Pulmonary Hypertension Secondary to COPD

The development of pulmonary hypertension in COPD adversely affects survival and exercise capacity and is associated with an increased risk of severe acute exacerbations. Unfortunately not all patients with COPD who meet criteria for long term oxygen therapy benefit from it. Even in those who benefit from long term oxygen therapy, such therapy may reverse the elevated pulmonary artery pressure but cannot normalize it. Moreover, the recent discovery of the key roles of endothelial dysfunction and inflammation in the pathogenesis of PH provides the rationale for considering specific pulmonary vasodilators that also possess antiproliferative properties and statins

Echocardiographic Findings and Their Impact on Outcomes of Critically Ill Patients with AIDS in the Era of HAART

Objective. To describe the echocardiographic findings in critically ill patients with AIDS and their impact on clinical outcome. Design. A retrospective chart review of consecutive AIDS patients over 18 years of age, who had a trans-thoracic echocardiogram performed during the course of intensive care unit stay over the course of 2 years at a tertiary care hospital. Main outcome measures. The prevalence of echocardiogram abnormalities in this population and its impact on ICU mortality, ICU length of stay, hospital mortality, hospital length of stay and 60 day survival. Results. Among 107 patients who met the inclusion criteria, an admission echocardiogram was performed in 62 (58%). The prevalence of cardiac abnormalities was 60%. The most common admission diagnosis was respiratory failure n = 27 (43%). The most common finding on echocardiogram was left ventricular (LV) dysfunction n = 31 (50%) followed by pulmonary hypertension n = 25 (40%). None of these findings had a significant impact on clinical outcomes. There was trend toward reduced 60 day survival among patients with depressed LV function. Conclusions. Although echocardiogram abnormalities were prevalent among this population none of these findings had a significant impact on ICU mortality or hospital mortality and ICU length of stay or hospital length of stay

Pulmonary Hypertension Secondary to COPD

The development of pulmonary hypertension in COPD adversely affects survival and exercise capacity and is associated with an increased risk of severe acute exacerbations. Unfortunately not all patients with COPD who meet criteria for long term oxygen therapy benefit from it. Even in those who benefit from long term oxygen therapy, such therapy may reverse the elevated pulmonary artery pressure but cannot normalize it. Moreover, the recent discovery of the key roles of endothelial dysfunction and inflammation in the pathogenesis of PH provides the rationale for considering specific pulmonary vasodilators that also possess antiproliferative properties and statins

Optimization of Preload in Severe Sepsis and Septic Shock

In sepsis both under- and overresuscitation are associated with increased morbidity and mortality. Moreover, sepsis can be complicated by myocardial dysfunction, and only half of the critically ill patients exhibit preload responsiveness. It is of paramount importance to accurately, safely, and rapidly determine and optimize preload during resuscitation. Traditional methods of determining preload based on measurement of pressure in a heart chamber or volume of a heart chamber (“static” parameters) are inaccurate and should be abandoned in favor of determining preload responsiveness by using one of the “dynamic parameters” based on respiratory variation in the venous or arterial circulation or based on change in stroke volume in response to an endogenous or exogenous volume challenge. The recent development and validation of a number of noninvasive technologies now allow us to optimize preload in an accurate, safe, rapid and, cost-effective manner

An unusual cause of pulmonary artery hypertension in a patient with chronic obstructive airway disease

AbstractPulmonary artery hypertension is a common entity in patients with obstructive airway disease mostly associated with chronic hypoxia. Presence of pulmonary artery hypertension can add to the respiratory distress patients experience during the clinical course of the disease. This is a case of a 55 year old man with severe chronic obstructive pulmonary disease with the alternative diagnosis of anomalous pulmonary venous return as a cause of pulmonary hypertension and persistent dyspnoea. This alternative etiology can lead to unsatisfactory results inspite of optimal treatment and therefore needs to be addressed individually

Mounier-Kuhn syndrome masquerading as obstructive lung disease

AbstractChronic obstructive pulmonary disease (COPD) is present in 10.1% of the population and is the fourth leading cause of death in the United States while the prevalence of asthma in adults is 6.7%.1 Patients presenting to primary care offices with lower respiratory tract symptoms like dyspnea and wheezing are often diagnosed with COPD or asthma and started on treatment. There are uncommon conditions like Mounier-Kuhn syndrome (MKS) that can present with similar symptoms and it is important for the primary care physician to keep them in mind when evaluating patients. It is important to identify MKS, as early recognition can lead to better management and prevention of complications. We describe a case of an older gentleman with recurrent symptoms of shortness of breath and intermittent spells of productive sputum who was misdiagnosed with COPD for years. Our diagnosis was supported by a clinical history and confirmed by radiographic evidence

Optimization of Preload in Severe Sepsis and Septic Shock

In sepsis both under-and overresuscitation are associated with increased morbidity and mortality. Moreover, sepsis can be complicated by myocardial dysfunction, and only half of the critically ill patients exhibit preload responsiveness. It is of paramount importance to accurately, safely, and rapidly determine and optimize preload during resuscitation. Traditional methods of determining preload based on measurement of pressure in a heart chamber or volume of a heart chamber ("static" parameters) are inaccurate and should be abandoned in favor of determining preload responsiveness by using one of the "dynamic parameters" based on respiratory variation in the venous or arterial circulation or based on change in stroke volume in response to an endogenous or exogenous volume challenge. The recent development and validation of a number of noninvasive technologies now allow us to optimize preload in an accurate, safe, rapid and, cost-effective manner

Assessment of Pulmonary Arterial Hypertension by Magnetic Resonance Imaging

Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary artery pressure (PAP), altered pulmonary artery (PA) hemodynamics, and vessel wall characteristics that affect the right ventricular (RV) function. Magnetic resonance imaging (MRI) has recently been considered in PAH and has shown promising results for estimating PAP, measuring PA hemodynamic parameters, assessing PA vessel wall stiffness, and evaluating RV global and regional functions. In this article, we review various MRI techniques and image analysis methods for evaluating PAH, with an emphasis on the resulting images and how they are interpreted for both qualitatively and quantitatively assessing the PA and RV conditions