Pulmonary Hypertension in William Hopkins, MD, FACC, FACP University of Vermont College of Medicine
|
|
|
- Letitia Tucker
- 7 years ago
- Views:
Transcription
1 Pulmonary Hypertension in 2013 RV William Hopkins, MD, FACC, FACP University of Vermont College of Medicine
2 Disclosures Merck Actelion 2
3 Case 1 61 year-old woman with severe dyspnea Doppler: severe pulmonary hypertension (PA systolic > 70 mmhg) RV RV
4 Case 1 Before and After 61 year-old woman with severe dyspnea Doppler: severe pulmonary hypertension (PA systolic > 70 mmhg) RV RV Baseline Treatment x 4 months
5 Pulmonary Hypertension Definition 4 th th World Symposium (Dana Point 2008) Normal PA pressure: mean 20 mmhg at rest Borderline elevated PA pressure: mean mmhg at rest Pulmonary hypertension: mean 25 mmhg at rest What do I tell patients? Pulmonary hypertension is high blood pressure of the blood vessels of the lungs!! *Pulmonary Hypertension* 5 th World Symposium Nice, France
6 Pulmonary Hypertension Symptoms *** Shortness of breath *** *Decreased CO Pleural effusions Fatigue Weakness Angina Syncope Abdominal distension Edema 6
7 Pulmonary Hypertension Clinical Approach Primary vs Secondary It doesn t t work anymore!!
8 World Health Organization Classification of Pulmonary Hypertension
9 WHO Group 1 Pulmonary Arterial Hypertension Small arteries and arterioles Idiopathic (IPAH formerly PPH) Heritable (Familial) Drug and toxin induced Anorexigens/methamph/amph/cocaine Associated with (APAH): Connective tissue diseases (scleroderma) Congenital heart disease Liver disease (portopulmonary hypertension) HIV infection (0.5-1% incidence) Schistsomiasis The Same 9
10 WHO Group 1 PAH Deadly Disease Survival (%) HIV Liver Scleroderma Non Group 1: HF, IPF, CTEPH Time (years) IPAH (PPH) mean age 35 yrs Mayo , n=120 NIH , n=194 Hopkins et al , n=57 Modified from: Hopkins et al. J Heart Lung Transplant 1996;15:100 5 Hopkins W. Coronary Artery Disease 2005, 16:19 25.
11 Kaplan-Meier Survival Estimates in Scleroderma By Organ Involvement Percent Survival None Lung Involvement (without PH) PAH Years from Diagnosis of Pulmonary Hypertension Koh et al. Brit J Rheumatol 1996;35:
12 Systolic CHF and Pulmonary Hypertension Chin and Rubin. J Am Coll Cardiol 2008;51: Copyright 2008 American College of Cardiology Foundation. Restrictions may apply.
13 Pathophysiology and Pathogenesis of PAH 1. Nitric oxide 2. Prostacyclin (PGI 2 ) 3. Endothelin The net result is: Vasoconstriction *Cell proliferation* McLaughlin V and McGoon M. 13 Circulation 2006;114:
14 Pulmonary Arterial Hypertension Advanced Medical Therapy Prostanoid Analogues Epoprostenol (Flolan - IV or inhaled; Veletri - IV) Treprostinil (Remodulin - IV, SQ; Tyvaso - Inhaled) Iloprost (Ventavis inhaled) Endothelin Receptor Antagonists (ERA) Bosentan (Tracleer - oral) Ambrisentan (Letairis - oral) Macitentan (Opsumit - oral) Nitric oxide guanylate cyclase cgmp pathway PDE 5 inhibitors Sildenafil (Revatio oral) (IV sildenafil available) Tadalafil (Adcirca oral) Soluble guanylate cyclase stimulators Riociguat (Adempas; oral) WHO Group 1 PAH WHO Group 1 PAH WHO group 4 CTEPH (Non-operative operative or post-operative) operative) 14
15 Treatment of PAH Why PDE-5 5 inhibitors or soluble guanylate cyclase stimulators? Ghofrani, H. A. et al.. J Am Coll Cardiol 2004;44: Lung 15 Copyright 2004 American College of Cardiology Foundation. Restrictions may apply.
