Navigating the identification, diagnosis and management of pulmonary hypertension using the updated ESC/ERS guidelines
|
|
|
- Shanon Boone
- 5 years ago
- Views:
Transcription
1 Navigating the identification, diagnosis and management of pulmonary hypertension using the updated ESC/ERS guidelines Host: Marc Humbert Speaker: Simon Gibbs
2 Marc HUMBERT, MD, PhD Professor of Respiratory Medicine Centre National de Référence de l Hypertension Pulmonaire Sévère Hôpital Bicêtre Assistance Publique Hôpitaux de Paris Inserm U999 Université Paris-Sud Le Kremlin-Bicêtre, France 2
3 DISCLOSURE Actelion: consultancy (current), board or advisory committee (current), speaker (current) Bayer: consultancy (current), board or advisory committee (current), speaker (current), research support (current) GSK: consultancy (current), board or advisory committee (current), speaker (current), research support (current) Novartis: consultancy (current), board or advisory committee (current), speaker (current) Pfizer: consultancy (current), board or advisory committee (current), speaker (current), research support (past) 3
4 Navigating the identification, diagnosis and management of pulmonary hypertension using updated ESC/ERS guidelines Case 1 Simon Gibbs Imperial College London & Hammersmith Hospital, London, UK
5 DISCLOSURE Actelion: consultancy (current), board or advisory committee (current), speaker (current) Amco: educational grant (current) Bayer: consultancy (current), board or advisory committee (current), speaker (current) Bellepheron: consultancy (current) Gilead: consultancy (past) GSK: consultancy (current), board or advisory committee (current), speaker (current) Pfizer: consultancy (current), board or advisory committee (past), speaker (past) United Therapeutics: educational grant (current) 5
6 Abbreviations we shall use PH, pulmonary hypertension PAH, pulmonary arterial hypertension CTEPH, chronic thromboembolic pulmonary hypertension RV, right ventricle
7 69 y old female: presenting complaint 2 years gradual onset breathlessness on exertion 18 months ankle swelling 2 weeks admitted to local hospital: poor exercise tolerance and low oxygen saturation echo:? pulmonary hypertension treated with diuretics and oxygen Referred to Hammersmith Hospital
8 69 y old female WHO functional class III Breathless walking m on the level No orthopnoea, paroxysmal nocturnal dyspnoea, syncope, angina or palpitations Past history Systemic hypertension Diabetes mellitus type II Chronically impaired renal function (egfr 34 ml/min) Hypercholesterolaemia Cholecystectomy
9 69 y old female Ex smoker 20 y previously; 20 pack years Treatment included: furosemide 40 mg od bisoprolol 5 mg od ramipril 2.5 mg od atorvastatin 40 mg od gliclazide MR 30 mg od
10 69 y old female: examination Well perfused Heart rate 80 bpm BP 135/74 Jugular venous pressure +7 cm by inspection Respiratory rate 18 per min Oxygen saturation on oxygen 2l/min = 85% Loud P2 Chest clear Mild ankle swelling
11 Echocardiogram tricuspid regurgitation velocity
12 Question: In this patient with a tricuspid regurgitation velocity of 3.3 m/s: This velocity translates to a mean pulmonary artery pressure of 24 mm Hg Pulmonary hypertension is not likely to be clinically significant and the patient should be discharged The patient requires cardiac catheterization Further echocardiographic measurements should be made at this stage A repeat echocardiogram should be undertaken in 4-6 months
13 Echocardiographic probability of PH in symptomatic patients with a suspicion of PH Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
14 Echocardiogram parasternal short axis
15 Echocardiogram apical 4 chamber
16 Echocardiogram pulmonary artery 29 mm
17 Echocardiographic signs suggesting PH used to assess the probability of PH in addition to tricuspid regurgitation velocity measurements For more details of echocardiographic assessment of the right heart: Rudski LG et al J Am Soc Echocardiogr 2010;23: Lang RM et al Eur Heart J Cardiovasc Imaging 2015;16: Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
18 Diagnostic management according to echocardiographic probability of PH in patients with symptoms, without risk factors for PAH or CTEPH Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
19 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
20 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
21 Resting ECG on admission
22 Lung function FEV l 119% predicted FVC 3.18 l 133% FEV1/FVC 74% Gas diffusion and static lung volumes were not measured because the patient was unwilling to come off oxygen. On 2 l/min oxygen: ph 7.45 PCO2 4.3 kpa po2 7.2 kpa Bicarbonate 24.0 mmol/l
