[Pulmonary hypertension].

Area of Science:

• Cardiology
• Pulmonology
• Vascular Medicine

Context:

• Pulmonary hypertension (PH) is a progressive condition marked by elevated pulmonary arterial pressure.
• This elevation leads to right ventricular hypertrophy and dilatation, ultimately reducing cardiac ejection fraction.
• PH can stem from increased downstream pressure, hyperkinetic states, or elevated pulmonary vascular resistance.

Purpose:

• To provide an overview of pulmonary hypertension, its pathophysiology, clinical presentation, and evolving treatment landscape.
• To highlight the challenges and risks associated with surgical and anesthetic management in PH patients.

Summary:

• Pulmonary hypertension is defined by increased pulmonary arterial pressure, causing right ventricular strain and impaired function.
• Pathophysiologically, it can be passive, hyperkinetic, or due to increased pulmonary vascular resistance.
• Advanced stages involve right ventricular hypertrophy, tricuspid regurgitation, and septal deviation, impacting overall cardiac function.
• Clinical symptoms are often non-specific, complicating early diagnosis.
• Historically, treatment was limited; however, newer therapies include nitric oxide, phosphodiesterase-5 inhibitors (e.g., sildenafil), prostacyclin analogs, and endothelin receptor antagonists.
• Surgery and anesthesia present significant risks, including right ventricular failure, postoperative hypoxia, and coronary ischemia.

Impact:

• Understanding the multifaceted nature of pulmonary hypertension is crucial for effective patient management.
• The advent of novel pharmacotherapies has expanded treatment options, improving patient outcomes.
• Awareness of surgical risks is vital for perioperative care planning in this vulnerable patient population.