Hypertension pulmonaire et connectivites
|
|
|
- Richard Blankenship
- 7 years ago
- Views:
Transcription
1 Hypertension pulmonaire et connectivites Luc Mouthon Pôle de Médecine Interne, Centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance publique- Hôpitaux de Paris, Paris Université Paris Descartes, Inserm U1016, Institut Cochin, Paris Uth rs DH U Société Médicale des Hôpitaux de Paris le 10 octobre 2014
2 Conflicts of interest Consultant: Actelion, CSL Behring, Cytheris, GSK, LFB Biotechnologies, Lilly, Pfizer Financial support to ARMIIC Investigator: Actelion, CSL Behring, Pfizer Financial support (grants): Actelion, CSL Behring, GSK, LFB Biotechnologies, Pfizer
3 Updated classifi cation of pulmonary hypertension Connective tissue diseases Simmoneau G et al. J Am Coll Cardiol 2013
4 Pulmonary arterial hypertension in France : results from a national registry Humbert M et al. AJRCCM 2006, Feb 2; [Epub ahead of print]
5 Classification criteria for SLE (ARA 1982)* Malar rash Discoid lupus Photosensitivity Oral or nasal ulcers Non erosive arthritis 2 peripheral joints Pericarditis, pleuresis Protéinuria 0,5 g/d Seizure or psychosis Hemolytic anemia or Leucopenia < 4000/µl on two occasions or Lymphopenia < 1500/µl on two occasions or Thrombocytopenia < /µl LE cells or anti-native, double strand DNA or Anti-Sm or Positive VDRL (negative TPHA) on two occasions at six months intervals Abnormal ANA titer in the absence of drug *4 criteria simultaneous/successive to assess the diagnosis of SLE (sensitivity and specificity of 96%).
6 PAH-SLE: prevalence Reference Number of patients Definition of PAH Prevalence Perez HD Echo 9.3 % Quismorio FP 1984 Echo Badui E Echo 9 % Simonson JS syst PAP > 30 mmhg echo 14 % Winslow TM syst PAP > 30 mmhg echo 14 (43) % Pan TL syst PAP > 30 mmhg echo 7.5 % Johnson SR syst PAP > 40 mmhg echo 14 %
7 Characteristics of 93 SLE patients according to pulmonary hypertension status Demographics No PH group n = 81 PH group n = 12 p * SLE duration at evaluation, (mean ± SD) years Clinical, n (%) 9.5 ± 8 14 ± * Péricarditis 22 (27) 7 (58) 0.04 * PNS involvement 3 (4) 3 (25) 0.02 * Antibodies detected, n (%) Anti-Sm antibodies 9 (11) 5 (42) 0.01 * Anti-cardiolipin antibodies 25 (31) 9 (75) * Fois E et al. Clin Exp Rheumatol Nov-Dec;28(6):836-41
8 Vascular hyperreactivity Raynaud s phenomenon Renal crisis Pulmonary arterial hypertension SYSTEMIC SCLEROSIS Fibrosis Autoimmunity Skin Lung Bowell Heart Autoantibodies Anti-Scl70 Anti-centromere Anti-ARNPolIII Ac anti-fibroblasts
9 Systemic sclerosis: prevalence Authors States technique USA Prevalence /million Michet Rochester Hospital 138 Mayes Detroit Multiples sources 242 Maricq Caroline du sud Population Océanie Chandran South Australia Roberts-Thomson South Australia Multiples sources 233 Asie Shinkai Japon Public health 7 Tamaki Tokyo Public health Europe Silman West midland Multiples sources 31 Asboe-Hansen Danemark Hospital 126 Le Guern Seine St Denis, France Multiples sources 158
10 2013 classification criteria for SSc: an ACR/EULAR collaborative initiative (I) Skin thickening of the fingers extending proximal to the metacarpophalangeal joints: SSc; If that is not present, 7 additive items apply: skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud s phenomenon, SSc-related autoantibodies. van den Hoogen F et al. Ann Rheum Dis 2013
11 Skin thickening of the fingers (I) Score = 2 Only count higher score Puffy fingers
12 Skin thickening of the fingers (II) Sclerodactily Score = 4 Only count higher score
13 fingertip lesions Digital ulcers Score = 2 Fingertip pitting scars Score = 3 Only count higher score
14 Score = 2 telangiectasia
15 Telangiectases in Scleroderma: A Potential Clinical Marker of Pulmonary Arterial Hypertension Shah et al. J Rheumatol 2010