16 Baseline Case 2 56 year-old woman with idiopathic pulmonary arterial hypertension (IPAH) RA: 10 mmhg PA: 107/41 (64) mmhg PCWP: 6 mmhg LVEDP: 7 mmhg CO: 3.8 liters/minute CI: 2.1 L/min/m 2 PVR: 15 Wood Units 16
17 Case 2 56 year-old woman with idiopathic pulmonary arterial hypertension (IPAH) Baseline RA: 10 mmhg PA: 107/41 (64) mmhg PCWP: 6 mmhg LVEDP: 7 mmhg CO: 3.8 liters/minute CI: 2.1 L/min/m 2 PVR: 15 Wood Units IV treprostinil + bosentan 4 mmhg 57/27 (39 mmhg) 6.3 liters/min 4.3 Wood units 17
18 Case 2 56 year-old woman with idiopathic pulmonary arterial hypertension (IPAH) Baseline IV treprostinil + bosentan 18
19 Pulmonay Hypertension Why do people die? RV failure or 19
20 World Health Organization Classification of Pulmonary Hypertension
21 WHO Group 2 Pulmonary Hypertension Left Atrial Hypertension 2. PH Due to Left Heart Disease Valvular disease Systolic dysfunction Diastolic dysfunction Mitral stenosis Mitral regurgitation Systolic CHF
22 Case 1 Before and After 61 year-old woman with severe dyspnea Doppler: severe pulmonary hypertension (PA systolic > 70 mmhg) RV RV Baseline Treatment x 4 months
23 Case 1 CXR and Chest CT FVC: 2.59 (81% predicted) FEV1: 1.02 (42% predicted) FEV1/FVC: 40 (50% predicted) DLCO: 27% predicted
24 WHO Group 3 Pulmonary Hypertension Hypoxic vasoconstriction +/- vascular remodelling OXYGEN 3. PH Due to Lung Diseases and / or Hypoxia COPD ILD Other pulmonary diseases with mixed restrictive and obstructive pattern Sleep-disordered breathing Alveolar hypoventilation disorders Chronic exposure to high altitude Developmental abnormalities
25 Regulation of Potassium Channels by Oxygen in Pulmonary Artery Smooth Muscle Cells Mechanism to minimize ventilation-perfusion mismatch Weir EK et al. N Engl J Med 2005;353:
26 TBL: Pulmonary Hypertension Case 3 72 year-old man from Norwich, VT Retired college professor Exercised on a regular basis (daily); strong and fit Healthy with no history of heart or lung disease 2002 sudden onset of SOB with exertion no progression, but no improvement Echocardiogram RV dilatation and dysfunction Severe pulmonary hypertension PA systolic 80 mmhg Referred to our Pulmonary Hypertension Clinic in
27 Ventilation-Perfusion Lung Scan Diagnosis: chronic thromboembolic pulmonary hypertension (CTEPH; WHO group 4)
28 Pulmonary Thromboendarterectomy University of California San Diego
29 World Health Organization Classification of Pulmonary Hypertension
30 Pulmonary Arterial Hypertension Advanced Medical Therapy Prostanoid Analogues Epoprostenol (Flolan - IV or inhaled; Veletri - IV) Treprostinil (Remodulin - IV, SQ; Tyvaso - Inhaled) Iloprost (Ventavis inhaled) Endothelin Receptor Antagonists (ERA) Bosentan (Tracleer - oral) Ambrisentan (Letairis - oral) Macitentan (Opsumit - oral) Nitric oxide guanylate cyclase cgmp pathway PDE 5 inhibitors Sildenafil (Revatio oral) (IV sildenafil available) Tadalafil (Adcirca oral) Soluble guanylate cyclase stimulators Riociguat (Adempas; oral) WHO Group 1 PAH WHO Group 1 PAH WHO group 4 CTEPH (Non-operative operative or post-operative) operative) 30
31 Pulmonary Hypertension Final Thoughts Try to use the WHO classification system Don t t start calcium channel blockers they don t t work in most patients, and they may be dangerous Don t t start advanced medical therapy without a thorough evaluation Viagra/sildenafil Evaluation should include a comprehensive hemodynamic evaluation (don t t cut corners) Therapeutic progress has been made 31
1. Phosphodiesterase Type 5 Enzyme Inhibitors: Sildenafil (Revatio), Tadalafil (Adcirca)
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutic
PULMONARY ARTERIAL HYPERTENSION AGENTS
Approvable Criteria: PULMONARY ARTERIAL HYPERTENSION AGENTS Brand Name Generic Name Length of Authorization Revatio Sildenafil citrate Calendar Year Adcirca Tadalafil Calendar Year Letairis Ambrisentan
Pharmacy Policy Bulletin
