Pulmonary arterial hypertension diagnosed during pregnancy – echocardiography as a tool for management

Introduction: Despite advanced therapies for pulmonary arterial hypertension (PAH), maternal mortality in women with PAH and their offspring remains high (30-56% and 11-28%) and is especially high during the post-partum period1,2. Case report: 39-years-old woman was presented in 24th week of pregnancy with moderate dyspnea and cyanosis without peripheral edema. ECG showed right ventricular strain and NT-proBNP was 1300 ng/L. Echocardiogram showed severe precapillary pulmonary hypertension with systolic pulmonary pressure (PAP) 103 mmHg, reduced stroke volume (SVI 29 ml/m2), normal cardiac output (CI 2.6 L/min/m2) and mildly reduced systolic function of the right ventricle (FAC 30%, PMI TDI 0.8) with normal central venous pressure (CVP) 3 mmHg. Right heart catheterization confirmed echocardiographic hemodynamic measurements (mean pulmonary pressure 61 mmHg, pulmonary vascular resistance (PVR) 9.4 WU) and the vasoreactivity test was negative. Epoprostenol was initiated, titrated up to 22 ng/kg/min and on 30th week planned caesarean section was performed with NO inhalations, noradrenalin and dobutamine. Fortunately, standby supportive therapy - ECMO and high urgency lung transplantation, was not needed. The baby did well. The patient was extubated on the same day and sildenafil was added. The patient was discharged after 4 weeks. After 2 months epoprostenol was switched to treprostinil up to 26 ng/kg/min and macitentan was added. NT-proBNP stabilized at 170 ng/L. Echocardiography was performed weekly to monitor CI, CVP and right systolic function indexes. Favorable echocardiographic dynamics after therapy were observed: mean PAP 60 mmHg to 45-50 mmHg, PVR from 10 WU to 7 WU, stroke volume normalized and CVP remained normal. However, right ventricular systolic function improved but did not normalize (Table 1). In conclusion, with complete echocardiographic hemodynamic assessment and thorough clinical assessment high-risk pregnancies in patients with severe PAH can be managed. In addition, FAC, MPI TDI, 3D ejection fraction and RV free strain better assess right ventricular systolic function than TAPSE

Relational Family Therapy in the Treatment of Sudden Cardiac Arrest Survivors and their Relatives

Sudden cardiac arrest is the most common single cause of death in the contemporary world, but the proportion of survivors is increasing thanks to modern intensive methods of hospital treatment. However, data show that survivors experience high rates of neurological and cognitive deficits and poorer emotional well-being, which is a major challenge in treating these individuals and encouraging their integration in everyday life. These issues range from a number of emotional problems, such as anxiety and depression, to lower levels of participation in social life and a low rate of return to their workplace. The need for security and support increases because of the feelings of insecurity, vulnerability and fear of the recurrence of symptoms. Relatives/caregivers who report emotional problems and a higher level of post-traumatic stress are physically and mentally burdened, too. Hence, sudden cardiac arrest is a life-threatening event which is traumatic for survivors and their close relatives. It triggers strong emotional responses that are characteristic of all types of trauma (reliving the trauma, avoidance, negative thoughts and mood, increased agitation). People who have survived trauma thus suffer long-term effects, which are reflected in various dysfunctional behaviours and activities due to inadequate regulation of affective states. Because of these issues, there is a need for effective interventions that can psychologically help patients and relatives after surviving sudden cardiac arrest. In this paper, we will present the model of Relational Family Therapy, which can enable survivors and their relatives to appropriately emotionally-affectively process this experience and thus more appropriately integrate into a new way of life. With the qualitative research method of task analysis, we will show the process of change, which is based on the establishment of a new regulation of affect and allows in-depth processing of difficult emotional states after this event.Sudden cardiac arrest is the most common single cause of death in the contemporary world, but the proportion of survivors is increasing thanks to modern intensive methods of hospital treatment. However, data show that survivors experience high rates of neurological and cognitive deficits and poorer emotional well-being, which is a major challenge in treating these individuals and encouraging their integration in everyday life. These issues range from a number of emotional problems, such as anxiety and depression, to lower levels of participation in social life and a low rate of return to their workplace. The need for security and support increases because of the feelings of insecurity, vulnerability and fear of the recurrence of symptoms. Relatives/caregivers who report emotional problems and a higher level of post-traumatic stress are physically and mentally burdened, too. Hence, sudden cardiac arrest is a life-threatening event which is traumatic for survivors and their close relatives. It triggers strong emotional responses that are characteristic of all types of trauma (reliving the trauma, avoidance, negative thoughts and mood, increased agitation). People who have survived trauma thus suffer long-term effects, which are reflected in various dysfunctional behaviours and activities due to inadequate regulation of affective states. Because of these issues, there is a need for effective interventions that can psychologically help patients and relatives after surviving sudden cardiac arrest. In this paper, we will present the model of Relational Family Therapy, which can enable survivors and their relatives to appropriately emotionally-affectively process this experience and thus more appropriately integrate into a new way of life. With the qualitative research method of task analysis, we will show the process of change, which is based on the establishment of a new regulation of affect and allows in-depth processing of difficult emotional states after this event

Relational Family Therapy in the Treatment of Sudden Cardiac Arrest Survivors and their Relatives

Sudden cardiac arrest is the most common single cause of death in the contemporary world, but the proportion of survivors is increasing thanks to modern intensive methods of hospital treatment. However, data show that survivors experience high rates of neurological and cognitive deficits and poorer emotional well-being, which is a major challenge in treating these individuals and encouraging their integration in everyday life. These issues range from a number of emotional problems, such as anxiety and depression, to lower levels of participation in social life and a low rate of return to their workplace. The need for security and support increases because of the feelings of insecurity, vulnerability and fear of the recurrence of symptoms. Relatives/caregivers who report emotional problems and a higher level of post-traumatic stress are physically and mentally burdened, too. Hence, sudden cardiac arrest is a life-threatening event which is traumatic for survivors and their close relatives. It triggers strong emotional responses that are characteristic of all types of trauma (reliving the trauma, avoidance, negative thoughts and mood, increased agitation). People who have survived trauma thus suffer long-term effects, which are reflected in various dysfunctional behaviours and activities due to inadequate regulation of affective states. Because of these issues, there is a need for effective interventions that can psychologically help patients and relatives after surviving sudden cardiac arrest. In this paper, we will present the model of Relational Family Therapy, which can enable survivors and their relatives to appropriately emotionally-affectively process this experience and thus more appropriately integrate into a new way of life. With the qualitative research method of task analysis, we will show the process of change, which is based on the establishment of a new regulation of affect and allows in-depth processing of difficult emotional states after this event