Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 59: Pulmonary HTN with Jochen Steppan
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Oct 17, 2017 Dr. Jochen Steppan, an international pulmonary hypertension expert, discusses the basics and diagnosis of pulmonary hypertension. They also cover the use of cell dentifil, vasopressin, and milrinone in treatment. The importance of heart rate and volume status is highlighted. Complications in the post-operative phase are explored with an emphasis on pain control and fluid shifts.
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Pulmonary Hypertension Definition
- Pulmonary hypertension is defined by a mean pulmonary artery pressure above 25 mmHg at rest measured by right heart catheterization.
- It involves complex mechanisms including inflammation, endothelial dysfunction, and impaired vasodilation.
Severity Not Defined by Pressures
- Severity classifications like mild, moderate, or severe pulmonary hypertension are not officially defined.
- Patient symptoms and right heart function are more predictive of outcomes than pulmonary artery pressure alone.
Preoperative Testing Recommendations
- Evaluate pulmonary hypertension patients preoperatively with exercise tolerance and a six-minute walk test when possible.
- Echocardiograms and right heart catheterization data, including vasoreactivity testing, are vital for assessment.