Pharmacy Policy Bulletin Title: Policy #: Pulmonary Arterial Hypertensive (PAH) agents Rx.01.83 Application of pharmacy policy is determined by benefits and contracts. Benefits may vary based on product
PULMONARY HYPERTENSION. Charles A. Thompson, M.D., FACC, FSCAI Cardiovascular Institute of the South Zachary, Louisiana
PULMONARY HYPERTENSION Charles A. Thompson, M.D., FACC, FSCAI Cardiovascular Institute of the South Zachary, Louisiana What is Pulmonary Hypertension? What is normal? Pulmonary artery systolic pressure
Pulmonary Artery Hypertension
Pulmonary Artery Hypertension Janet M. Pinson, RN, MSN, ACNP Maureen P. Flattery, RN, MS, ANP Virginia Commonwealth University Health System Richmond, VA Pulmonary artery hypertension (PAH) is defined
OVERVIEW FDA-APPROVED INDICATIONS
Tufts Health Together Tufts Health Direct Pharmacy Medical Necessity Guidelines Pulmonary Hypertension Effective: December 9, 2014 Clinical documentation and prior authorization required Not covered Pharmacy
Pharmacy Medical Necessity Guidelines: Pulmonary Hypertension Medications
Pharmacy Medical Necessity Guidelines: Pulmonary Hypertension Medications Effective: January 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review
*Documentation of pretreatment results from right heart catheterization and PEA required, as applicable
DRUG POLICY BENEFIT APPLICATION Pulmonary Arterial Hypertension Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal. Drugs for the treatment of pulmonary arterial hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Drugs for the treatment of Remit / Appraisal objective: Final scope To appraise the clinical and cost effectiveness of
Pulmonary Arterial Hypertension. Matt Hegewald, MD FCCP St Charles Medical Center Intermountain Medical Center University of Utah
Pulmonary Arterial Hypertension Matt Hegewald, MD FCCP St Charles Medical Center Intermountain Medical Center University of Utah Intermountain Pulmonary Arterial Hypertension Program Outline Causes of
CLINICAL POLICY Department: Medical Management Document Name: Pulmonary Arterial Hypertension Therapies
Page: 1 of 15 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
Corporate Medical Policy
Corporate Medical Policy Pulmonary Hypertension, Drug Management File Name: Origination: Last CAP Review: Next CAP Review: Last Review: pulmonary_hypertension_drug_management 06/1998 3/2015 3/2016 3/2015
Hope in 2011 Clinical Advances Where is the road taking us?
Hope in 2011 Clinical Advances Where is the road taking us? Richard Channick, MD Arlene Schiro, NP Disclosures Arlene Schiro no relevant financial and/or commercial relationships to disclose Hope is like
Pulmonary Arterial Hypertension: Review and Updates. Is it Primary vs Secondary Pulmonary Hypertension? No!! Dated Nomenclature. Veronica Franco, MD
Pulmonary Arterial Hypertension: Review and Updates Veronica Franco, MD Section of Pulmonary Hypertension Section of Heart Failure and Transplantation Ohio State University Is it Primary vs Secondary Pulmonary
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY Contents ELIGIBILITY CRITERIA FOR INITIATION OF PULMONARY ARTERIAL HYPERTENSION THERAPY... 2 Initial Application for Funding of Pulmonary
Advanced Therapies for Pharmacological Treatment of Pulmonary Hypertension
Advanced Therapies for Pharmacological Treatment of Pulmonary Hypertension Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana,
Riociguat Clinical Trial Program
Riociguat Clinical Trial Program Riociguat (BAY 63-2521) is an oral agent being investigated as a new approach to treat chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension
Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease
Heart Failure Center Hadassah University Hospital Type II Pulmonary Hypertension: Pulmonary Hypertension due to Left Heart Disease Israel Gotsman MD The Heart Failure Center, Heart Institute Hadassah University
We can learn a lot from you...