23 Chest radiograph on admission
24 Coronal CT showing dilated pulmonary artery and normal lung parenchyma with preserved volumes; CTPA showed no thromboembolism
25 Diagnostic algorithm for pulmonary hypertension What would you do next? Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
26 Question: What would you do next? The clinical picture now looks like COPD: commence therapy for COPD Arrange a ventilation perfusion scan Undertake cardiac catheterization Arrange a dual energy CT scan Arrange a cardiopulmonary exercise test
27 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
28 Ventilation perfusion scan: bilateral reduced upper lobe perfusion and normal ventilation scan
29 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
30 Recommendations for right heart catheterization in pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
31 95% 123/70 m92 64% = 10 91% 64% mean 14 84/37 m54 Vasoreactivity study with nitric oxide negative 66%
32 Pulmonary Arterial Hypertension PAPm 25 mmhg; PAWP 15 mmhg; PVR > 3 Wood units PAPm, mean pulmonary artery pressure; PAWP, pulmonary artery wedge pressure; PVR, pulmonary vascular resistance
33 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
34 What type of PAH? History No history of exposure to drugs / toxins associated with PAH No history of travel outside Europe No history of congenital heart disease Two generation family history negative Blood tests Autoimmune screen negative including antinuclear antigen, double stranded DNA ELISA, ANCA, antiphospholipid antibodies HIV-1 and HIV-2 serology negative Hepatitis B and C negative Liver function tests were within normal limits
35 Liver ultrasound showing normal portal blood flow
36 Diagnostic algorithm for pulmonary hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
37 37 Galie N et al Eur Heart J 2016;37: & Eur Respir J 46: Comprehensive clinical classification of pulmonary hypertension Pulmonary arterial hypertension describes a group of PH patients with pre-capillary PH with a PVR >3 Wood units
38 Risk assessment in pulmonary arterial hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
39 Risk assessment in pulmonary arterial hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
40 Question: What treatment of PAH do you recommend? 1. Calcium channel blocker 2. Phosphodiesterase 5 inhibitor or a soluble guanylate cyclase stimulator 3. Endothelin receptor antagonist 4. Intravenous epoprostenol with/without a phosphodiesterase 5 inhibitor or an endothelin receptor antagonist 5. Combination of 2 and 3
41 Treatment algorithm for pulmonary arterial hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
42 Treatment algorithm for pulmonary arterial hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
43 PAH treatment Sildenafil 20 mg TDS Warfarin to maintain INR 2-3 Long-term oxygen therapy 3l/min Furosemide 40 mg Bisoprolol discontinued
44 Risk assessment after 3 months monotherapy Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
45 Treatment algorithm for pulmonary arterial hypertension Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
46 PAH treatment: sequential combination Ambrisentan 10 mg OD Sildenafil 20 mg TDS Warfarin to maintain INR 2-3 Long-term oxygen therapy 3l/min Furosemide 40 mg
47 Risk assessment after 6 months dual oral combination Galie N et al Eur Heart J 2016;37: & Eur Respir J 46:903-75
48 PAH treatment: sequential combination at 6 months treatment Nebulized iloprost 2.5 mcg uptitrated to 5 mcg six times/day Ambrisentan 10 mg OD Sildenafil 20 mg TDS Warfarin to maintain INR 2-3 Long-term oxygen therapy 2l/min Furosemide 40 mg
49 Summary A 69 year old female presented with 2 years worsening breathlessness and ankle swelling in WHO functional class III. Investigations confirmed a diagnosis of idiopathic PAH which was treated with sequential monotherapy. Although she improved, she remained at intermediate risk. Treatment has been escalated with the aim of achieving a low risk state.
50 Key messages Echocardiography is the first investigation of choice in patients with suspected pulmonary hypertension Follow the diagnostic algorithm Risk assessment guides treatment of PAH
The Case of Marco Nazzareno Galiè, M.D.
The Case of Marco Nazzareno Galiè, M.D. DIMES Disclosures Consulting fees and research support from Actelion Pharmaceuticals Ltd, Bayer HealthCare, Eli Lilly and Co, GlaxoSmithKline and Pfizer Ltd Clinical
The Case of Lucia Nazzareno Galiè, M.D.
