Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1246 Pulmonary Hypertension

tests

Laboratory

■Basic blood tests

■Rule out secondary causes of PH (CBC, LFT’s, HIV, serologic tests for

connective tissue diseases and hypercoagulable states).

Imaging

■Basic imaging tests:

■CXR- rule out significant lung or cardiac disease

■Echocardiogram- noninvasively measures pulmonary pressure and

evaluates for secondary causes of PH

■EKG-typically shows RA and RV enlargement, may show rsR’ or

RBBB, RAD

Specific Diagnostic Tests

■Pulmonary function tests

■Ventilation/perfusion lung scan to rule out occult pulmonary emboli

■Hi resolution chest CT if lung disease identified by CXR/PFT’s or

history of connective tissue disease

■Right heart catheterization: gold standard for diagnosis of pul-

monary hypertension and for determining if there is a post-capillary

component (elevated wedge pressure) or shunt

➣Diagnosis made by pulmonary artery systolic pressure >25 mm

Hg at rest or >30 mm Hg with during exercise

differential diagnosis

■Diagnosis can be confirmed by right heart catheterization

■Symptoms of dyspnea may be related to other underlying lung or

cardiac disease

■Secondary causes of pulmonary hypertension most commonly

include: COPD with accompanying right heart failure (cor pul-

monale), post capillary pulmonary hypertension to LV dysfunction,

connective tissue diseases (scleroderma, lupus, rheumatoid arthri-

tis), and chronic occult pulmonary emboli

management

■Assess severity of pulmonary hypertension and severity of compli-

cations.

■Treat underlying causes for secondary PH.

■For primary PH, assess candidacy for transplant while initiating spe-

cific therapy.