Pulmonary Hypertension: “You Take My Breath Away”
Pulmonary hypertension is a disease process affecting the pulmonary vasculature and right heart with a high morbidity and mortality. Increases in pulmonary vasculature pressures cause both diastolic and systolic dysfunction of the right ventricle. The resulting preload-dependent output of the right ventricle makes patients sensitive to small fluid losses. The dilation of the right ventricle also causes increases in fluid volume to overstretch the right ventricle and reduce contractility. As a result, pulmonary hypertension patients live within a narrow margin of fluid balance. To aid right heart function many patients are continuously infused medication to reduce pulmonary resistance and right ventricle afterload. However, this also comes with complications, especially when there is an abrupt failure in the delivery of these medications. Overall, these are difficult patients to manage during acute episodes of decompensation due to their marginal cardiac function, hypersensitivity to changes in volume status, and limited usefulness of many exam findings or tests used to assess volume status.
KeywordsPulmonary hypertension Right heart failure Respiratory distress Cardiac emergencies Pulmonary emergencies Critical care Emergency medicine Ultrasound
The authors of this chapter report no significant disclosures.
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