The Case of Lucia Nazzareno Galiè, M.D. DIMES Disclosures Consulting fees and research support from Actelion Pharmaceuticals Ltd, Bayer HealthCare, Eli Lilly and Co, GlaxoSmithKline and Pfizer Ltd Clinical
Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college
Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college PULMONARY HYPERTENSION Difficult to diagnose early Because Not detected during routine physical examination and Even in advanced cases symptoms
From Pulmonary Embolism to Chronic Thromboembolic Pulmonary Hypertension
From Pulmonary Embolism to Chronic Thromboembolic Pulmonary Hypertension Dr Rachel Davies Respiratory Physician National Pulmonary Hypertension Service Hammersmith Hospital Royal College of Physicians
SA XXXX Special Authority for Subsidy
SA XXXX Special Authority for Subsidy Special authority approved by the Pulmonary Arterial Hypertension (PAH) Panel. Application forms can be obtained from PHARMAC s website: www.pharmac.govt.nz or: PAH
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY Contents Eligibility criteria for Pulmonary Arterial Hypertension therapy...2-6 Initial Application for funding of Pulmonary Arterial Hypertension
Real-world experience with riociguat in CTEPH
Real-world experience with riociguat in CTEPH Matthias Held Center of Pulmonary Hypertension and Pulmonary Vascular Disease, Medical Mission Hospital, Würzburg, Germany Tuesday, 29 September ERS International
ADVANCED THERAPIES FOR PHARMACOLOGICAL TREATMENT OF PULMONARY HYPERTENSION
Status Active Medical and Behavioral Health Policy Section: Medicine Policy Number: II-107 Effective Date: 04/21/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
Real life management of CTEPH: patient case
2 nd International Congress on cardiovascular imaging in clinical practice k Real life management of CTEPH: patient case Anastasia Anthi Pulmonary Hypertension Clinic, Attikon University Hospital, Athens
Case Presentation : Pulmonary Hypertension: Diagnosis and Imaging
Case Presentation 9.40-11.20: Pulmonary Hypertension: Diagnosis and Imaging Eftychia Demerouti MD, MSc, PhD Cardiologist Onassis Cardiac Surgery Center Conflicts of interest Consulting fees and fees for
Pulmonary Hypertension: When to Initiate Advanced Therapy. Jonathan D. Rich, MD Associate Professor of Medicine Northwestern University
Pulmonary Hypertension: When to Initiate Advanced Therapy Jonathan D. Rich, MD Associate Professor of Medicine Northwestern University Disclosures Medtronic, Abbott: Consultant Hemodynamic Definition of
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal. Drugs for the treatment of pulmonary arterial hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Drugs for the treatment of Draft remit / appraisal objective: Draft scope To appraise the clinical and cost effectiveness
Pharmacy Management Drug Policy
SUBJECT: Pulmonary Arterial Hypertension (PAH) POLICY NUMBER: Pharmacy-42 Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed
Teaching Round Claudio Sartori
Teaching Round 14.03.2017 Claudio Sartori Cas clinique Femme 47 ans, connue pour un BPCO, asthénie, douleurs thoraciques, dyspnée à l effort, œdèmes membres inférieurs, deux syncopes. Tabac, BMI 31 kg/m2
Pulmonary hypertension in sarcoidosis
Pulmonary hypertension in sarcoidosis Olivier SITBON Centre de Référence de l Hypertension Pulmonaire Sévère Hôpital Universitaire de Bicêtre INSERM U999 Université Paris-Sud Le Kremlin-Bicêtre France
Pulmonary Arterial Hypertension - Overview
Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The
Pulmonary Arterial Hypertension - Overview
Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The
Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension
Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension Hap Farber Director, Pulmonary Hypertension Center Boston University School of Medicine Disclosures 1) Honoria: Actelion, Gilead,
PULMONARY HYPERTENSION
PULMONARY HYPERTENSION REVIEW & UPDATE Olga M. Fortenko, M.D. Pulmonary & Critical Care Medicine Pulmonary Vascular Diseases Sequoia Hospital 650-216-9000 Olga.Fortenko@dignityhealth.org Disclosures None
Pulmonary arterial hypertension. Pulmonary arterial hypertension: newer therapies. Definition of PH 12/18/16. WHO Group classification of PH
Pulmonary arterial hypertension Pulmonary arterial hypertension: newer therapies Ramona L. Doyle, MD Clinical Professor of Medicine, UCSF Attending Physician UCSF PH Clinic Definition and classification
