medigraphic.com
A partir del año 2010, la Revista Oficial del INER cambió a NCT (Neumología y Cirugía de Tórax)

 Ver actualización

2004, Number S1

<< Back Next >>

Rev Inst Nal Enf Resp Mex 2004; 17 (S1)

Pulmonary hypertension in chronic obstructive pulmonary disease

Villegas EJF

Language: Spanish
References: 31
Page: 71-82
PDF size: 928.96 Kb.


ABSTRACT

Pulmonary hypertension is the most common and serious cardiovascular complication in patients with severe chronic obstructive pulmonary disease. Its has a variable degrees of severity, but when a patient is symptomatic or the diagnosis clinical of that disease, the quality of life and survival are very limited, for this reason it has been considered one of main predictors of mortality. There are several steps in its development with important anatomic changes in the pulmonary vasculature without non specific symptoms; however the patient usually refers respiratory symptoms as shortness of breath, retroesternal chest pain and pedal edema.
Standard evaluation includes history and physical examination, chest X ray, spirometry, electrocardiography, arterial blood gases, DLCO, 6-minute walk test, cardiopulmonary exercise testing and the exhale expired gases analysis, but all of them are usually inadequate to identify right ventricular dysfunction. Noninvasive techniques such as electrocardiogram, echocardiography, radionuclide ventriculography, transcutaneous jugular vein blood flow, high resolution CT-scan and magnetic resonance imaging, have largely replaced invasive pulmonary artery catheterization in the initial assessment of pulmonary hypertension and cor pulmonale, but the gold standard still being the right heart catheterization. There is not a specific treatment and includes bronchodilators both ß adrenergics and anticholinergics, theophylline, oxygen, diuretics, vasodilators, nitric oxide, prostaglandins, receptor-1 antagonists, sildenafil, phlebotomy and inotropic medications but the outcome is poor in a short time.


REFERENCES

  1. Pauels RA, Buits S, Calvery PMA, Jenkins C, Hurd S. Global Strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Am J Respir Crit Care Med 2001;(163):1256-1276.

  2. Lee-Chiong TL, Matthay RA. Pulmonary Hypertension and Cor Pulmonale in COPD. Semin Respir Crit Care Med 2003;24(3):263-272

  3. Kessler R, Faller M, Weitzenblum E, CHaouat A, Aykut A, Ducoloné A, et al. Natural History of Pulmonary Hypertension in a Series of 131 Patients with Chronic Obstructive Lung Disease. Am J Respir Crit Care Med 2001;164:219-224.

  4. Wiedemann HP, Matthay RA. Cor Pulmonale in Chronic Obstructive Pulmonary Disease. Clin Chest Med 1990;11:523-545

  5. Budev MM, Arroliga A, Weidemann, HP, Matthay RA. Cor Pulmonale: An Overview. Semin Respir Crit Care Med 2003;24(3):233-243.

  6. Stevens D, Sharma K, Rich S, Mc Laughlin V, Kesten S. Severe Pulmonary Hypertension Associated with COPD. Am J Respir Crit Care Med 1999;159:A155.

  7. Presberg KW, Dincer E. Pathophysiology of Pulmonary Hypertension Due to Lung Disease. Curr Opin Pulm Med 2003;9(2):131-138.

  8. MacNee W. Pathophysiology of Cor Pulmonale in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1994;150:833-852.

  9. MacNee W. Pathophysiology of Cor Pulmonale in Chronic Obstructive Pulmonary Disease: Part Two. Am J Respir Crit Care Med 1994;150:1158-1168.

  10. Barberá JA, Peinado VI, Santos S. Pulmonary Hipertensión in Chronic Obstructive Pulmonary Disease. Eur Respir J 2003;21:892-905.

  11. Clini E, Cremona G, Campana M, Scotti C, Pagani M, Bianchi L, et al. Production of Endogenous Nitric Oxide in Chronic Obstructive Pulmonary Disease and Patients with Cor Pulmonale. Am J Respir Crit Care Med 2002;162:446-450.

  12. Hill NS. The Cardiac Exam in Lung Disease. Clin Chest Med 1987;8:273-285.

  13. Baudouin SV. Oedema and Cor Pulmonale Revisited. Thorax 1997;52:401-402.

  14. Chetty KG, Brown SE, Light RW. Identification of Pulmonary Hypertension in Chronic Obstructive Disease From Routine Chest Radiographs. Am Rev Respir Disease 1982;126:338-341.