Educational program by Material endorsed by We can learn a lot from you... When it comes to pulmonary arterial hypertension (PAH), the members of your specialist healthcare team are experts on the best
Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled Therapeutic Class Review (TCR) March 30, 2015
Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled Therapeutic Class Review (TCR) March 30, 2015 No part of this publication may be reproduced or transmitted in any form or by any means, electronic
Target therapies for the treatment of pulmonary arterial hypertension in Adults
Paper K2 National Specialised Commissioning Group Commissioning Policy Target therapies for the treatment of pulmonary arterial hypertension in Adults POLICY PUBLISHED: 1 JULY 2008 POLICY REVISED: 14 JANUARY
Scottish Medicines Consortium
Scottish Medicines Consortium sildenafil citrate 20mg tablets (Revatio ) No. (235/06) Pfizer New indication 6 January 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the above
Copyright 2012 Oregon State University. All Rights Reserved
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
Therapeutic Class Overview Pulmonary Arterial Hypertension Agents
Therapeutic Class Overview Pulmonary Arterial Hypertension Agents Therapeutic Class Overview/Summary: The oral pulmonary hypertension agents are Food Drug Administration (FDA)-approved for the treatment
PAH has an incidence
Pulmonary Arterial Hypertension: A Serious Problem Pulmonary arterial hypertension (PAH) is a serious disease with significant morbidity and mortality and no cure. In this article, Dr. Porhownik and Dr.
Pulmonary Hypertension in Sickle Cell Disease. Jorge Ramos Hematology Fellows Conference June 28, 2013
Pulmonary Hypertension in Sickle Cell Disease Jorge Ramos Hematology Fellows Conference June 28, 2013 Patient Presentation 28F with SCD, genotype SS. Presented to UWMC ER with 1 month progressive DOE and
PAH in. Registry to Evaluate Early and Long-Term PAH Disease Management
PAH in Registry to Evaluate Early and Long-Term PAH Disease Management Ioana R. Preston, MD Co-Director, Pulmonary Hypertension Center Tufts Medical Center, Boston, MA Background What is REVEAL? Multi-center,
Clinical Commissioning Policy: Targeted Therapies for Pulmonary Hypertension Functional Class II. April 2013. Reference : NHSCB/A11/P/a
Clinical Commissioning Policy: Targeted Therapies for Pulmonary Hypertension Functional Class II April 2013 Reference : NHS Commissioning Board Clinical Commissioning Policy: Amendment to National Policy
The Global Alliance against Chronic Respiratory Diseases
The Global Alliance against Chronic Respiratory Diseases Pulmonary hypertension Dr Marc Humbert What is the burden of pulmonary hypertension? The true burden of pulmonary hypertension is currently unknown
Chronic Thromboembolic Disease. Chronic Thromboembolic Disease Definition. Diagnosis Prevention Treatment Surgical Nonsurgical
Chronic Thromboembolic Disease Diagnosis Prevention Treatment Surgical Nonsurgical Chronic Thromboembolic Disease Definition Pulmonary Hypertension due to chronic thromboembolism 6 months post acute PE:
CADTH Therapeutic Review Report
Canadian Agency for Drugs and Technologies in Health Agence canadienne des médicaments et des technologies de la santé CADTH Therapeutic Review Report March 2015 Drugs for Pulmonary Arterial Hypertension:
CADTH CANADIAN DRUG EXPERT REVIEW COMMITTEE FINAL RECOMMENDATION
