the total prevalence could reach 10% to 20% in the general population. 13, 14 The prevalence of pulmonary hypertension increases with age. 12 Group 5 is multifactorial in etiology and best characterized in the setting of sickle cell disease, where it is an independent predictor of mortality.
11 After an acute pulmonary embolism, one study found a 3.8% incidence of chronic thromboembolic pulmonary hypertension (group 4) after two years. It is found in 20% of patients who have been hospitalized and in more than 50% of patients with end-stage disease. In patients with chronic obstructive pulmonary disease (COPD), the prevalence of pulmonary hypertension increases with COPD severity. 10 Pulmonary hypertension is also common in patients with lung disease and/or hypoxia (group 3). 9 In systolic or diastolic left heart failure, prevalence estimates range from 25% to 83%. Pulmonary hypertension is most prevalent in those with left heart disease (group 2). Perioperative assessment of patients with pulmonary hypertension should include echocardiographic assessment of right ventricular function.įamily physicians most often encounter pulmonary hypertension in patients with chronic disease such as heart failure, obstructive lung disease, and thromboembolism. Patients with pulmonary hypertension should receive seasonal influenza vaccination and age-appropriate pneumococcal vaccination, unless contraindicated. Patients with chronic thromboembolic pulmonary hypertension should receive lifelong anticoagulation in the absence of contraindications. Use of vasodilator therapies in patients with pulmonary hypertension due to lung disease or left heart disease is potentially harmful and not recommended. In patients with pulmonary hypertension and hypoxia, supplemental oxygen should be administered to maintain saturation above 90%. In patients with pulmonary hypertension due to lung disease or left heart disease, treatment should focus on optimizing comorbid conditions. Results from invasive hemodynamic testing with right heart catheterization, preferably at an expert center, should be obtained before initiating treatment with vasodilator therapy in patients with pulmonary arterial hypertension.
Other important considerations for patients with pulmonary hypertension include influenza and pneumonia immunizations, contraception counseling, preoperative assessment, and mental health.Įchocardiography is the recommended initial test in the evaluation of patients with suspected pulmonary hypertension. There are no directed therapies for many other categories of pulmonary hypertension therefore, family physicians have a central role in managing contributing comorbidities. For certain categories of pulmonary hypertension, particularly pulmonary arterial hypertension, treatment options are rapidly evolving, and early diagnosis and prompt referral to an expert center are critical to ensure the best prognosis. A definitive diagnosis cannot be made on echocardiographic abnormalities alone, and some patients require invasive evaluation by right heart catheterization. Echocardiography is recommended as the initial step in the evaluation of patients with suspected pulmonary hypertension. There is limited evidence to support screening of asymptomatic individuals. Patients often initially present to family physicians however, because the symptoms are typically nonspecific or easily attributable to comorbid conditions, diagnosis can be challenging and requires a stepwise evaluation. Pulmonary hypertension is a common, complex group of disorders that result from different pathophysiologic mechanisms but are all defined by a mean pulmonary arterial pressure of 25 mm Hg or greater.
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