16 Score = 2 Abnormal nailfold capillaries
17 Interstitial lung disease/pulmonary arterial hypertension Score = 2 Score = 2 Maximum score = 2
18 Raynaud s phenomenon Score = 3
19 SSc-related autoantibodies Anti-centromere Anti-topoisomerase I Anti-RNA polymerase III Score = 3 Maximum score = 3
20 SYSTEMIC SCLEROSIS : EVOLUTION Diffuse ILD + PAH Bowell Lung Myositis PAH Kidney Bowell Raynaud s syndrome ILD Limited cutaneous Years Skin score Visceral involvement
21 Legendre P, Mouthon L. Presse Med 2014 Auteur Année de publication HTAP-ScS: prévalence Pays Définition HTAP (cathétérisme cardiaque droit) Prévalence Mukerjee et al. Hachulla E, et al Royaume Uni 2005 France Vonk, et al Pays-Bas Phung, et al Australie PAPm> 25 mmhg au repos ou > 30 à l effort et CPC < 14 mmhg PAPm 25mmHg au repos, ou 30mmHg à l'effort et PCP < 15mmHg PAPm 25mmHg au repos et PCP normale PAPm 25mmHg au repos, ou 30mmHg à l'effort et PCP < 15mmHg et RPV> 240 dyn/s/cm² 12% (86/722) 7,85% (47/599) 9,9% (113/1,148) 13% (24/184) Avouac, et al France et Italie PAPm 25mmHg au repos, ou 30mmHg à l'effort et PCP < 15mmHg en absence de fibrose pulmonaire 3,6% (42/1,165) Hsu et al Amérique du Nord PAPm 25mmHg au repos, ou 30mmHg à l'effort et PCP < 15mmHg 13,9% (35/251)
22 Pulmonary vascular remodeling in SSc-PAH Le Pavec J et al 2010 AJRCCM
23 Disproportionate elevation of N-terminal probrain natriuretic peptide in SSc-related pulmonary hypertension Mathai et al. Eur Resp J 2010 NT-proBNP levels are 1) significantly higher in PAH-SSc than IPAH despite less severe haemodynamic perturbations, 2) stronger predictors of survival in PAH-SSc, suggesting tha t neurohormonal regulation may differ between PAH-SSc and IPAH. Box and whisker plots of the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels measured in IPAH and PAH-SSc patients.
24 Reference Methodology Number of patients RG Ungerer 1983 USA Prospective Monocentric 1973 to 1979 PAH-SSc: Prevalence SSc profile PAH definition PAH prevalence 49 Proximal SSc and CREST Mean PAP > 20 mmhg and mean PCP < 12 mmhg (right heart catheterization) 16% I. Murata 1992 Japan Prospective Monocentric 1988 to SSc and MCTD V IT > 2,5 m/s Doppler Echo 17% R. Battle 1996 USA Prospective Monocentric 34 Diffuse or limited c SSc PAPs > 30 mmhg Doppler Echo 35% ET Koh 1996 Canada Prospective Monocentric 1978 to Diffuse or limited cutaneous SSc PAPm > 25 and cap m < 12 mmhg upon RHC, or Ps VD > 35 mmhg (echo) or RV dilatation, P or T insufficiency, or paradoxical septum motion upon echo 4,9% AJ MacGregor, 2001 UK Prospective Monocentric 1992 to Diffuse or limited c SSc PAPs > 30 mmhg Doppler Echo 13% D Mukerjee, 2003 UK Prospective Monocentric 1998 to Diffuse or limited c SSc mpap > 25 mmhg at rest or > 30 at exercise pulmonary capillary < 14 mmhg 12 % Hachulla et al 2005 France Prospective Multicentric Diffuse or limited c SSc mpap > 25 mmhg at rest or > 30 at exercise pulmonary capillary < 14 mmhg 7.85%
25 Cardiac EchoDoppler PAH definition V IT V IT < 2.5 m/s (~ spap < 30 mmhg) V IT m/s (~spap mmhg) V IT > 3 m/s (~ spap > 45 mmhg) No dyspnea or dyspnea related to another cause Dyspnea (not related to other causes) No PAH PAH echography Right cardiac catheterisation Hachulla et al. Arthritis Rheum 2005
26 Cardiac catheterisation (n=33) PAH : 18 [mpap > 25 mmhg at rest or > 30 mmhg at exercise with PAwP < 15 mmhg] mmhg: mmhg: 3 45 mmhg: 1 Post-capillary venous pulmonary hypertension: 3 (10%) No PAH : 12 => 6 with mpap > 20 mmhg Hachulla et al. Arthritis Rheum 2005
27 Estimated incidence of pulmonary hypertension during the 3-year followup period* Hachulla et al. Arthritis Rheum 2009
28
29
30
