Advances in PH Journal
Evaluation and Management of PH and Right Heart Dysfunction in the ICU, 2015, Winter 2015 (Vol 13, No 4)
- 2015 (Vol 13, No 4): Table of Contents
- Right Ventricular Metabolism: A Brief Review
The primary function of the right ventricle (RV) is to receive systemic venous return and pump it into the normally low-pressure, highly distensible pulmonary arterial system. Compared to the left ventricle (LV), the RV is thinner with less mass, has 2 layers of muscles rather than 3, and has a bellow shape rather than an ellipsoid shape.
- Pathophysiologic Principles in the Management of Severe PAH
In the face of tremendous advances in our understanding of the pathophysiology and new treatment options, for many patients, pulmonary arterial hypertension (PAH) remains a progressive condition.
- Sepsis and Pulmonary Arterial Hypertension in the ICU
The management of sepsis in the patient with pulmonary arterial hypertension (PAH) is dependent on 2 primary principles: 1) optimizing right ventricular (RV) function, and 2) reducing pulmonary vascular resistance. In this review, we will discuss the major challenges that health care provider face in trying to achieve these goals.
- PHPN: Meeting the Challenge of Hospitalized PAH Patients Receiving IV Prostacyclins
In this PHPN column, we invited members from around the country to share their experiences and tips on several aspects of dealing with PAH patients in the hospital setting, particularly related to infusion pumps. Former section editor Martha Kingman, DNP, FNP-C, University of Texas Southwestern Medical Center at Dallas, provides valuable insight as an introduction to the topic.
- News to Use
PHA Resources Notepad, a Tom Lantos Community Service Project. These notepads were made so it is easier for you to tell patients about the resources the Pulmonary Hypertension Association has to offer. Intended to be used as part of a discharge packet, circle the parts of PHA's website you are "prescribing" for your patient. Created by the Generation Hope Advisory Board and funded by the Tom Lantos Innovation in Community Service Award.
- Pulmonary Hypertension Care Centers: Hope for the Future From a Patient's and Caregiver's Perspectives
In 1987, after three years of being treated aggressively for asthma and then a prolapsed mitral valve, I was finally diagnosed with primary pulmonary hypertention (PPH). I was told I would be lucky if I lived 2 years without having a heart/double lung transplant and that I didn't have much time to get my affairs in order. There were fewer than 200 patients in the United States at the time. There were no treatment centers, support groups, or even an advocacy group like PHA. I struggled with the loneliness of this diagnosis and the lack of information available.
- Management of Right Ventricular Failure in Acute Pulmonary Embolism
The management of acute right ventricular (RV) failure in acute pulmonary embolism (PE) differs from RV failure in chronic forms of pulmonary hypertension (PH) such as PAH. In PE, RV failure generally occurs suddenly and there is far less ability to acutely compensate.
- Interventional Therapies for Right Ventricular Failure Secondary to Precapillary Pulmonary Hypertension
Patients with pulmonary hypertension that progress to acute decompensation present high mortality rates. The main mechanism of death in this population is right ventricular failure. Once this scenario becomes refractory to optimized medical therapies, mechanical support is increasingly considered as either a bridge to recovery or, most often, as a bridge to definitive surgical treatment (such as lung transplantation, surgical embolectomy, or pulmonary endarterectomy).
- Pulmonary Hypertension Roundtable: Pulmonary Hypertension and Right Heart Failure in the ICU: Tackling Difficult Issues
A group of thought leaders in management of pulmonary hypertension gathered by phone on January 27, 2015 to discuss their approach to difficult issues encountered with PAH and RV-failure patients are in the ICU.
- ICUs, PAH, RV Dysfunction, and More …
Despite major advances in the evaluation and management of pulmonary arterial hypertension (PAH), this disease continues to be a challenge to clinicians caring for these patients, both in PH centers as well as in the community.
- Editor's Memo
The appreciation of the right ventricle (RV) can be traced to the work of William Harvey with his landmark publication Exercitatio Anatomica de Motu Cordis et sanguinis in Animabilus in 1628, in which based on observations and experiments, Harvey had the incredible insight to differentiate the functions of the two ventricles when he stated: “So it appears that whereas one ventricle, the left, suffices for distributing the blood to the body and drawing it from the vena cava, as is the case in all animals lacking lungs, nature was compelled when she wished to filter blood through the lungs to add the right ventricle. Thus the right ventricle may be said to be made for the
sake of transmitting blood through the lungs, not for nourishing them.”