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Harrison's Principles of Internal Medicine, 18e
| Part 10. Disorders of the Cardiovascular System > Section 5. Vascular Disease > |
Chapter 250. Pulmonary Hypertension
Sections: Pulmonary Hypertension: Introduction, Pulmonary Arterial Hypertension, Idiopathic Pulmonary Arterial Hypertension, Conditions Associated with Pulmonary Hypertension, Pulmonary Venous Hypertension, Pulmonary Hypertension Associated with Lung Disease and Hypoxemia, Pulmonary Hypertension Due to Thromboembolic Disease, Other Disorders Affecting the Pulmonary Vasculature, Further Readings.
Topics Discussed: pulmonary hypertension.
Excerpt:"Pulmonary hypertension, an abnormal elevation in pulmonary artery pressure, may be the result of left heart failure, pulmonary parenchymal or vascular disease, thromboembolism, or a combination of these factors. Whether the pulmonary hypertension arises from cardiac, pulmonary, or intrinsic vascular disease, it generally is a feature of advanced disease. Because the causes of pulmonary hypertension are so diverse, it is essential that the etiology underlying the pulmonary hypertension be clearly determined before beginning treatment.The right ventricle responds to an increase in pulmonary vascular resistance by increasing right ventricular (RV) systolic pressure to preserve cardiac output. In some patients, chronic changes occur in the pulmonary circulation, resulting in progressive remodeling of the vasculature, which can sustain or promote pulmonary hypertension even if the initiating factor is removed.(Fig. 250-1) The chest x-ray generally shows enlarged central pulmonary arteries. The lung fields may reveal other pathology. The electrocardiogram usually shows right axis deviation and RV hypertrophy. The echocardiogram commonly demonstrates RV and right atrial enlargement, a reduction in left ventricular (LV) cavity size, and..."
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