2001, Number S1
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Arch Cardiol Mex 2001; 71 (S1)
Right ventricular failure in pulmonary hypertension
Sandoval ZJ
Language: Spanish
References: 10
Page: 164-167
PDF size: 38.80 Kb.
ABSTRACT
The present review is focused on chronic RV pressure overload or Cor Pulmonale as it may occur in the setting of two distinct disorders: those associated with abnormal pulmonary gas exchange (hypoxemia and/or hypercapnia) where chronic obstructive pulmonary disease (COPD) is the leading cause, and those associated with pulmonary vascular obstruction where primary pulmonary hypertension (PDDH) is the representative example. The clinical curse, prognostic, implications, and therapeutic strategies differ considerably in these two clinical entities. Right ventricular failure (RVF) may adversely influence the natural history and prognosis of patients with diverse cardiopulmonary disorders. It has been long established that right ventricular (RV) ischemia, RV overload, and RV pressure overload, alone or in combination, are the main factors involved in the pathogenesis of RVF. From the pathophysiologic point of view, RVF of COPD is more a congestive type of failure, in which activation of renin-angiotensin system is involved. In PPH, a low cardiac output state is predominant and the precise mechanism of RVF remains unknown. Current evidence in favor of the pathogenetic role of ischemia, adrenergic overdrive, and genetic determination are all reviewed during the course.
REFERENCES
BARNARD D, ALPERT JS: Right ventricular function in health and disease. Curr Probl Cardiol 1987; 12: 417-449.
BRISTOW M, ZIZMAN L, LANCES BD, ABRAHAM WT, BADESCH DB, GROVES B, VOELKEL NF, LYNCH DMB, QUAIFE RA: The pressure-overloaded right ventricle in pulmonary hypertension. Chest 1998; 114: 101S-106S.
SANDOVAL J, BAUERLE O, PALOMAR A, GÓMEZ A, MARTÍNEZ-GUERRA ML, BELTRÁN M, ET AL: Survival in primary pulmonary hypertension: validation of a prognostic equation. Circulation 1994; 89: 1733-44.
VLAHAKES GJ, TURLEY K, HOFFMAN JIE: The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical correlations. Circulation 1981; 63: 87-95.
FERLINZ J: Right ventricular function in adult cardiovascular disease. Prog Cardiovasc Dis 1982; 25: 225-267.
PIENE H: Pulmonary arterial impedance and right ventricular function. Physiol Rev 1986; 66: 606-651.
MACNEE W: Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 150: 833-852 (Part I); 1158-1168 (Part II).
CARGILL RI, KIELY DG, LIPWORTH BJ: Hypoxemia and the renin-angiotensin system: New answers for old questions. Pulm Pharmacol 1994; 7: 279-284.
ZAJARIAS A, GÓMEZ A, BIALOSTOZKY D, SANTOS LE, PALOMAR A, MARTÍNEZ-GUERRA ML, ARIAS A, SANDOVAL J: Right ventricular ischemia in patients with primary pulmonary hypertension. Chest 1999; 268S (Abstract).
SANDOVAL J, GASPAR J, PULIDO T, BAUTISTA E, MARTÍNEZ-GUERRA ML, ZEBALLOS M, ET AL: Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment. J Am Coll Cardiol 1998; 32: 297-304.
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