31 Detect: results Six simple assessments in Step 1 of the algorithm determined referral to echocardiography. In Step 2, the Step 1 predicton score and two echocardiographic variables determined referral to RHC. FVC % predicted/dlco %predicted Current/past telangiectasia Ant-centromere Abs Serum NT-pro-BNP Serum urate ECG: right axis deviaton Right atrium area TR velocity Coghlan G, ARD, 2013
32
33 Changes in causes of Systemic Sclerosis related deaths between 1972 and 2001 Steen et Medsger. Ann Rheum Dis 2007
34 Causes of death in SSc patients Hachulla et al. Rheumatology 2009
35 Age Myocardial involvement The impact of comorbidities Musculoskeletal involvement Pulmonary fibrosis Pulmonary Veno-Occlusive Disease
36 SSc-PAH: why a so bad prognosis? Multivariate analysis, factors associated with increased death: Left ventricular dysfunction Pericardial effusion Fisher et al. Arthritis Rheum 2006
37 Right ventricular function in SSc-PAH SSc-PAH has a poorer exercise capacity and worse prognosis than those reported in other types of PAH. This appears related to a relative RV failure, explained by altered contractility and maybe also decreased pulmonary arterial compliance. Overbeek et al. ERJ 2008
38 PAH complicating Pulmonary fibrosis Mathai et al,arthritis Rheum. 2009;60:
39 Fibrous remodeling of the pulmonary venous system in PAH associated with CTD
40 SSc-PAH: treatment Preventive measures Conventionnal medical treatment (02 - diuretics - anticoagulants) Calcium chanel blockers Epoprostenol continuous infusion Endothelin receptor antagonists PDE-5 inhibitors/gc stimulators Combined treatments Lung transplantation
41 Lung transplantation 29 SSc patients vs 70 patients with IPF and 38 with IPAH End point: death. During 2 years of followup, 11 patients with scleroderma (38%), 23 with IPF (33%), and 14 with IPAH (37%) died. Cumulative survival at 6 months posttransplantation was 69% in the scleroderma group compared with 80% in the IPF group (log-rank P = 0.21) and 79% in the IPAH group (P = 0.38). Cumulative survival at 2 years was comparable (64%). Schachna L. et al. Arthritis Rheum 2006
42 Some PAH patients with associated CTD may improve with anti-inflammatory agents Retrospective analysis of clinical and haemodynamic effects of immunosuppressants given 1st therapy to 28 patients with PAH-CTD All patients received monthly intravenous pulse cyclophosphamide (600 mg/m 2 ) during at least 3 months and 22 out of 28 patients received oral prednisone 9 (32%) patients were responders (SLE 6/12 and MCTD (3/8). None of the 8 patients with SSc responded At 1 year of therapy, responders to immunosuppressive therapy were those who could be reclassified in New York Heart Association (NYHA) functional class I or II Sanchez et al. Chest 2006
43 A number of patients with PAH improved with anti-infl ammatory agents Immunosuppressive therapy in connectve tssue disease associated PAH (Sanchez O et al Chest 2006) Immunotherapy in SLE and MCDT associated PAH (Jaïs X et al Arthrits Rheum 2008) Reversibility of PAH in HIV/HHV8-associated Castlemann disease (Montani et al Eur Respir J 2005) PAH: a rare complicaton of primary Sjogren s syndrome (Launay D et al, (Baltmore) 2007)
44 Conclusions PAH rare manifestation of SLE Treatment: combination of Immunosuppressants and classical PAH treatments. 8-12% of SSc patients develop PAH/Incidence 0.6% Detection: echocardiography Comfirmation: Right heart catheterization (treshold.) Detect algorithm: step 1 and step 2 Prognosis: reserved Impact of comorbidities New treatments/combined treatments Lung transplantation
45 Centre de Référence Maladies Rares, Hôpital Cochin, Paris
Differential Diagnosis
Differential Diagnosis Limited Scleroderma and Scleroderma-Like Disorders Morphea, or localized Scleroderma, usually begins between the ages of 20 to 50 years as patches of yellowish or ivory-colored rigid,
