Pulmonary%20arterial%20hypertension Management

Management

Monitoring

A sustained response is considered when treated patients continue in World Health Organization (WHO) functional class I or II with near-normal hemodynamics after several month of treatment

Prevention

General Care

Maintenance of Intravascular Volume

Near-normal intravascular volume is important in the long-term management of idiopathic pulmonary arterial hypertension (IPAH)
- Sodium-restricted (<2400 mg/day) diet, fluid restriction and judicious use of diuretics reduces volume overload in patients with pulmonary hypertension (PH) and right ventricular hypertension

Monitor renal function and blood biochemistry in patients to avoid hypokalemia and the effects of decreased intravascular volume leading to pre-renal failure

Hemoglobin (Hb) Levels

PAH patients are extremely sensitive to decreases in hemoglobin (Hb) levels
- Anemias should be promptly treated

Phlebotomies should be done if hematocrit (Hct) >65% in symptomatic patients (headache, poor concentration)

Concomitant Medications

Avoid drugs that interfere with oral anticoagulants or increase risk of GI bleeding
Empiric use of angiotensin-converting enzyme (ACE) inhibitors or beta-blockers should be discouraged as this may result in hypotension and right heart failure

Prevention of Infection

Due to potentially devastating effects of respiratory tract infection in patients with pulmonary hypertension, immunization with influenza and pneumococcal vaccine is warranted
Respiratory tract infection should be treated aggressively

Follow Up

Ensure compliance of patients to their follow-up schedule, especially those belonging to WHO FC I
Follow-up visit at 3-6 months and 6-12 months after initial follow-up is advised
Baseline measurements of the following should be established during the initial follow-up, and in all patients showing signs of worsening clinical status:
- Medical history
- WHO-FC
- ECG
- 6MWT/Brog dyspnea score
- Basic blood exams (eg CBC, INR, serum creatinine, sodium, potassium, AST/ALT, bilirubin, BNP/NT-proBNP)
- CPET
- Echocardiography
- Specific laboratory tests (eg TSH, troponin, uric acid, iron levels)
- Blood gas analysis
- Right heart catheterization (RHC)
Patient’s medical history and functional class should be assessed using ECG, 6MWT/Borg dyspnea score and basic laboratory exams (eg CBC, INR, serum creatinine, sodium, potassium, AST/ALT, bilirubin, BNP/NT-proBNP levels) every follow-up visit of 3-6 months
CPET, echocardiography, specific laboratory tests (eg TSH, troponin, uric acid, iron levels), blood gas analysis, and RHC should be added at 6-12 months follow-up visit
At 3-6 months after every treatment adjustment, repeat evaluation of the patient’s complete medical history, functional class, ECG, 6MWT, echocardiography, basic blood tests, blood gas analysis and RHC are recommended

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Multipathogen testing an essential part of Test-Target-Treat strategy for respiratory illnesses

Dr. Mohan Ravuru, Dr. Johnny Sinon, Assoc Prof. Nuntra Suwantarat, 16 Dec 2022

At a recent webinar, experts discussed the paradigm shift in respiratory illnesses and treatment practices as the COVID-19 pandemic transitions to an endemic phase. The late Dr Mohan Ravuru, Physician Researcher and former Asia Pacific Medical Director, Abbott, Dr Johnny Sinon, Senior Emergency Physician from Makati Medical Center, Philippines, and Associate Professor Nuntra Suwantarat, Infectious Disease Specialist, from Chulabhorn International College of Medicine, Thammasat University, Thailand, delivered informative presentations and engaged the audience through a stimulating panel discussion.

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