Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension

Authors

Roxanne Pisa MHA, MSPA, PA-C, University of LynchburgFollow

Specialty

Cardiothoracic Surgery

Abstract

Early diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) significantly improve morbidity and mortality for patients suffering from this condition. Pulmonary embolism (PE) is a disruption to the blood flow of the pulmonary vasculature, due to obstruction from a clot. This phenomenon leads to decreased gas exchange of oxygen and carbon dioxide between the alveoli of the lungs and the pulmonary capillary beds. Additionally, PE causes increased pulmonary vascular resistance (PVR), leading to right heart failure and cardiogenic shock if left untreated. Pulmonary embolism affects many, and more importantly, carries a high risk of morbidities, such as CTEPH in 5% of those affected by PE, and mortality. CTEPH is treatable, especially in its early stages. However, morbidity and mortality increase greatly if the diagnosis is delayed or missed. In a patient with a known history of PE, with persistent or progressive dyspnea, it is imperative to investigate further. Echo and CT chest are non-invasive options to start with, as well as a V/Q scan to look for perfusion defects in the pulmonary vasculature. Once the diagnosis is made, treatment options include medical management of pulmonary hypertension with a vasodilator and vitamin K agonist (eg. warfarin), balloon pulmonary angioplasty (BPA), and/or depending on the location of the pulmonary vascular obstruction, pulmonary endarterectomy (PEA). Early diagnosis and treatment are essential for increased survival and quality of life.

Recommended Citation

Pisa R. Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(2).