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
DU maladies systémiques Biothérapies des maladies systémiques Le 25 mai 2012
DU maladies systémiques Biothérapies des maladies systémiques Le 25 mai 2012 10h-10h10 10h10-10h40 10h40-11h10 11h10-11h40 11h40-12h10 12h10-12h40 -Introduction : Luc Mouthon -Immunoglobulines intraveineuses
STUDY DESCRIPTION Background information, study purpose and study rationale
Sylvana M. Hidalgo, MD Originating Department: Pediatric Cardiology Submitting to: Medical Center Title: Single-Center Description of Clinical Presentation of Pulmonary Hypertension in Patients Also Diagnosed
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
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
Systemic Lupus Erythematosus
Harvard-MIT Division of Health Sciences and Technology HST.021: Musculoskeletal Pathophysiology, IAP 2006 Course Director: Dr. Dwight R. Robinson Systemic Lupus Erythematosus A multi-system autoimmune
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
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
Rheumatology Labs for Primary Care Providers. Robert Monger, M.D., F.A.C.P. 2015 Frontiers in Medicine
Rheumatology Labs for Primary Care Providers Robert Monger, M.D., F.A.C.P. 2015 Frontiers in Medicine Objectives Review the Indications for and Interpretation of lab testing for the following diseases:
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: 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
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
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
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
A patientwithsystemicsclerosis andjointpain. Christian Beyer University Erlangen-Nuremberg(GER)
A patientwithsystemicsclerosis andjointpain Christian Beyer University Erlangen-Nuremberg(GER) Whatisimportanttoyou? lungs GI tract fatigue heart skin muscles Raynaud s joints Whatisimportanttopatients?
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
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
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,
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
The ANA Test: All You Need to Know Department of Family and Community Medicine Family Medicine Update April 25, 2014
The ANA Test: All You Need to Know Department of Family and Community Medicine Family Medicine Update April 25, 2014 Celso R. Velázquez MD Division of Rheumatology University of Missouri velazquezc@health.missouri.edu
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
Does C-Reactive Protein Predict the Long-Term Progression of Interstitial Lung Disease and Survival in Patients With Early Systemic Sclerosis?
Arthritis Care & Research Vol. 65, No. 8, August 2013, pp 1375 1380 DOI 10.1002/acr.21968 2013, American College of Rheumatology BRIEF REPORT Does C-Reactive Protein Predict the Long-Term Progression of
Objective. An algorithm for the detection of pulmonary arterial hypertension (PAH), based on the
ARTHRITIS & RHEUMATISM Vol. 60, No. 6, June 2009, pp 1831-1839 DOI 10.1002/art.24525 2009, American College of Rheumatology The Three-Year Incidence of Pulmonary Arterial Hypertension Associated With Systemic
Cytori Therapeutics NASDAQ: CYTX
Cytori Therapeutics Scleroderma Informational Session January 2015 Restoring Lives 1 Forward-looking Statements This presentation contains certain forward-looking statements about Cytori Therapeutics,
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
Atherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
SPECIALTY : CARDIOLOGY CLINICAL PROBLEM: HEART FAILURE
SPECIALTY : CARDIOLOGY CLINICAL PROBLEM: HEART FAILURE Summary Heart failure has a worse prognosis than many cancers with an annual mortality of 40% in the first year following diagnosis and 10% thereafter.
