Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 19 Rhythms
- 20 Basic haemodynamic support
- 21 Mechanical circulatory support
- 22 Systemic hypertension
- 23 Pulmonary hypertension
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
23 - Pulmonary hypertension
from 3.1 - CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- SECTION 3 System Management in Cardiothoracic Critical Care
- 3.1 CARDIOVASCULAR SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 19 Rhythms
- 20 Basic haemodynamic support
- 21 Mechanical circulatory support
- 22 Systemic hypertension
- 23 Pulmonary hypertension
- 3.2 RESPIRATORY SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.3 RENAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.4 HAEMATOLGY AND TRANSFUSION IN CARDIOTHORACIC CRITICAL CARE
- 3.5 GASTROINTESTINAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.6 IMMUNE SYSTEM AND INFECTION IN CARDIOTHORACIC CRITICAL CARE
- 3.7 ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- 3.8 NEUROLOGICAL SYSTEM IN CARDIOTHORACIC CRITICAL CARE
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
Pulmonary hypertension (PHT) can be associated with a variety of both pulmonary and extrapulmonary diseases. Acute PHT in critical care may often be secondary to conditions such as acute respiratory failure, left heart failure and pulmonary embolism, or due to decompensation of chronic PHT by concurrent pulmonary or cardiovascular disease. Patients with chronic PHT can also be admitted to critical care for the treatment of other conditions, or as part of their perioperative management. Some are admitted because they have benefited from a specific operation to treat the underlying pulmonary condition (lung transplantation, pulmonary endarterectomy).
Definition
Pulmonary arterial hypertension (PAH) is a term used to classify a variety of conditions that share in common an injury to the pulmonary vasculature that produces elevations in pulmonary arterial pressure. It is noteworthy that the definition of PHT has been the subject of heated debates for many years, and various numbers or indices have been proposed to define it.
It is now accepted that PHT can be defined as a sustained elevation of pulmonary arterial mean pressure to more than 25 mmHg at rest or 30 mmHg with exercise. It is defined as PAH if in addition the mean capillary wedge pressure and left ventricular end-diastolic pressure are less than 15 mmHg.
Clinically, PHTis a condition in which an increase in the right ventricular (RV) afterload leads to organ damage, either as a consequence of hypoxia or decreased blood flow. Treating PHT is ultimately taking care of the RV because it is the integrity of RV function, rather than the degree of vascular injury, that is the major determinant of symptoms and survival in PHT.
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- Core Topics in Cardiothoracic Critical Care , pp. 174 - 180Publisher: Cambridge University PressPrint publication year: 2008