CADTH CANADIAN DRUG EXPERT REVIEW COMMITTEE FINAL RECOMMENDATION RIOCIGUAT (Adempas Bayer HealthCare Inc.) Indication: Pulmonary Arterial Hypertension Recommendation: The CADTH Canadian Drug Expert Review
Pulmonary Arterial Hypertension: Assessment of disease s severity
Pulmonary Arterial Hypertension: Assessment of disease s severity Carmine Dario Vizza Dept. Cardiovascular and Respiratory Diseases La Sapienza University of Rome e-mail : dario.vizza@uniroma1.it Pulmonary
Pulmonary Arterial Hypertension (PAH) Agents 12/01/2009
Pulmonary Arterial Hypertension (PAH) Agents 12/01/2009 Copyright 2006-2009 by Provider Synergies, L.L.C. All rights reserved. Printed in the United States of America. All rights reserved. No part of this
PAH. Salman Bin AbdulAziz University College Of Pharmacy 22/01/35
Salman Bin AbdulAziz University College Of Pharmacy PAH Therapeutics II PHCL 430 Ahmed A AlAmer PharmD R.W. is a 38-year-old obese woman who presents with increasing symptoms of fatigue and shortness of
Pulmonary Arterial Hypertension. Mark Rumbak, MD Professor of Medicine Morsani College of Medicine University of South Florida
Pulmonary Arterial Hypertension Mark Rumbak, MD Professor of Medicine Morsani College of Medicine University of South Florida PAH Disease State Module Outline Background and definition Clinical classification
Recently approved drugs offer significant improvements for treatment options in pulmonary arterial hypertension
DISEASE MANAGEMENT Recently approved drugs offer significant improvements for treatment options in pulmonary arterial hypertension Treatment of pulmonary arterial hypertension (PAH) Class I. PAH without
Research Review EDUCATIONAL SERIES. Pulmonary Arterial Hypertension
Research Review EDUCATIONAL SERIES About the Reviewers Dr Ken Whyte is a Respiratory Physician at Auckland DHB Respiratory Services and Honorary Associate Professor of Medicine at the University of Auckland.
Idiopathic Pulmonary Fibrosis (IPF) Research
Idiopathic Pulmonary Fibrosis (IPF): Why Early Referral is Critical Even if Your Patient is Not Eligible for a Clinical Trial Idiopathic Pulmonary Fibrosis (IPF) Research Management of IPF requires a confident
Statement on Disability: Pulmonary Hypertension
Statement on Disability: Pulmonary Hypertension Ronald J. Oudiz, MD and Robyn J. Barst, MD on behalf of Pulmonary Hypertension Association The Scientific Leadership Council of the Pulmonary Hypertension
P pulmonary Hypertension and Its Importance to the Body
Cardiol Clin 22 (2004) 441 452 Diagnosis and treatment of pulmonary arterial hypertension Richard Channick, MD a, *, Timothy L. Williamson, MD b a Division of Pulmonary and Critical Care, University of
HEART HEALTH WEEK 3 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease HEART FAILURE. Relatively mild, symptoms with intense exercise
WEEK 3 SUPPLEMENT HEART HEALTH A Beginner s Guide to Cardiovascular Disease HEART FAILURE Heart failure can be defined as the failing (insufficiency) of the heart as a mechanical pump due to either acute
Pulmonary Arterial Hypertension
Chapter 27 Pulmonary Arterial Hypertension Gandharba Ray, L Ravi Kumar INTRODUCTION ABSTRACT Pulmonary arterial hypertension (PAH) is a syndrome resulting from decreased flow of blood in the pulmonary
Medicare C/D Medical Coverage Policy
Nebulizer Medications Origination: June 17, 2009 Review Date: October 21, 2015 Next Review: October, 2017 Medicare C/D Medical Coverage Policy DESCRIPTION Nebulizer medications are used to prevent and
2. Background This drug had not previously been considered by the PBAC.
PUBLIC SUMMARY DOCUMENT Product: Ambrisentan, tablets, 5 mg and 10 mg, Volibris Sponsor: GlaxoSmithKline Australia Pty Ltd Date of PBAC Consideration: July 2009 1. Purpose of Application The submission
Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology
Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) The diabetes mellitus codes are combination codes
Diagnosis and Management of Pulmonary Arterial Hypertension: Implications for Respiratory Care
Diagnosis and Management of Pulmonary Arterial Hypertension: Implications for Respiratory Care Deborah Jo Levine MD Introduction Definition Normal Physiology Pathophysiology Pathogenesis Classification
Acknowledgements. PAH in Children: Natural History. The Sildenafil Saga
The Sildenafil Saga David L. Wessel, MD Executive Vice President Chief Medical Officer Ikaria Distinguished Professor of Critical Care Children s National Medical Center Washington, DC, USA Acknowledgements
Non-Invasive Risk Predictors in (Children with) Pulmonary Hypertension
Ideal risk prognosticator Easy to acquire Non-Invasive Risk Predictors in (Children with) Pulmonary Hypertension Safe -- Non-invasive Robust Gerhard-Paul Diller Astrid Lammers Division of Adult Congenital
Meta-Analysis of Randomized Controlled Trials on Treatment of Pulmonary Arterial Hypertension
Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Meta-Analysis of Randomized Controlled Trials on Treatment of Pulmonary Arterial Hypertension Bing He, BSc;
PAH: Standard of Care
PAH: Standard of Care Nazzareno Galiè Istituto di Cardiologia Università di Bologna nazzareno.galie@unibo.it TF 7 Therapy Standard of Care Questions A. Do we have additional information on the role of
She was 39 years old, gravida 4, para 2. She had an Idiopathic Pulmonary. Arterial Hypertension (PAH) revealed during pregnancy by a New York Heart
Case #1 (year 1992): She was 39 years old, gravida 4, para 2. She had an Idiopathic Pulmonary Arterial Hypertension (PAH) revealed during pregnancy by a New York Heart Association (NYHA) functional class
Liver Function Essay
Liver Function Essay Name: Quindoline Ntui Date: April 20, 2009 Professor: Dr. Danil Hammoudi Class: Anatomy and Physiology 2 Liver function The human body consist of many highly organize part working
Pulmonal hypertensjon. Arne K. Andreassen Kardiologisk avdeling Oslo Universitetssykehus Rikshospitalet
Pulmonal hypertensjon Arne K. Andreassen Kardiologisk avdeling Oslo Universitetssykehus Rikshospitalet Clinical classification of pulmonary hypertension 1. Pulmonary arterial hypertension (PAH) 2. Pulmonary
Pulmonary arterial hypertension (PAH) is a
Eur Respir Rev 2010; 19: 118, 279 287 DOI: 10.1183/09059180.00008010 CopyrightßERS 2010 REVIEW Management of severe pulmonary arterial hypertension J-L. Vachiéry* and G. Simonneau # ABSTRACT: Pulmonary
Potential Causes of Sudden Cardiac Arrest in Children
Potential Causes of Sudden Cardiac Arrest in Children Project S.A.V.E. When sudden death occurs in children, adolescents and younger adults, heart abnormalities are likely causes. These conditions are
Milwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version
Case Study: Factors that Affect Blood Pressure Instructor Version Goal This activity (case study and its associated questions) is designed to be a student-centered learning activity relating to the factors
CHF: In the trenches. David K. Orth MS RN CNS PHN UCSF, San Francisco, CA, USA
CHF: In the trenches David K. Orth MS RN CNS PHN UCSF, San Francisco, CA, USA No conflicts of interest to disclose Disclosures Objectives Recognize significance of CHF in our patient population Differentiate
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL
Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT
Pulmonary Arterial Hypertension (PAH)
Pulmonary Arterial Hypertension (PAH) Contents 1. Introduction 3 2. What is PAH? 4 3. Classification of PAH 5 4. How is PAH severity classified? 7 5. How common is PAH? 7 6. Why does PAH develop? 8 7.
ANAESTHESIA FOR THE PATIENT WITH PULMONARY HYPERTENSION ANAESTHESIA TUTORIAL OF THE WEEK 228
ANAESTHESIA FOR THE PATIENT WITH PULMONARY HYPERTENSION ANAESTHESIA TUTORIAL OF THE WEEK 228 20 TH JUNE 2011 Dr Sarah Thomas, Senior Anaesthetic Registrar Royal Hobart Hospital Correspondence to sarah.thomas@dhhs.tas.gov.au
Evidence briefing on drug treatments for functional class II pulmonary hypertension
Evidence briefing on drug treatments for functional class II pulmonary hypertension The North of England Specialised Commissioning Group is the lead organisation charged with commissioning targeted therapies
HEART FAILURE ROBERT SOUFER, M.D.
