Internal Medicine

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

1248 Pulmonary Hypertension

contribution such as an intracardiac shunt, congenital heart dis-

ease, or an impaired RV

■Experimental treatments

➣Newer agents being tested include subcutaneous esoprostenol

and oral endothelin receptor antagonists

Side Effects & Contraindications

■Vasodilators (oral)

➣Side effects: systemic hypotension, oxygen desaturation, or

➣increased cardiac output which may lead to increased right heart

failure

➣Contraindications (relative): SBP <90 mm Hg,

■Esoprostenol

➣Side effects: nausea, headache, flushing, diarrhea, jaw claudica-

tion, joint pain, catheter related infection

➣Contraindications (absolute): pulmonary veno-occlusive dis-

ease

➣Contraindications (relative): thrombocytopenia

follow-up

During Therapy

■With vasodilators and esoprostenol

➣Monitor for changes in pulmonary artery pressure, cardiac out-

put, systemic BP, and oxygen saturation and symptoms.

➣Drugs need gradual up titration to achieve hemodynamic

effect

Routine

■Esoprostenol dose must be gradually titrated upwards every 4–6

weeks as patients develop tolerance for the drug

complications and prognosis

Complications

■Right heart failure (63%)

■Hypoxemia and pneumonia

■Sudden death- usually due to arrhythmias

Prognosis

■Severe progressive symptoms in most patients

■1 year survival 64%

■3 year survival 48%