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
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 ;
SF-DCT INFORMATION FOR MIXED CONNECTIVE TISSUE DISEASE (MCTD) CLAIMS OPTION 1. (MCTD claims are not eligible for Disease Option 2)
SF-DCT INFORMATION FOR MIXED CONNECTIVE TISSUE DISEASE (MCTD) CLAIMS OPTION 1 (MCTD claims are not eligible for Disease Option 2) 1 Mixed Connective Tissue Disease (MCTD) Mixed Connective Tissue Disease
Supplementary Patient and Methods. This Supplementary material is meant to provide more details on the Patients and Methods section of the manuscript.
3 SF-36 version 2 44 GLOBAL HEALTH ACR provisional composite response index for clinical trials in early diffuse cutaneous systemic Supplementary Patient and Methods This Supplementary material is meant
Health Insurance Carriers Can Restrict Recruitment on a Randomized Clinical Trial of Stem Cell Transplant for Autoimmune Disease
Health Insurance Carriers Can Restrict Recruitment on a Randomized Clinical Trial of Stem Cell Transplant for Autoimmune Disease Keith M Sullivan, M.D. Duke University Medical Center For the SCOT (Scleroderma:
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
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
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
Corporate Medical Policy
Corporate Medical Policy Serum Biomarker Panel Testing for Systemic Lupus Erythematosus File Name: Origination: Last CAP Review: Next CAP Review: Last Review: serum_biomarker_panel_testing_for_systemic_lupus_erythematosus
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
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent
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
Inconsistencies in the Use of Cardiac Biomarkers or Echocardiography in Patients with Acute Non-Massive Pulmonary Embolism
Inconsistencies in the Use of Cardiac Biomarkers or Echocardiography in Patients with Acute Non-Massive Pulmonary Embolism The Swiss Venous Thromboembolism Registry (SWIVTER) Nils Kucher University Hospital
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
TREATING AUTOIMMUNE DISEASES WITH HOMEOPATHY. Dr. Stephen A. Messer, MSEd, ND, DHANP Professor and Chair of Homeopathic Medicine
TREATING AUTOIMMUNE DISEASES WITH HOMEOPATHY Dr. Stephen A. Messer, MSEd, ND, DHANP Professor and Chair of Homeopathic Medicine AUTOIMMUNE DISEASES An autoimmune disorder occurs when the body s immune
Co-morbiditeit associeert met respiratoire aandoeningen louter omwille van de leeftijd. COPD patiënten hebben veel meer kans op longkanker dan rokers
Academisch centrum huisartsgeneeskunde Pneumologie Juni 2012 Prof W Janssens Co-morbiditeit associeert met respiratoire aandoeningen louter omwille van de leeftijd. COPD patiënten hebben veel meer kans
Arthritis and Rheumatology. Antoni Chan MBChB, FRCP, PhD Consultant Rheumatologist Royal Berkshire NHS Foundation Trust
Antoni Chan MBChB, FRCP, PhD Consultant Rheumatologist Royal Berkshire NHS Foundation Trust Rheumatology Investigation, Diagnosis, Treatment The challenge 8 billion a year in cost 700,000 people suffering
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,
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
Systemic Lupus Erythematosus Overview. Clinical presentation, pathophysiology, and therapeutic strategies over the course of disease
Systemic Lupus Erythematosus Overview Clinical presentation, pathophysiology, and therapeutic strategies over the course of disease Systemic Lupus Erythematosus (SLE) An inflammatory, multisystem, autoimmune
PDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/65615
Acute heart failure may be de novo or it may be a decompensation of chronic heart failure.
Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left
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
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.
