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Pulmonary hypertension is defined as a mean PAP of at least 20 mm Hg (3300 Pa) at rest, and PAH is defined as precapillary pulmonary hypertension (i.e. mean PAP ≥ 20 mm Hg with pulmonary arterial occlusion pressure [PAOP] ≤ 15 mm Hg and pulmonary vascular resistance [PVR] > 3 Wood Units). [58]
The pathophysiology of pulmonary heart disease (cor pulmonale) has always indicated that an increase in right ventricular afterload causes RV failure (pulmonary vasoconstriction, anatomic disruption/pulmonary vascular bed and increased blood viscosity are usually involved [1]), however most of the time, the right ventricle adjusts to an overload in chronic pressure.
Since the main causes of right ventricular hypertrophy is tricuspid regurgitation or pulmonary hypertension (discussed above), management involves treatment of these conditions. [3] Tricuspid regurgitation is typically treated conservatively by aiming to treat the underlying cause and following up the patient regularly. [ 12 ]
Pulmonary Arterial Hypertension (PAH) is a syndrome in which the blood pressure in the pulmonary arteries and pulmonary arterioles (the blood vessels located proximal to the capillary bed, the site of oxygen exchange in the lungs) is elevated. This pre-capillary pulmonary artery pressure being elevated is essential, and by definition a mean ...
Other signs provide evidence for specific causes of pressure overload. Hypertension is diagnosed by sphygmomanometry. A narrow pulse pressure is a sign of aortic stenosis. The chest x-ray may show pulmonary hyperaemia in the case of pulmonary hypertension, and pulmonary oligemia in pulmonary stenosis.
Right heart strain can be caused by pulmonary hypertension, [3] pulmonary embolism (or PE, which itself can cause pulmonary hypertension [4]), RV infarction (a heart attack affecting the RV), chronic lung disease (such as pulmonary fibrosis), pulmonic stenosis, [5] bronchospasm, and pneumothorax.
The causes of TR are divided into hereditary and acquired; and also primary and secondary. Primary TR refers to a defect solely in the tricuspid valve, such as infective endocarditis ; secondary TR refers to a defect in the valve as a consequence of some other pathology, such as left ventricular failure or pulmonary hypertension .
Air is pushed in and out of the lungs as air flows from the higher pressured region to the lower pressured region. During inhalation, the diaphragm contraction causes an increase in the thoracic cavity volume. This decreases the pressure inside the lungs, forcing the air to flow into the lungs.