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CIRCULATIA
PULMONARA NORMALA
.-oxigenareHb
.-filtru(particule,bacterii)
.-eliminareaCO2echilibruacido-bazic
CIRCULATIA CIRCULATIA
PULMONARABRONSICA
a. pulmonaraa. bronsice
CapilareCapilare
PLAMANUL
CIRCULATIA BRONSICA
-bronsiectazii
-fibroza chistica
-boli congenitale
cardio-vasculare
HIPERTENSIUNEA
PULMONARA (HTP)
NORMAL
NORMAL
-diast. 6-10 mm Hg
-medie 12-16 mm Hg
-diast. > 15 mm Hg
HIPERTENSIUNEA
PULMONARA (HTP)
REACTIVITATEA
VASCULARA PULMONARA
HIPOXIA CRONICA
VASOCONSTRICTIE
Hipoxia
Acidoza
Prostaglandine F2asi A2
HISTAMINA H1
SEROTONINA ?
ANGIOTENSINA A2
ALTITUDINE
VASODILATATIE
Alcaloza
PROSTAGLANDINE I2si E
BLOCANTI a
STIMULARE (ISOPROTERENOL)
ACETILCOLINA (prin
EDRF)
INDOMETACINcreste rezistentapulmonara
La 10 000 m altitudine
1.HTP arteriala
1.1. Idiopatica
1.2. Ereditara
1.4. Asociatacu:
Bolide colagen
HIV
Hipertensiuneportala
Bolicardiacecongenitale
Schistosomiaza
Anemiehemoliticacronica
1 Boalavenoocluzivapulmonarasi/sauhemangiomatozacapilarapulmonara
2. HTP prinsuferintaventricululuistang
2.1. Disfunctiesistolica
2.2. Disfunctiediastolica
2.3. Bolivalvulare
3. HTP prinbolipulmonaresauhipoxie
3.1. BPOC
3.2. Boliinterstitiale
4. HTP printromboembolism
5. HTP prinfactorimultiplineclari
CATEVA MECANISME
FIZIOPATOLOGICE
In suferintainimiistangi
CATEVA MECANISME
FIZIOPATOLOGICE
MODIFICARI ANATOMICE
Test
Notable Findings
Chest x-ray
Electrocardiography
Right axis deviation and precordial T wave abnormalities are early signs.
Echocardiography
Contrast echocardiography
Doppler echocardiography
Exercise testing
This is very helpful to assess the efficacy of therapy. Severe exerciseinduced hypoxemia should cause consideration of a right-to-left shunt.
SINDROM
EISENMENGER
.Toatesunturilesistemico-pulmonarerezultanddin
maridefectecare ducla cresteride presiunein VD sila inversareasuntului(pulmonarsistemic) sausuntbidirectional cu: cianoza, eritrocitozasimultiple
suferintede organ
Eisenmenger syndrome
MODIFICARI ANATOMICE
Rx nHTP
Normal
Gravitatie
-presiune
.Creste Fvenos
HTP arteriala
-vasoconstrictie periferica
-vasospasm
Rx
Rx nHTP
Rx nHTP
P venoasa > 8 12 mm Hg
P venoasa > 25 mm Hg
.Edem pulmonar
Rx nHTP
Mecanisme
.Presiunea interstitiala .
.Complianta pulmonara .
.Spasm arterial
HTPIDIOPATICA
ETIOLOGIE
HTPIDIOPATICA
MODIFICARI HISTOLOGICE
Distrugeri de endoteliu
Tromboza
Leziuni plexiforme
HTPIDIOPATICA
HTPIDIOPATICA
ASPECTE CLINICE
.Femei tinere
4 simptome principale
.Dispnee de efort
.Accentuarea zgomotului II
.Modificari Rx cardiomegalie
-HAD
Mai rar:
-Edeme
-Fenomene Raynaud
PROGNOSTIC
MOARTEA
DUREREA TORACICA
.Ischemia subendocardului VD
.Distensia a pulmonare
HTPIDIOPATICA
SEMNE CLINICE
HTPIDIOPATICA
HTPIDIOPATICA
CTFa pulmonare
ECHOCARDIOGRAFIA
Ingrosarea septului
HTPIDIOPATICA
SCINTIGRAFIA PULMONARA-normala
.RISCANTE
.Presiunea in VD egala sau chiar mai mare decit presiunea sistemica
.Rezistenta vasculara pulmonara depaseste uneori pe cea sistemica
.Uneori foramen ovale este patent
.Presiunile stg. sunt normale sau mici, dar uneori greu de determinat
BIOPSIA PULMONARA
HTPIDIOPATICA
DIAGNOSTIC DIFERENTIAL
TESTUL
VASODILATATOR
PROGNOSTICUL
Factori de prognostic:
Sincopa
Hemoptizie
Test de vasodilatatienegativ
TRATAMENTUL
MEDICAL
1. Anticoagulantele
2. Oxigenoterapia
-Diuretice
4. Tratamentul vasodilatator
PAD > 10 mm Hg
TRATAMENTUL
MEDICAL
Responders: Ca.-blockers
.(if bradicardic)
Nifedipine:120 -240 mg
.(if tahicardic)
Diltiazem240-720 mg
TRATAMENTUL
MEDICAL(PG)
TRATAMENTUL
MEDICAL
Indicatii
TRATAMENTUL
MEDICAL(PG)
Efecte adverse:
Preparate folosite:
TRATAMENTUL
MEDICAL(PG)
TRATAMENTUL
MEDICAL(PG)
Prostanoid analogues
Epoprostenol
>100.000 $ /year
Treprostenil
and inhalatoryadm.(6-9 d )
Beraprost
Iloprost
(20-40 microg/d.)
TRATAMENTUL
MEDICAL(ARE)
Type A receptor:
( vasodilation )
activates aldosterone,
thromboxane, norepinephrine.
( vasoconstriction )
BREATHE-3 (children )
EARLY
Sitaxsentan
Warfarineinterference
TRATAMENTUL
MEDICAL(IFD)
7.Inhibitoride fosfodiesteraza(Sildenafil)
Phosphodiesteraseinhibitors
Sildenafil ( REVATIO )
25 mg t.i.d.
Available in Romania
25 mg t.i.d.
Available in Romania
.Tadalafil( Cialis )
Circulation. 2004;110:3149-3155
vardenafil),
TRATAMENTE
CHIRURGICALE
.Trombendarterectomie
.Transplantpulmonar
TRATAMENTE
CHIRURGICALE
Indicatiitransplant
Raspuns +
Raspuns -
IC > 2,1
IC < 2,1
Blocanti de Ca
Nu raspund la tratament
Prostaglandine
+/-transplant
Frequently asked
questions
Frequently asked
questions
BREATHE -2
CONCLUSIONS
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