Scleroderma and Lung INTRODUCTION. DEFINITION Definition of Scleroderma
CHAPTER 15 Scleroderma and Lung Tatjana Peroš-Golubičić INTRODUCTION Scleroderma is a chronic systemic disease of unknown cause, affecting around 15 persons in one million inhabitants in all parts of the
SOLUBLE TUMOR-ASSOCIATED ANTIGENS AND SECONDARY MALIGNANCIES IN AUTOIMMUNE- RHEUMATOID DISEASES
SOLUBLE TUMOR-ASSOCIATED ANTIGENS AND SECONDARY MALIGNANCIES IN AUTOIMMUNE- RHEUMATOID DISEASES ÉVA SZEKANECZ, MD Tutors: Emese Kiss MD, associate professor Gabriella Szőcs MD, assistant professor UNIVERSITY
The Most Common Autoimmune Disease: Rheumatoid Arthritis. Bonita S. Libman, M.D.
The Most Common Autoimmune Disease: Rheumatoid Arthritis Bonita S. Libman, M.D. Disclosures Two googled comics The Normal Immune System Network of cells and proteins that work together Goal: protect against
Atrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
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
HYPERTENSION ASSOCIATED WITH RENAL DISEASES
RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein
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
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
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.
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus by Erik Letko, M.D. Boston, MA Case report A 54-year old Caucasian woman was admitted to the Massachusetts General Hospital for renal failure and changes in mental status.
The heart then repolarises (or refills) in time for the next stimulus and contraction.
Atrial Fibrillation BRIEFLY, HOW DOES THE HEART PUMP? The heart has four chambers. The upper chambers are called atria. One chamber is called an atrium, and the lower chambers are called ventricles. In
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
NURS 821 Alterations in the Musculoskeletal System. Rheumatoid Arthritis. Type III Hypersensitivity Response
NURS 821 Alterations in the Musculoskeletal System Margaret H. Birney PhD, RN Lecture 12 Part 2 Joint Disorders (cont d) Rheumatoid Arthritis Definition: Autoimmune disorder occurring in genetically sensitive
History and Physical Examination for Rheumatic Disease for MUSC Students
History and Physical Examination for Rheumatic Disease for MUSC Students Inflammatory vs. non-inflammatory arthritis Inflammatory Prolonged stiffness after rest Stiffness improved with use Warmth Prolonged
Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
Version 1 2015. Module guide. Preliminary document. International Master Program Cardiovascular Science University of Göttingen
Version 1 2015 Module guide International Master Program Cardiovascular Science University of Göttingen Part 1 Theoretical modules Synopsis The Master program Cardiovascular Science contains four theoretical
ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014
ATRIAL FIBRILLATION RATE VS RHYTHM CONTROL NCVH BIRMINGHAM 2014 Facts 4 million or so people have atrial fibrillation 16 billion dollars spent yearly in USA 30% of strokes attributable to AF and AFL 3-5
CARDIOVASCULAR DYSFUNCTION IN LIVER CIRRHOSIS
LUCIAN BLAGA UNIVERSITY OF SIBIU VICTOR PAPILIAN FACULTY OF MEDICINE CARDIOVASCULAR DYSFUNCTION IN LIVER CIRRHOSIS Ph.D. THESIS SUMMARY COORDINATOR: PROF.DR. MANIŢIU IOAN Ph.D. STUDENT: LORENA MĂRIEŞ SIBIU
Frequency of disease subsets and patterns of organ involvement among Egyptian scleroderma patients
Frequency of disease subsets and patterns of organ involvement among Egyptian scleroderma patients THESIS Submitted for fulfillment of Master Degree in Rheumatology and Rehabilitation PRESENTED BY Shaimaa
DRUGS FOR TREATING SYSTEMIC LUPUS ERYTHEMATOSUS: GLOBAL MARKETS
DRUGS FOR TREATING SYSTEMIC LUPUS ERYTHEMATOSUS: GLOBAL MARKETS PHM159A March 2014 Sanjukta Bhattacharyya Project Analyst ISBN: 1-56965-754-8 BCC Research 49 Walnut Park, Building 2 Wellesley, MA 02481
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
Systemic Sclerosis 2 nd Edition
Systemic Sclerosis 2 nd Edition by Philip J. Clements and Daniel E. Furst Chapter 23: Introduction Facing an illness like scleroderma is often seen as a crisis, yet the overall impact of the disease can
PATTERNS OF ARTHRITIS: LAB AND OTHER TESTING
PATTERNS OF ARTHRITIS: LAB AND OTHER TESTING Paul B. Halverson MD Objectives Present several patterns of arthritis Where lab and imaging fit into various patient presentations Benefits and pitfalls related
