0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19
Pulmonary Hypertension 1247■Patients should avoid significant physical exertion or high altitudes
■Discontinue potential offending medications (appetite suppres-
sants) and other meds which may lead to pulmonary artery vaso-
constriciton (decongestants)specific therapy
■Vasodilators
➣Some benefit in select patients
➣May improve symptoms and pulmonary artery pressures
➣No change in survival
➣Initiate slowly in CCU with cardiology consultation and with right
heart catheter in place to monitor pressures
➣Only continue as outpatient if drug has a hemodynamic benefit
➣Calcium channel blockers traditionally used (diltiazem, nifedip-
ine)
➣Inhaled nitric oxide used in acute situations especially in pedi-
atric cases
■Epoprostenol (Prostacyclin)
➣Vasodilator and inhibitor of platelet aggregation
➣May improve symptoms, hemodynamics and survival in select
patients
➣Must be initiated in CCU with cardiology consultation through
IV
➣Continuous infusion requires indwelling central line
■Anticoagulation
➣Warfarin may have some benefit on survival based on uncon-
trolled trials
➣May prevent DVT’s from venous stasis or in-situ thrombosis from
PH
■Oxygen
➣For use in patients with demonstrated hypoxemia
■Diuretics and digoxin
➣May help with right heart failure and lower extremity edema
■Surgery
➣For patients with secondary PH from large pulmonary emboli,
pulmonary thromboendarterectomy is indicated
➣For chronic small pulmonary emboli, patients should have a vena
caval filter placed
➣In PPH, single or double lung transplantation is reserved for
advanced cases in ideal candidates
➣Heart-lung transplantation is done for patients with a cardiac