  15. Longmore DB, Klipstein RH, Underwood SR, Firmin DN, Hounsfield GN, Watanabe M. Dimensional Accuracy of Magnetic Resonance Studies of the Heart. Lancet 1985;1:1360-1362.

  16. American Thoracic Society. Guidelines for the Six Minute Walk Test. Am J Respir Crit Care Med 2002;166:111-117.

  17. Carter R, Holiday DB, Nwasuruba C, Stocks J, Tiep B. 6-Minute Walk Work for Assessment of Functional Capacity in Patients with COPD. Chest 2003;123: 1408-1415.

  18. Incalzi RA, Fuso L, De Rosa M, Di Napoli A, Basso S, Paliari G. Electrocardiographic Signs of Chronic Cor Pulmonale: a Negative Prognostic Finding in Chronic Obstructive Pulmonary Disease. Circulation 1999;99:1600.

  19. Arcasoy SM, Christie JD, Ferrari VA, Sutton MSJ, Zisman DA, Blumenthal NP, et al. Echocardiographic Assessment of Pulmonary Hypertension in Patients with Advanced Lung Disease. AJRCCM 2003;167:735-740.

  20. Nocturnal Oxygen Therapy Trial Group. Continuous or Nocturnal Oxygen Therapy in Hypoxemic Chronic Obstructive Lung Disease. Ann Intern Med 1980;93:391-398.

  21. Roberts, DH; Lepore, JJ, Maroo A, Semigran MJ, Ginns LC. Oxygen Therapy Improves Cardiac Index and Pulmonary Vascular Resistance in Patients With Pulmonary Hypertension. Chest 2001;120:1547-1555.

  22. Sajkov D, Wang T, Frith PA, Bune AJ, Alpers JA, McEvoy RD. A Comparison of Two Long-Acting Vasoselective Calcium Antagonists in Pulmonary Hypertension Secondary to COPD. Chest 1997; 111:1622-1630.

  23. Roger N, Barberà JA, Roca J, Rovira I, Gómez FP, Rodriguez-Roisin R. Nitric Oxide Inhalation During Exercise in Chronic Obstructive Pulmonary Disease. AJRCCM 1997;156:800-806.

  24. Cockrill BA, Kacmarek RM, Fifer MA, Bigatello LM, Ginns LC, Zapol WM, et al. Comparison of the Effects of Nitric Oxide, Nitroprusside, and Nifedipine on Hemodynamics and Right Ventricular Contractility in Patients With Chronic Pulmonary Hypertension. Chest 2001; 119:128-136.

  25. Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S, Badesch DB, et al. The Primary Pulmonary Hypertension Study Group. A Comparison of Continuous Intravenous Epoprostenol (Prostacyclin) with Conventional Therapy for Primary Pulmonary Hypertension. N Engl J Med 1996; 334:296-301.

  26. Blumberg FC, Riegger JAG, Pfeifer M. Hemodynamic Effects of Aerosolized Iloprost in Pulmonary Hypertension at Rest and During Exercise. Chest 2002;121:1566-1571.

  27. Olschewski H, Rohde B, Behr J, Ewert R, Gessler T, Ghofrani HA, et al. Pharmacodynamics and Pharmacokinetics of Inhaled Iloprost, Aerosolized by Three Different Devices, in Severe Pulmonary Hypertension. Chest 2003;124:1294-1304.

  28. Sitbon O, Badesch DB, Channick RN, Frost A, Robbins IM, Simonneau G, et al. Effects of the Dual Endothelin Receptor Antagonist Bosentan in Patients with Pulmonary Arterial Hypertension: A 1-Year Follow-up Study. Chest 2003;124: 247-254.

  29. Stiebellehner L, Petkov V, Vonbank K, Funk G, Schenk P, Ziesche R, et al. Long term Treatment with Oral Sildenafil in Addition to Continuous IV Epoprostenol in Patients with Pulmonary Arterial Hypertension. Chest 2003;123:1293-1295.

  30. Lodato RF. Viagra for Impotence of Pulmonary Vasodilator Therapy? AJRCCM 2001;163:312.

  31. 31 Ziegler JW, Ivy DD, WigginsJW, Kinsella JP, Clarke WR, Abman SH. Effects of Dipyridamole and Inhaled Nitric Oxide in Pediatric Patients with Pulmonary Hypertension. AJRCCM 1998;158:1388-1395.




2020     |     www.medigraphic.com