Guidelines for diagnosis and management of acute pulmonary embolism
Guidelines for diagnosis and management of acute pulmonary embolism By Dr. Ahmed Zaghloul M.D. Anesthesia & Critical Care 2014 Predisposing factors for VTE Predisposing factor Strong predisposing factors
Graves disease in childhood Antithyroid drug therapy
83rd Annual Meeting of the ATA October 620, 203 Duration of antithyroid drugs treatment Disclosure Nothing to disclose Pr Juliane Léger Paediatric Endocrinology Department Paris Diderot University Hôpital
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
Collagen Vascular Lung Disease
6 Collagen Vascular Lung Disease Collagen vascular or connective tissue disorders are a group of autoimmune diseases in which antibodies attack the body s own organs and systems. Among the many targets
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
Rheumatoid arthritis: an overview. Christine Pham MD
Rheumatoid arthritis: an overview Christine Pham MD RA prevalence Chronic inflammatory disease affecting approximately 0.5 1% of the general population Prevalence is higher in North America (approaching
Pulmonary Manifestations of Connective Tissue Diseases
2015 26 177-185 Pulmonary Manifestations of Connective Tissue Diseases Te-Wei Hseun, and Ren-Guang Wu Department of Internal medicine, Chung-Kang Branch, Cheng-Ching General Hospital Abstract Pulmonary
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
Management in the pre-hospital setting
Management in the pre-hospital setting Inflammation of the joints Two main types: Osteoarthritis - cartilage loss from wear and tear Rheumatoid arthritis - autoimmune disorder Affects all age groups,
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.
Early identification and treatment - the Norwegian perspective. Till Uhlig Dept of Rheumatology Diakonhjemmet Hospital Oslo, Norway
Early identification and treatment - the Norwegian perspective Till Uhlig Dept of Rheumatology Diakonhjemmet Hospital Oslo, Norway Oslo Rheumatoid Arthritis Registry (ORAR) Very early Arthritis Clinic
The new Heart Failure pathway
The new Heart Failure pathway An integrated and seamless Strategy Dr Sunil Balani Definition of Heart Failure The inability of the heart to pump blood at a rate commensurate with the requirements of metabolising
SF-DCT INFORMATION FOR SCLERODERMA (SS) CLAIMS OPTIONS 1 & 2
SF-DCT INFORMATION FOR SCLERODERMA (SS) CLAIMS OPTIONS 1 & 2 1 Scleroderma (SS) Scleroderma (skler-a-der-ma) Scleroderma is a chronic and progressive disease that causes inflammation and thickening 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
on behalf of the AUGMENT-HF Investigators
One Year Follow-Up Results from AUGMENT-HF: A Multicenter Randomized Controlled Clinical Trial of the Efficacy of Left Ventricular Augmentation with Algisyl-LVR in the Treatment of Heart Failure* Douglas
Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.
Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years
ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY
Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF
Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla
Hodgkin Lymphoma Disease Specific Biology and Treatment Options John Kuruvilla My Disclaimer This is where I work Objectives Pathobiology what makes HL different Diagnosis Staging Treatment Philosophy
Rheumatoid arthritis (RA) is a systemic inflammatory disorder which has pleuroparenchymal
Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disorder which has pleuroparenchymal involvement with varied manifestations which includes organizing pneumonia, interstitial fibrosis,
Juvenile idiopathic arthritis and its long term outcome
Focus Juvenile idiopathic arthritis and its long term outcome Sue Rudge is a paediatric rheumatologist at the Wellington Regional Rheumatology Unit and Starship Hospital, Auckland Introduction KEY POINTS
Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
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
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
Chest Pain. Acute Myocardial Infarction: Differential Diagnosis and Patient Management. Common complaint in ED. Wide range of etiologies
Acute Myocardial Infarction: Differential Diagnosis and Patient Management Presented By: Barbara Furry, RN-BC, MS, CCRN, FAHA Director The Center of Excellence in Education Director of HERO Chest Pain
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: