Pulmonary Arterial HTN Flashcards
what is the normal PA pressure
PAP 8-20
what is used to dx PAH
right heart catheterization with a vasoreactive test using NO, epoprostenol or adenosine
what are the different causes of PAH
group 1: idiopathic or genetic
group 2: 2/2 left heart disease
group 3: 2/2 lung disease or hypoxia
group 4: 2/2 chronic thromboembolic pulmonary HTN (CTEPH)
what drugs cause PAH
cocaine
stimulants
SSRI in pregnancy –> PPHN
weight loss drugs (phentermine)
what is the overall patho behind PAH
increase vasoconstriction (TXA2, endothelin-1)
decreased vasodilation (prostacyclins)
non-pharm recommendations for PAH
salt <2.4g a day
no NSAIDs
influenza and pneumococcal vaccines
avoid high altitudes
O2 >90%
what can be used to treat volume overload in PAH
loops
what can be used to treat low CO and afib in PAH
digoxin
what can be used to treat clot risk in PAH
warfarin preferred
all patients with a PAH dx should be
referred to a PAH specialty care center
what is the first line tx option for patients whose R heart cath testing showed an mPAP decrease by 10mmHg to an absolute value of <40mmHg (|40mmHg|)
CCB!
LA nifedipine
amlodipine
diltiazem
why is verapamil not recommended in PAH treatment
contractility properties too strong
what are the treatment options for patients whose R heart cath testing showed an mPAP decrease that was still 40mmHg +
1-2 of the following…
prostacyclin analogues
endothelin-1 R antagonists
PDE5-i (sildenafil and tadalafil)
Riociguat
what are the prostacyclin analogues recommended in PAH non responsive to vasoreactive testing?
Epoprostenol (Flolan)
Treprostinil (Remodium)
prostacyclin analogues
SE
CI
SE - bleed risk due to plt aggregation inhibition, hypotension
CI in HFrEF!!!!!