CHAPTER 14 HEART FAILURE ROBERT SOUFER, M.D. The heart s primary function is to pump blood to all parts of the body, bringing nutrients and oxygen to the tissues and removing waste products. When the body
Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
Pulmonary Diseases. Lung Disease: Pathophysiology, Medical and Exercise Programming. Overview of Pathophysiology
Lung Disease: Pathophysiology, Medical and Exercise Programming Overview of Pathophysiology Ventilatory Impairments Increased airway resistance Reduced compliance Increased work of breathing Ventilatory
Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions?
Cardiovascular Disease and Maternal Mortality what do we know and what are the key questions? AFSHAN HAMEED, MD, FACOG, FACC Associate Clinical Professor Maternal Fetal Medicine and Cardiology University
Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
Exchange solutes and water with cells of the body
Chapter 8 Heart and Blood Vessels Three Types of Blood Vessels Transport Blood Arteries Carry blood away from the heart Transport blood under high pressure Capillaries Exchange solutes and water with cells
James F. Kravec, M.D., F.A.C.P
James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice
Pulmonary Arterial Hypertension Special Issues and Current Therapeutic Approaches: Part Two
The online version of this article, along with access to discussion threads on NATF s eforum, is available at: www.natfonline.org/ethrombosis.php (January, 2010) Pulmonary Arterial Hypertension Special
High Blood Pressure. Dr. Rath s Cellular Health Recommendations for Prevention and Adjunct Therapy
4 High Blood Pressure Dr. Rath s Cellular Health Recommendations for Prevention and Adjunct Therapy The Facts About High Blood Pressure Dr. Rath s Cellular Health Recommendations: - Documented Health Benefits
How To Understand What You Know
Heart Disorders Glossary ABG (Arterial Blood Gas) Test: A test that measures how much oxygen and carbon dioxide are in the blood. Anemia: A condition in which there are low levels of red blood cells in
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It?
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It? Indiana Chapter-ACC 17 th Annual Meeting Indianapolis, Indiana October 19, 2013 Deepak Bhakta MD FACC FACP FAHA FHRS CCDS Associate
Arterial Blood Gas Case Questions and Answers
Arterial Blood Gas Case Questions and Answers In the space that follows you will find a series of cases that include arterial blood gases. Each case is then followed by an explanation of the acid-base
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity
Low-gradient severe aortic stenosis with normal LVEF: A disturbing clinical entity Jean-Luc MONIN, MD, PhD Henri Mondor University Hospital Créteil, FRANCE Disclosures : None 77-year-old woman, mild dyspnea
Electronic version is available on the following websites: www.moh.gov.my
STATEMENT OF INTENT These guidelines were developed to be guides for clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not necessarily
Vtial sign #1: PULSE. Vital Signs: Assessment and Interpretation. Factors that influence pulse rate: Importance of Vital Signs
Vital Signs: Assessment and Interpretation Elma I. LeDoux, MD, FACP, FACC Associate Professor of Medicine Vtial sign #1: PULSE Reflects heart rate (resting 60-90/min) Should be strong and regular Use 2
Resuscitation in congenital heart disease. Peter C. Laussen MBBS FCICM Department Critical Care Medicine Hospital for Sick Children Toronto
Resuscitation in congenital heart disease Peter C. Laussen MBBS FCICM Department Critical Care Medicine Hospital for Sick Children Toronto Evolution of Congenital Heart Disease Extraordinary success: Overall
1p36 and the Heart. John Lynn Jefferies, MD, MPH, FACC, FAHA
1p36 and the Heart John Lynn Jefferies, MD, MPH, FACC, FAHA Director, Advanced Heart Failure and Cardiomyopathy Services Associate Professor, Pediatric Cardiology and Adult Cardiovascular Diseases Associate
CIALIS (See-AL-iss) (tadalafil) tablets
1 Patient Information CIALIS (See-AL-iss) (tadalafil) tablets Read this important information before you start taking CIALIS and each time you get a refill. There may be new information. You may also find
Bosentan in Pulmonary Arterial Hypertension Secondary to Scleroderma
Bosentan in Pulmonary Arterial Hypertension Secondary to Scleroderma AMIT JOGLEKAR, FAUSAN S. TSAI, DEBORAH A. McCLOSKEY, JULIANNE E. WILSON, JAMES R. SEIBOLD, and DAVID J. RILEY ABSTRACT. Objective. To
Listen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
INTRODUCTION TO EECP THERAPY
INTRODUCTION TO EECP THERAPY is an FDA cleared, Medicare approved, non-invasive medical therapy for the treatment of stable and unstable angina, congestive heart failure, acute myocardial infarction, and
Atrial Fibrillation Management Across the Spectrum of Illness
Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,
2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.
DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart
Objectives. The ECG in Pulmonary and Congenital Heart Disease. Lead II P-Wave Amplitude during COPD Exacerbation and after Treatment (50 pts.
The ECG in Pulmonary and Congenital Heart Disease Gabriel Gregoratos, MD Objectives Review the pathophysiology and ECG signs of pulmonary dysfunction Review the ECG findings in patients with: COPD (chronic
Respiratory Concerns in Children with Down Syndrome
Respiratory Concerns in Children with Down Syndrome Paul E. Moore, M.D. Associate Professor of Pediatrics and Pharmacology Director, Pediatric Allergy, Immunology, and Pulmonary Medicine Vanderbilt University
Functional Class Improvement and 3-Year Survival Outcomes in Patients With Pulmonary Arterial Hypertension in the REVEAL Registry
CHEST Original Research PULMONARY VASCULAR DISEASE Functional Class Improvement and 3-Year Survival Outcomes in Patients With Pulmonary Arterial Hypertension in the REVEAL Registry Robyn J. Barst, MD ;
A Review of Sitaxsentan Sodium in Patients with Pulmonary Arterial Hypertension
A Review of Sitaxsentan Sodium in Patients with Pulmonary Arterial Hypertension The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
24. HIV-associated Pulmonary Hypertension
24. HIV-associated Pulmonary Hypertension Georg Friese, Mirko Steinmüller and Ardeschir Ghofrani Etiology, pathogenesis, classification 629 Pulmonary hypertension is a severe life-limiting disease, often
High Blood Pressure (Essential Hypertension)
Sacramento Heart & Vascular Medical Associates February 18, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 What is essential hypertension? Blood pressure is the force
Acquired Heart Disease: Prevention and Treatment
Acquired Heart Disease: Prevention and Treatment Prevention and Treatment Sharon L. Roble, MD Assistant Professor Adult Congenital Heart Program The Ohio State University/Nationwide Children s Hospital
Universitätsklinik für Kardiologie. Test. Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1
Test Thomas M. Suter Akute Herzinsuffizienz Diagnostik und Therapie thomas.suter@insel.ch 1 Heart Failure - Definition European Heart Journal (2008) 29, 2388 2442 Akute Herzinsuffizienz Diagnostik und
Pre-Operative Services Teaching Rounds 2 Jan 2011
Pre-Operative Services Teaching Rounds 2 Jan 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu
ACLS PHARMACOLOGY 2011 Guidelines
ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.
ACTELION S MARKETED PRODUCTS
ACTELION S Actelion has over 1,000 highly experienced sales, marketing and medical professionals with a proven track record in both specialty and GP markets. The company has over 30 operative affiliates
4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts
Cardiac Rehabilitation: From the other side of the glass door No disclosures, no conflicts Charles X. Kim, MD, FACC, ABVM Objectives 1. Illustrate common CV benefits of CV rehab in real world practice.
ECG may be indicated for patients with cardiovascular risk factors
eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,
CARDIO/PULMONARY MEDICINE FOR PRIMARY CARE. San Diego, California San Diego Marriott Marquis & Marina October 3 5, 2014. Participating Faculty
CARDIO/PULMONARY MEDICINE FOR PRIMARY CARE San Diego, California San Diego Marriott Marquis & Marina October 3 5, 2014 Participating Faculty Hector O. Ventura, MD, FACC Section Head, Cardiomyopathy and