A Nurse's Perspective on the Alert for Pulmonary Arterial Hypertension

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On The Alert for Pulmonary Arterial Hypertension
On The Alert for Pulmonary Arterial Hypertension
Summarized by: Joanne Marie Tarrobal-Baynosa
Arellano University - INP
Summarized by: Joanne Marie Tarrobal-Baynosa
Arellano University - INP

By Vincent M. Vacca, Jr., RN, CCRN, MSN
Nursing Journal, December 2009 Issue
By Vincent M. Vacca, Jr., RN, CCRN, MSN
Nursing Journal, December 2009 Issue

Nurse Vincent M. Vacca, Jr. aptly described in this issue of the Nursing Journal the significance of early detection and health management of people who are or are maybe suffering from Pulmonary Arterial Hypertension. He described PAH as a condition wherein a patient is having a mean pulmonary arterial (PA) pressure of greater than 25 mm HG with a pulmonary capillary or left atrial pressure less than 15 Hg; which is significantly higher than the normal range of between 12-16mm Hg in a healthy adult. 1 PAH, he said, is a condition, which is a result of the thickening of the pulmonary arterial wall causing a state of permanent vasoconstriction. In addition, the pulmonary vasculature that produces the body’s natural vasodilators becomes impaired therefore further contributing to pulmonary vascular remodeling, systemic hypoxia, and pulmonary thrombosis. All these, he said, could cause an elevated mean PA pressure and eventually a state of permanent pulmonary hypertension. PAH, according to nurse Vacca is prevalent amongst patients ages 30s or 40s and are more common in female rather than male patients. This condition is usually asymptomatic but some patients can exhibit exertional dyspnea caused by low cardiac output during the early stages of the condition. However, he said that a patient could also develop signs and symptoms of right-sided heart failure because the right ventricle could no longer overcome the high mean PA pressure. Some of the signs and symptoms he mentioned are ascites, congestive hepatomegaly, anasarca, and increased abdominal girth. Additionally, he said that PAH also predisposes the patient to pulmonary thrombosis and pulmonary embolism. Nurse Vacca also described in the article the following four classes describing the severity of the condition as per the New York Heart Association: * Class I – no symptom – induced limits on physical activity * Class II – slight symptom – induced limits on physical activity * Class III – marked symptom - induced limits on physical activity * Class IV – right sided heart failure, with dyspnea and fatigue at rest, and an inability to perform any physical activity without symptoms.2 He then discussed several diagnostic testing that is currently being done to diagnose PAH, but reiterated the fact that it is typical for a patient with PAH to be diagnose 2 years after the symptom onset primarily because the symptoms that is being experience by patients with PAH such as dyspnea and fatigue are both nonspecific; therefore requiring doctors to rule out other conditions like chronic obstructive pulmonary disease, acute respiratory distress syndrome, cardiac disease, and liver disease. The diagnostic testing he mentioned are chest x-ray to show enlargement of the right ventricle, ECG to check for ventricular hypertrophy and right axis deviation, thyroid function test, cardiac biomarkers, CT scan, Doppler echocardiography, and right sided cardiac catheterization. All these test he said could be use to rule out other lung condition and diagnose PAH. The treatment plan for PAH is done following the administration of a vasodilator via an IV line to make certain that the patient is responding well with the vasodilator. The indication, he said, for a positive response is a “reduction of 10mm Hg or more in mean PA pressure, to a mean PA pressure of 40 mm Hg or less with no change or increase in CO”.3 The following treatment plans are then discussed as possible options that would be provided by a health care provider: * Calcium channel blockers

* I.V. prostanoids...
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