Cardiovascular Images
Cardiovascular Images Pulmonary Embolism Diagnosed From Right Heart Changes Seen After Exercise Stress Echocardiography Brian C. Case, MD; Micheas Zemedkun, MD; Amarin Sangkharat, MD; Allen J. Taylor,
Pulmonary Hypertension Perioperative Management
Pulmonary Hypertension Perioperative Management Bruce J Leone, MD Professor of Anesthesiology Chief, Neuroanesthesiology Vice Chair for Academic Affairs Mayo Clinic Jacksonville, Florida Introduction Definition
ΔΙΑΓΝΩΣΗ ΚΑΙ ΘΕΡΑΠΕΙΑ ΤΗΣ ΧΡΟΝΙΑΣ ΘΡΟΜΒΟΕΜΒΟΛΙΚΗΣ ΥΠΕΡΤΑΣΗΣ (CTEPH)
Aristotle University of Thessaloniki Cardiology Clinic, AHEPA Hospital ΔΙΑΓΝΩΣΗ ΚΑΙ ΘΕΡΑΠΕΙΑ ΤΗΣ ΧΡΟΝΙΑΣ ΘΡΟΜΒΟΕΜΒΟΛΙΚΗΣ ΥΠΕΡΤΑΣΗΣ (CTEPH) Charalampos I. Karvounis, MD Professor of Cardiology Aristotle
Pulmonary Hypertension in 2012
Pulmonary Hypertension in 2012 Evan Brittain, MD December 7, 2012 Kingston, Jamaica VanderbiltHeart.com Disclosures None VanderbiltHeart.com Outline Definition and Classification of PH Hemodynamics of
Pulmonary Arterial Hypertension: The Approach to Management in 2019
Pulmonary Arterial Hypertension: The Approach to Management in 2019 Munir S. Janmohamed M.D. FACC Medical Director Mechanical Circulatory Support/Heart Failure Program Mercy General Hospital/Mercy Medical
Pulmonary hypertension on. Simon MacDonald BSc(Hons) BMBCh DPhil FRCP Consultant Cardiologist in Adult Congenital Heart Disease
Pulmonary hypertension on echowhat next.? Simon MacDonald BSc(Hons) BMBCh DPhil FRCP Consultant Cardiologist in Adult Congenital Heart Disease Definition of PAH Mean PA pressure 25mmHg Precapillary if
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH Javier Jimenez MD PhD FACC Director, Advanced Heart Failure and Pulmonary Hypertension Miami Cardiac & Vascular Institute
National Horizon Scanning Centre. Tadalafil for pulmonary arterial hypertension. October 2007
Tadalafil for pulmonary arterial hypertension October 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a
1. Phosphodiesterase Type 5 Enzyme Inhibitors: Sildenafil (Revatio), Tadalafil (Adcirca)
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutic
Pharmacy Management Drug Policy
SUBJECT: POLICY NUMBER: PHARMACY-42 EFFECTIVE DATE: 6/2005 LAST REVIEW DATE: 4/19/2018 If the member s subscriber contract excludes coverage for a specific service or prescription drug, it is not covered
Assessing the Impact on the Right Ventricle
Advances in Tricuspid Regurgitation Congress of the European Society of Cardiology (ESC) Munich, August 25-29, 2012 Assessing the Impact on the Right Ventricle Stephan Rosenkranz, MD Clinic III for Internal
Oral Therapies for Pulmonary Arterial Hypertension
Oral Therapies for Pulmonary Arterial Hypertension Leslie Wooten, PharmD PGY2 Internal Medicine Pharmacy Resident University of Cincinnati Medical Center April 30 th, 2018 Objectives Pharmacist Objectives
Screening for CETPH after acute pulmonary embolism: is it needed? Menno V. Huisman Department of Vascular Medicine LUMC Leiden
Screening for CETPH after acute pulmonary embolism: is it needed? Menno V. Huisman Department of Vascular Medicine LUMC Leiden m.v.huisman@lumc.nl Background CETPH Chronic Thrombo Embolic Pulmonary Hypertension
Pulmonary Hypertension: Clinical Features & Recent Advances
Pulmonary Hypertension: Clinical Features & Recent Advances Lisa J. Rose-Jones, MD Assistant Professor of Medicine, Division of Cardiology Advanced Heart Failure/Cardiac Transplantation & Pulmonary Hypertension
Pulmonary Hypertension: Another Use for Viagra
Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A
Patient Case. Patient Case 6/1/2013. Treatment of Pulmonary Hypertension in a Community
Treatment of Pulmonary Hypertension in a Community Hospital Serena Von Ruden, PharmD, RN, BSN St. Francis Hospital Federal Way, WA Franciscan Health System HPI: 66 year old male with advanced oxygendependent
Cor pulmonale. Dr hamid reza javadi
1 Cor pulmonale Dr hamid reza javadi 2 Definition Cor pulmonale ;pulmonary heart disease; is defined as dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature
Sinus venosus atrial septal defect in a 31- year-old female patient: a case for surgical repair
Eur Respir Rev 2010; 19: 118, 340 344 DOI: 10.1183/09059180.00007610 CopyrightßERS 2010 CASE REPORT Sinus venosus atrial septal defect in a 31- year-old female patient: a case for surgical repair M.A.
Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How?
Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How? Teresa De Marco, MD University of California, San Francisco Disclosures: Grants/Research: United Therapeutics, Lung Biotechnology,
Therapeutic approaches in P(A)H and the new ESC Guidelines
Therapeutic approaches in P(A)H and the new ESC Guidelines Jean-Luc Vachiéry, FESC Head Pulmonary Vascular Diseases and Heart Failure Clinic Hôpital Universitaire Erasme Université Libre de Bruxelles Belgium
Chapter. Diffusion capacity and BMPR2 mutations in pulmonary arterial hypertension
Chapter 7 Diffusion capacity and BMPR2 mutations in pulmonary arterial hypertension P. Trip B. Girerd H.J. Bogaard F.S. de Man A. Boonstra G. Garcia M. Humbert D. Montani A. Vonk Noordegraaf Eur Respir
PULMONARY HYPERTENSION & THALASSAEMIA
3rd Pan-American Thalassaemia Conference Buenos Aires 2010 Dr Malcolm Walker Cardiologist University College & the Heart Hospital LONDON Clinical Director Hatter Cardiovascular Institute - UCLH PULMONARY
Pulmonary Hypertension. Pulmonary Arterial Hypertension Diagnosis, Impact and Outcomes
Pulmonary Hypertension Pulmonary Arterial Hypertension Diagnosis, Impact and Outcomes Pulmonary Arterial Hypertension Disease of small pulmonary arteries Characteristic changes Medial hypertrophy Intimal
PULMONARY ARTERIAL HYPERTENSION AGENTS
Approvable Criteria: PULMONARY ARTERIAL HYPERTENSION AGENTS Brand Name Generic Name Length of Authorization Adcirca tadalafil Calendar Year Adempas riociguat Calendar Year Flolan epoprostenol sodium Calendar
22nd Annual Heart Failure 2018 an Update on Therapy. Pulmonary Arterial Hypertension: Contemporary Approach to Treatment
22nd Annual Heart Failure 2018 an Update on Therapy Pulmonary Arterial Hypertension: Contemporary Approach to Treatment Ronald J. Oudiz, MD, FACP, FACC, FCCP Professor of Medicine The David Geffen School
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program Advanced Heart Failure & Cardiac Transplant Temple University
Where are we now in the longterm. of PAH and CTEPH? Hits and misses of medical treatment. Hap Farber Boston University School of Medicine, Boston, USA
Where are we now in the longterm management of PAH and CTEPH? Hits and misses of medical treatment Hap Farber Boston University School of Medicine, Boston, USA Monday, 28 September ERS International Congress
Annual Congress of the European Society of Cardiology Munich, August
Annual Congress of the European Society of Cardiology Munich, August 26 2012 Gas exchange measurements during exercise show early pulmonary arterial hypertension in scleroderma patients Daniel Dumitrescu,
ACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This continuing medical education activity is planned to meet the needs of primary care physicians who can contribute to early detection of disease and who are responsible
Disclosures. Objectives. RV vs LV. Structure and Function 9/25/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension
Disclosures A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension No financial relationships Susan P. D Anna MSN, APN BC, CHFN September 29, 2016 Objectives RV vs LV Differentiate
Understanding Complex Pulmonary Hypertension through Advanced Hemodynamics
Understanding Complex Pulmonary Hypertension through Advanced Hemodynamics Franz Rischard, DO, MS Director, Pulmonary Hypertension Program Assistant Professor of Medicine University of Arizona Lillian
2017 UnitedHealthcare Services, Inc.
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2020-10 Program Prior Authorization/Medical Necessity PAH Agents Medication Adcirca (tadalafil), Adempas (riociguat), Letairis
Abstract Book. Inspiring Approaches to Clinical Challenges in Pulmonary Hypertension
Inspiring Approaches to Clinical Challenges in Pulmonary Hypertension Abstract Book A symposium sponsored by Bayer Schering Pharma at ERS 2008 Annual Congress www.ventavis.com Welcome Dear Colleague, It
2/4/2011. Nathan Kerner, M.D.
Nathan Kerner, M.D. Definition Elevated pressures - cut off usually >40 mmhg pulmonary artery systolic pressure (PASP) Usually associated with elevated pulmonary vascular resistance (PVR) measured in dynessec/cm
Does Tadalafil Improve Exercise Capacitance in Patients over 12 Years Old with Pulmonary Hypertension?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2012 Does Tadalafil Improve Exercise Capacitance
Disclosures. Inhaled Therapy in Pediatric Pulmonary Hypertension. Inhaled Prostacyclin: Rationale. Outline
Disclosures Inhaled Therapy in Pediatric Pulmonary Hypertension The University of Colorado receives fees for Dr Ivy to be a consultant for Actelion, Gilead, Lilly, Pfizer, and United Therapeutics Dunbar
THERAPEUTICS IN PULMONARY ARTERIAL HYPERTENSION Evidences & Guidelines
THERAPEUTICS IN PULMONARY ARTERIAL HYPERTENSION Evidences & Guidelines Vu Nang Phuc, MD Dinh Duc Huy, MD Pham Nguyen Vinh, MD, PhD, FACC Tam Duc Cardiology Hospital Faculty Disclosure No conflict of interest
Pulmonary Hypertension Essentials. PD Dr. med. Silvia Ulrich Somaini University Hospital of Zurich
Pulmonary Hypertension Essentials PD Dr. med. Silvia Ulrich Somaini University Hospital of Zurich Agenda Basics and Presentation Classification Diagnosis Pathogenesis Diagnosis Treatment Pathogenesis and
The Hemodynamics of PH Interpreting the numbers
The Hemodynamics of PH Interpreting the numbers Todd M Bull MD Associate Professor of Medicine Division of Pulmonary Sciences and Critical Care Medicine Pulmonary Hypertension Center University of Colorado
MACITENTAN DEVELOPMENT IN CHILDREN WITH PULMONARY HYPERTENSION (PAH)
MACITENTAN DEVELOPMENT IN CHILDREN WITH PULMONARY HYPERTENSION (PAH) ORPHAN DRUG AND RARE DISEASE 11 MAY 2017 Catherine Lesage, MD, Pediatrics Program Head, Actelion Copyright AGENDA Pulmonary Arterial
Update in Pulmonary Arterial Hypertension
Update in Pulmonary Arterial Hypertension Michael J Sanley, MD April 12, 2018 Disclosures I have nothing to disclose 2 1 Case Presentation 67 yo male with atrial fibrillation, CLL on IVIG, presents with
National Horizon Scanning Centre. Oral and inhaled treprostinil for pulmonary arterial hypertension: NYHA class III. April 2008
Oral and inhaled treprostinil for pulmonary arterial hypertension: NYHA class April 2008 This technology summary is based on information available at the time of research and a limited literature search.
Updates on Pulmonary Hypertension Treatment
Updates on Pulmonary Hypertension Treatment Dane Mellgren, PharmD PGY-1 Pharmacy Practice Resident Hennepin County Medical Center 04/27/18 Disclosure I have no disclosures to be made regarding the content
Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year
![Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year](/thumbs/76/74263761.jpg "Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year")
PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart
Neonatal and Pediatric Pulmonary Vascular Disease
Neonatal and Pediatric Pulmonary Vascular Disease Emma Olson, MS, ARNP Pediatric Cardiology Nurse Practitioner Canadian Respiratory Conference April 14, 2018 Financial Interest Disclosure (over the past
Updates in Pulmonary Hypertension Pharmacotherapy. Ziad Sadik PharmD BCPS
Updates in Pulmonary Hypertension Pharmacotherapy Ziad Sadik PharmD BCPS Disclosure Information I have no financial relationship to disclose AND I will not discuss off label use and/or investigational
Chronic Thromboembolic Pulmonary Hypertention CTEPH
Chronic Thromboembolic Pulmonary Hypertention CTEPH Medical Management Otto Schoch, Prof. Dr. Klinik für Pneumologie und Schlafmedizin Kantonsspital St.Gallen CTEPH: Medical Management Diagnostic aspects
Contreversies in the management of PH What is controversial in treatment?
Contreversies in the management of PH What is controversial in treatment? Service de Pneumologie et Réanimation National reference center for pulmonary hypertension Université Paris Sud Hôpital Antoine
SATELLITE SYMPOSIUM OF MSD. sgc Stimulation for the treatment of PH. Real life management of PAH: case presentation
SATELLITE SYMPOSIUM OF MSD sgc Stimulation for the treatment of PH Real life management of PAH: case presentation Eftychia Demerouti MD, MSc, PhD Cardiologist Onassis Cardiac Surgery Center Conflict of
Clinical implication of exercise pulmonary hypertension: when should we measure it?
Clinical implication of exercise pulmonary hypertension: when should we measure it? Jang-Young, Kim Wonju College of Medicine, Yonsei Univ. Exercise pulmonary hypertension (EPH) Introduction of pulmonary
CONUNDRUMS IN PULMONARY ARTERIAL HYPERTENSION
CONUNDRUMS IN PULMONARY ARTERIAL HYPERTENSION MOHAMMED RAFIQUE ESSOP MILPARK HOSPITAL and UNIVERSITY OF THE WITWATERSRAND POINTS FOR DISCUSSION What is the pathogenetic mechanism of PAH? Importance of
Pulmonary Hypertension: ICD-10 I27.0, I27.2
Dr Manish Barman, MD. Membership and Affiliations ESC, European association of cardiovascular prevention and rehabilitation. Acute Cardiovascular Care Association. ESC, Working Group on Hypertension &
Atrial Fibrillation. A guide for Southwark General Practice. Key Messages. Always work within your knowledge and competency
Atrial Fibrillation A guide for Southwark General Practice Key Messages 1. Routinely offer pulse checks to patients at high risk of AF 2. Use the CHA 2 DS 2 VASc score to identify patients for anticoagulation
Πνευμονική Υπέρταση Ι.Ε. ΚΑΝΟΝΙΔΗΣ
Πνευμονική Υπέρταση Ι.Ε. ΚΑΝΟΝΙΔΗΣ PH is defined as PAPm 25 mm Hg at rest The general definition of PH remains unchanged Most of the relevant epidemiological and therapeutic studies have used the 25 mm
Medical Therapy for Pulmonary Arterial Hypertension* Updated ACCP Evidence-Based Clinical Practice Guidelines
CHEST Clinical Practice Guidelines Medical Therapy for Pulmonary Arterial Hypertension* Updated ACCP Evidence-Based Clinical Practice Guidelines David B. Badesch, MD, FCCP; Steven H. Abman, MD; Gerald
Treatment of Paediatric Pulmonary Hypertension
Treatment of Paediatric Pulmonary Hypertension Dunbar Ivy, MD The Children s Hospital Heart Institute University of Colorado School of Medicine 1 Disclosures I have the following financial relationships
2016 ESC Heart Failure Guidelines: what is new? Piotr Ponikowski Wroclaw, Poland
2016 ESC Heart Failure Guidelines: what is new? Piotr Ponikowski Wroclaw, Poland Disclosures Consultancy fees and speaker s honoraria from: Amgen, Servier, Novartis, Johnson & Johnson, Merck, Berlin Chemie,
Pharmacy Management Drug Policy
SUBJECT: POLICY NUMBER: PHARMACY-42 EFFECTIVE DATE: 6/2005 LAST REVIEW DATE: 10/1/2018 If the member s subscriber contract excludes coverage for a specific service or prescription drug, it is not covered
WHAT IS CTEPH. Helping you understand your type of PH. Provided by Bayer to help education of the PH community
Educational program by Material endorsed by WHAT IS CTEPH Helping you understand your type of PH Provided by Bayer to help education of the PH community WHAT IS PH? lood travels from your heart to the
WHAT IS. Helping your patients understand their type of PH. Educational program by. Material endorsed by
Educational program by Material endorsed by WHAT IS CTEPH Helping your patients understand their type of PH Provided by Bayer to help education of the PH community What is ph? B lood travels from your
A Patient s Guide to Understanding Pulmonary Arterial Hypertension in Systemic Sclerosis
A Patient s Guide to Understanding Pulmonary Arterial Hypertension in Systemic Sclerosis Compared with the general population, patients with systemic sclerosis (also known as scleroderma) have a higher
Disclosures. Objectives 6/16/2016. A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension
A Look at the Other Side: Focus on the Right Ventricle and Pulmonary Hypertension Susan P. D Anna MSN, APN-BC, CHFN June 24, 2016 Disclosures Objectives Differentiate structure and function of RV and LV
Drug Class Monograph. Policy/Criteria:
Drug Class Monograph Class: Pulmonary Arterial Hypertension Agents Drugs: Adcirca (tadalafil), Adempas (riociguat), Flolan (epoprostenol), Letairis (ambrisentan), Opsumit (macitentan), Orenitram (treprostinil),
Managing Multiple Oral Medications
Managing Multiple Oral Medications Chris Archer-Chicko, MSN, CRNP PENN Presbyterian Medical Center Arlene Schiro,, CRNP Massachusetts General Hospital Mary Bartlett, CRNP Winthrop University Hospital PH
Advances in Pharmacotherapy of PAH
24 th Annual Advances in Heart Disease Advances in Pharmacotherapy of PAH Gabriel Gregoratos, MD 12/14/2007 UCSF Cardiology 1 Faculty Disclosure Statement for Gabriel Gregoratos, MD Nothing to disclose
WHAT IS CTEPH. Helping you understand your type of PH. Provided by Bayer to help education of the PH community
Educational program by Material endorsed by WHAT IS CTEPH Helping you understand your type of PH Provided by Bayer to help education of the PH community WHAT IS PH? lood travels from your heart to the
Progress in PAH. Gerald Simonneau
Progress in PAH Gerald Simonneau National Reference center for Pulmonary Hypertension Bicetre University Hospital, INSERM U 999 Paris-Sud University Le Kremlin Bicêtre France Clinical Classification of
Pulmonary Arterial Hypertension Drug Prior Authorization Protocol
Pulmonary Arterial Hypertension Drug Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review
Tips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance
Tips & tricks on how to treat an acute heart failure patient with low cardiac output and diuretic resistance J. Parissis Attikon University Hospital, Athens, Greece Disclosures ALARM investigator received
Acute heart failure, beyond conventional treatment: persisting low output
Acute heart failure, beyond conventional treatment: persisting low output Alexandre Mebazaa, FESC Hôpital Lariboisière, Université Paris 7 U942 Inserm Conflict of Interest Lecture fee: Orion No other conflicts
Who and When to Refer for a Heart Transplant
Who and When to Refer for a Heart Transplant Dr Jayan Parameshwar Consultant Cardiologist Papworth Hospital BSH 24 th November 2017 BSH Annual Autumn Meeting 2017 Presentation title: Who and when to refer
PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT
PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT OBJECTIVE: To provide a diagnostic algorithm and treatment options for patients with acute pulmonary embolism (PE). BACKGROUND: Venous thromboembolism (VTE)
COPD as a comorbidity of heart failure in elderly patients
COPD as a comorbidity of heart failure in elderly patients Professor Mitja Lainscak, MD, PhD, FESC, FHFA Departments of Cardiology and Research&Education, General Hospital Celje Faculty of Medicine, University
Dr. J. R. Rawal 1 ; Dr. H. S. Joshi 2 ; Dr. B. H. Roy 3 ; Dr. R. V. Ainchwar 3 ; Dr. S. S. Sahoo 3 ; Dr. A. P. Rawal 4 ; Dr. R. A.
(6) EFFECT OF ORAL SILDENAFIL ON RESIDUAL PULMONARY ARTERIAL HYPERTENSION IN PATIENTS FOLLOWING SUCCESSFUL PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY (PBMV): SHORT TERM RESULTS IN 12 PATIENTS. Dr. J. R.
Riociguat for chronic thromboembolic pulmonary hypertension
Riociguat for chronic thromboembolic pulmonary hypertension This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a
Genetic Counselling in a Pulmonary Hypertension Referral Center
Genetic Counselling in a Pulmonary Hypertension Referral Center Marc HUMBERT, MD, PhD DÉPARTEMENT DE Centre National de Référence de l Hypertension Pulmonaire Sévère Hôpital Bicêtre, Assistance Publique
A Best Practices Approach to Treating Pulmonary Hypertension for the ED and Acute Care Provider. Disclosures
A Best Practices Approach to Treating Pulmonary Hypertension for the ED and Acute Care Provider Sean M. Studer, MD, MSc Chief, Pulmonary & Critical Care Director, Pulmonary Hypertension & Lung Transplantation
Clinical Commissioning Policy: Selexipag for treating pulmonary arterial hypertension (all ages)
Clinical Commissioning Policy: Selexipag for treating pulmonary arterial hypertension (all ages) NHS England Reference: 170065P 1 NHS England INFORMATION READER BOX Directorate Medical Operations and Information
4/14/2010. Pulmonary Hypertension: An Update. Tim Williamson, MD, FCCP. University of Kansas Hospital. Normal Physiology
Pulmonary Hypertension: An Update Tim Williamson, MD, FCCP Director, Pulmonary Vascular Program University of Kansas Hospital Normal Physiology 1 Pulmonary Perfusion 101 High Pressure Low Pressure Pulmonary