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Related Concept Videos

Pulmonary Hypertension: Classification and Pathogenesis01:30

Pulmonary Hypertension: Classification and Pathogenesis

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Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
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Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers01:26

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Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
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Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure01:16

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Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
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Cardiac Catheterization II: Right Heart Catheterization01:21

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Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Right Atrial Function in Pulmonary Arterial Hypertension.

Gabriela Querejeta Roca1, Patricia Campbell1, Brian Claggett1

  • 1From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.

Circulation. Cardiovascular Imaging
|October 31, 2015
PubMed
Summary

Right atrial (RA) reservoir and conduit functions are impaired in pulmonary arterial hypertension (PAH), even when accounting for RA size and pressure. These findings suggest underlying right ventricular failure in PAH patients.

Keywords:
echocardiographypulmonary heart diseasepulmonary hypertensiontrials

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Area of Science:

  • Cardiology
  • Pulmonary Hypertension
  • Cardiac Imaging

Background:

  • Elevated right atrial (RA) pressure is a known prognostic indicator in pulmonary arterial hypertension (PAH).
  • Limited understanding exists regarding the specific functional changes within the RA in PAH.
  • The study investigates RA function beyond pressure measurements.

Purpose of the Study:

  • To assess and compare the reservoir, conduit, and active functions of the RA in PAH patients versus healthy controls.
  • To investigate the association between RA functional parameters and invasive hemodynamics, cardiac structure, and N-terminal pro brain natriuretic peptide levels in PAH.
  • To elucidate the role of RA dysfunction in the context of right ventricular overload and failure.

Main Methods:

  • Utilized 2D speckle tracking to evaluate RA longitudinal strain (RA LS) in reservoir, conduit, and active phases.
  • Included 65 PAH patients (on multiple PAH-specific therapies) and 30 healthy controls.
  • Correlated RA functional measures with invasive hemodynamics, cardiac imaging, and NT-proBNP levels.

Main Results:

  • PAH patients exhibited significantly reduced RA reservoir (RA LS) and conduit (RA early LS rate) functions compared to controls, even after adjusting for RA size and pressure.
  • RA late LS rate was similar between groups, indicating preserved active RA function.
  • Worse RA LS in PAH patients correlated with larger RA size, higher RA pressure, right ventricular enlargement and dysfunction, and elevated NT-proBNP, independent of RA size and pressure.

Conclusions:

  • Right atrial reservoir and passive conduit functions are significantly impaired in PAH.
  • These functional deficits are independent of RA size and pressure, suggesting they are a consequence of right ventricular failure and overload.
  • RA functional assessment provides valuable insights into the pathophysiology of PAH beyond traditional pressure measurements.