HIPERTENSIUNEA ARTERIALA PULMONARA (HTAP) CORDUL PULMONAR CRONIC (CPC) Profesor Miron BOGDAN As. Univ.

Mona Sara MITRACHE UMF Carol Davila B ! res"i S #ar Defini"ia HTAP $ %&a"e Dana Poin" '(() Clasifi!area HTAP $ *eni!e '((+, %&a"e Dana Poin" '(() Pa"o-ene.a HTAP$ -ene"i!a in HTAP Al-ori"# l &e &ia-nos"i! Tra"a#en" l HTAP CPC in BPOC Tra"a#en" l CPC Definitie / Evian$ *eni!e !onsens s 0'((+1 $ #PAP 2 '3 ## H- in re%a s 0PCP4 53 ## H-, P*R 2 + 61 $ #PAP 2 +( ## H- la efor"

Dana Poin" !onsens s 0'(()1 $ #PAP 7 '( 8 '3 ## H- 8 borderline PH $ #PAP 2 '3 ## H- 8PH manifesta $ n #ai e9is"a !ri"eri l la efor" Clasifi!area HTAP $ *ene"ia '((+, %&a"e Dana Poin" '(()

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Hipertensiunea Arteriala Pulmonara (HTAP) : I&io%a"i!a 0i PAH1 Ere&i"ara 0BMPR II, A:; 5<1 Dro- ri si "o9ine Aso!ia"a ! = $ >oli &e !ola-en $ HI* $ ?i%er"ensi nea %or"ala $ >oli !ar&ia!e !on-eni"ale $ ane#ia !roni!a ?e#oli"i!a $ s!?is"os"o#ia.a HTP %ersis"en"a a no $nas! " l i

5@. $ >oala veno$o!l .iva $ ?e#an-io#a"o.a !a%ilara % l#onara 2. Hipertensiunea din bo i e !ardia!e stan"i &isf n!"ie sis"oli!a &isf n!"ie &ias"oli!a

valv lare 3. Hipertensiunea din bolile respiratorii cu hipoxemie / BPOC / Boli in"ers"i"iale % l#onare / Sin&ro# l &e a%nee in so#n / Al"i" &ine / Hi%oven"ila"ia alveolara / Ano#alii &e &e.vol"are 4. HTAP postembolica 5. i!erse 0Sar!oi&o.a, ?is"io!i"o.a A, li#fan-io#a"o.a, !o#%resia vaselor % l#onare 0a&eno%a"ie, " #ora, fi>ro.a #e&ias"inala1, >oli "iroi&iene, >oli ! s"o!aB &e -li!o-en, >oala Ga !?er, "elean-ie!"a.ia ?e#ora-i!a ere&i"ara, ?e#o-lo>ino%a"ii, >oli #ielo%rolifera"ive, s%lene!"o#ie, e"!1 Pa"olo-ia Hi%er"ensi nii Ar"eriale P l#onare

"#A$%&%"A'(A )*'P&*PAT*#*+%"A A ,A$"-#*PAT%(% %. HTAP / Ar"erio%a"ie P l#onara ?i%er"ensiva $ ?i%er%la.ie in"i#ala $ ?i%er"rofie a #e&iei $ in-rosarea a&ven"i"iei

DISFUNCTIA ENDOTE:IA:A $ vaso&ila"a"ori si an"i%rolifera"ivi = %ros"a!i!line, NO $ vaso!ons"ri!"ori si %rolifera"ivi= en&o"?eline 0ET$51

Tro#>o.a 0 in si" , TEP1 ET es"e #e&ia"or C!?eie in HTAP HTAP Fa#iliala / /)P'0%% es"e n #e#>r al s %erfa#iliei re!e%"or l i TGF$> / # "a"ia /)P'2 i&en"ifi!a"a la D(E in HTAP fa#iliala %ene"ran"a re& sa (.' # "a"ia /)P'2 a fos" i&en"ifi!a"a la +(E &in asa .isele HTAP s%ora&i!e Trei pasi in ia1nosticul Hipertensiunii Arteriale Pulmonare

Si#pto#e e in HTAP HTAP: o boala cu e!olutie rapida (xamenul "linic (xamenul "linic Radio"rafia pu #onara Radio"rafia pu #onara '

Radio"rafia pu #onara (lectrocardio1rama (chocardio1rafia Hipertrofie !entriculara dreapta E$p orarea fun!tiona a respiratorie / S%iro#e"rie 8 De>i"e % l#onare / Ple"is#o-rafie 8 CPT, *R. e"! / Ca%a!i"a"ea &e &if .i ne 8 S!?i#> l &e -a.e %oa a tro#boe#bo i!a !roni!a Con&i"ii / Boala "ro#>oe#>oli!a !roni!a Tra"a#en" / Me&i!al 8 An"i!oa- lare 8 Fil"r vena !ava / C?ir r-i!al 8 Tro#>oen&ar"ere!"o#ie Ana i&e san"'ine To#o"rafia !o#puteri&ata Con&i"ii / Boli de parenchim pulmonar 8 Emfizem 8 Fibroza pulmonara / Emboli in vasele pulm 8 Angiograma / Adenopatii 8 Mediastin

Cateteris# !ardia! drept SE*ERITATEA BO:II C:ASA NFHA TEST DE MERS G MINUTE / Corela"iE INTRE TMGM si !lasa NFHA HEMODINAMICA TRATAMENTUL HTAP

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Tra"a#en" l !onven"ional 0la "o"i %a!ien"ii1

Tra"a#en" s%e!ifi! HTAP 0!ls III$I* NFHA1 T('AP%A "*.,(.T%*.A#A / :IMITAREA AGRESIUNI:OR
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:IMITAREA EFORTU:UI FIHIC In"er.i!erea sar!inii A"en"ie la in"erven"iile !? r r-i!ale 0%re!a "ii %rivin& anes"e.ia -enerala1 Hi%o9ia 0al"i" &ine 2 '((( #, avioane ne%res ri.a"e1 8 %o" a-rava vaso!ons"ri!"ia

ANTICOAGU:AREA ORA:A 0INR 7 '.($+.(1 "*.,(.T%*.A# TH('AP2 / DIURETICE $ s!a& ?i%ervole#ia $ in &e!o#%ensarea ins fi!ien"ei !ar&ia!e &re%"e $ na"ri re"i! I an"ial&os"eroni! 0 F rose#i& I S%ironola!"ona1 / OAIGENOTERAPIE $ &a!a e9is"a ?i%o9e#ie $ NU la %a!ien"ii ! s n" ri !ar&ia!e DIGITA:ICE 8 NU s n" "ili.a"e in HTAP DOBUTAMINA $ in ins fi!ien"a !ar&ia!a &rea%"a &e!o#%ensa"a $ neori in a&#in !on"in a iv in HTAP avansa"a

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STRATE(IA TERAPEUTICA IN HTAP) SCURT ISTORIC / 5J)( Tera%ie !onven"ionala 0 &oar #as ri s %or"ive1 / 5J)5 Trans%lan" !ar&io% l#onar / 5JJ' Do.e #ari &e >lo!an"i ai !analelor &e !al!i
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5JJG

Analo-i &e %ros"a-lan&ine I* 0E%o%ros"enol $ F:O:ANK1

'((( $ '((3 Analo-i &e %ros"a!i!line Tre%ros"inil 0SC,I*1 $ REMODU:INK Ilo%ros" 0in?ale&1 $ *ENTA*ISK Bera%ros" 0oral1 An"a-onis"i &e re!e%"or &e en&o"elina Bosen"an 0 TRAC:EERK1 Si"a9sen"an 0 THE:INK1, A#>risen"an 0*O:IBRISK1

In?i>i"ori &e fosfo&ies"era.a * Sil&enafil 0 RE*ATIOK1

Analo-i &e %ros"a!i!lina

A"T%-.(: !asodilatatie3 antia1re1ant3 scaderea proliferarii musculaturii netede CI= Boala veno o!l .iva 0e&e# % l#onar1 Efe!"e se! n&are = ?i%o"ensi ne, r s?, !efalee, &is!o#for" a>&o#inal, -rea"a Co#%li!a"ii = lo!ale ale a&#inis"rarii I* sa SC. A )%.%$T'A'(A A.A#*+%#*' ( P'*$TA+#A. %.( CORDUL PULMONAR CRONIC DE*INITIE / Cordul pulmonar cronic reprezinta o modificare a structurii si functiei ventricului drept ca urmare a unei boli respiratorii &iaree, & reri ososase,

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Hi%er"rofia ven"ri! lara &rea%"a 0H*D1 es"e #o&ifi!area %re&o#inen"a in !or& l % l#onar !roni!, in "i#% !e in !a. rile a! "e %re&o#ina &ila"a"ia. A"a" ?i%er"rofia !a" si &ila"a"is s n" re. l"a" l nei !res"eri a %resi nii in ven"ri! l i

&re%". I%o"e.a Clasi!a Hi%o9ia alveolara !roni!a *as! lo%a"ie P l#onara Hi%er"ensi ne P l#onara Cor& P l#onar De!es IN+ESTI(ATII / Speciale pt ventriculul drept: 8 Ventriculografia Isotopica 8 Scintigrafia Miocardica !haliu" !c# C$ASIFICA%EA C$I&ICA A C'%()$)I *)$M'&A% / :a"en" / Co#%ensa" / De!o#%ensa" TRATAMENTUL CORDULUI PULMONAR DIN %POC 5. Tra"a#en" s%e!ifi! al BPOC '. Di-i"ali!e +. Di re"i!e

L. An"i>io"i!e 3. O9i-eno"era%ie G. An"i!oa- lan"e D. An"iari"#i!e ). Trans%lan" % l#onar Trata#entu %POC / In!e"area f #a" l i / Bron?o&ila"a"oare 8 an"i!oliner-i!e 0>ro# ra &e i%ra"ro%i #, "io"ro%i # 1 8 >e"a ' a-onis"i &e l n-a & ra"a 0sal#e"erol, for#o"erol1 8 "eofilina re"ar& / Cor"i!os"eroi.i in?ala"ori 0 &a!a are !el % "in + e9a!er>ari in ' ani1 / *en"ila"ie Noninva.iva CPAPM BiPAP 0&a!a es"e ne!esarN !roni!N1

Di"ita i!e / De o>i!ei NU / Even" al la %a!ien"ii ! ins fi!ien"a *D aso!ia"a

/ Do.e #i!i 03$G !% &i-o9inMsa%"a#ana1 Diureti!e / Na"ri re"i!e an& an"ial&os"eroni!e / Evi"area &o.elor #ari

/ ris! al!alo.a ?i%o!lore#i!a 0a!!en" ea.a &e%ri#area !en"r l i res%ira"or1 Antibioti!e / Doar in e9a!er>ari Despre o$i"enoterapia !roni!a , / CEA MAI IMPORTANTA TERAPIE / e9"ra!"or O' / &e>i"= '$+ lM#in / 53$5G ?M.i / Res l"a"e= I#> na"a"irea !ali"a"ii vie"ii S!a&erea ra"ei &e #or"i s >i"e S!a&erea %ro-resiva a ra"ei &e a-ravare a HTP 0 !or& l % l#onar1 Pro>a>il !res"e s %ravie" irea Anti!oa"u ante Da!a se s s%e!"e.a "ro#>o.a venoasa %rof n&a sa a-ravare &a"ori"a nor "ro#>o.e in si" Antiarit#i!e / ari"#ie si#%"o#a"i!a
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Tra"a#en" %rofila!"i! la %a!ien"ii ! ari"#ii s %raven"ri! lare re! ren"e

/ %ro%afenon, a#io&aron, vera%a#il TRANSPLANT PULMONAR / Rar in BPOC / Mor"ali"a"e #are 0s %ravie" ire 3 ani $ L(E1 Terapie spe!ifi!a a HTAP Hi%er"ensi nea % l#onara &in BPOC / Es"e in -eneral soara sa #o&era"a 0#PAP 4 +( ##H-1 / es"e #arOer &e severi"a"e a >olii res%ira"orii / NU ne!esi"a "ra"a#en" s%e!ifi!0e9!e%"an& o9i-eno"era%ia1 DOAR in Hi%er"ensi nea P l#onara severa 0&is%ro%or"iona"a1