Table 1 Etiologies of pulmonary hypertension (PH) and precipitants of acute right heart failure
From: Pulmonary Hypertension in an Oncologic Intensive Care Unit
| Â | General PH | Oncologic-related PH |
|---|---|---|
Cardiac | • Acute LV failure (systolic, diastolic) • LV ischemia or infarction • RV ischemia or infarction • Arrhythmias (SVT or VT) • Congenital heart disease (e.g., ASD, VSD, Ebstein’s anomaly) • Valvulopathies (TR, pulmonary valve stenosis) • Cardiomyopathies including infiltrative disorders • Myocarditis or other inflammatory disorders • Pericardial disease (tamponade, constrictive pericarditis) | • Amyloidosis • Carcinoid heart disease • Cardiac tumors • Radiation therapy • SVC syndrome • Anthracyclines (doxorubicin, epirubicin, idarubicin) • Anthraquinone (mitoxantrone) • Alkylating agents (cyclophosphamide, ifosfamide) • Taxanes (docetaxel) • Tyrosine kinase inhibitors (monoclonal antibody, trastuzumab, bevacizumab; small molecules, sunitinib, dasatinib, imatinib, lapatinib; antimetabolites, clofarabine; proteasome inhibitor, bortezomib) |
Endocrine | • Thyrotoxicosis • Pregnancy | • Thyroid cancer • Immunotherapy |
Hematologic | • Acute chest syndrome in sickle cell disease • Beriberi syndrome • Anemia | • Chronic myeloproliferative disorders (PAH, CTEPH) • Multiple myeloma |
Infection | • Systemic inflammatory states and sepsis | • Cancer patients susceptible due to immunosuppression |
Surgery | • Cardiac surgery (e.g., cardiac transplant or LVAD implantation, CAB, valvular) • Noncardiac surgery (e.g., abdominal, vascular) | • Surgery involving tumors around and in the pulmonary circulation and lung resection |
Pulmonary | • ARDS • Acute pulmonary embolism • Hypoxic pulmonary vasoconstriction related to parenchymal lung injury (pneumonia) • Mechanical ventilation • Exacerbation of lung disease (COPD, ILD, bronchiectasis) • Withdrawal of chronic PH therapy  • PH (WHO groups 1–5)  • Group 1, pulmonary arterial hypertension (PAH)  – Group 1, PVOD and/or PCH  • Group 2, PH due to left heart disease  • Group 3, PH due to lung disease and/or hypoxia including OSA/OHS  • Group 4, chronic thromboembolic pulmonary hypertension (CTEPH)  • Group 5, pulmonary hypertension with unclear multifactorial mechanisms | • Pneumonitis from drugs • Radiation injury (acute and chronic) • Pulmonary emboli • PAH (tyrosine kinase inhibitors, chronic myeloproliferative disease) • CTEPH • Pulmonary circulation tumors (pulmonary artery sarcoma, pulmonary vein sarcoma) • Fibrosing mediastinitis (radiation, fungal infection) • Tumor emboli (adenocarcinoma) • PVOD |