Google updates on Pulmonary arterial hypertension
The condition of Hypoxemia results from a constellation of factors they are low diffusing capacity, right to left shunting due to congenital heart disease CHD, patent foramen ovale, ventilation-perfusion mismatching or frank intrapulmonary shunting and low cardiac output resulting in low mixed venous oxygen saturation.
Although seen supplemental oxygen administration may not totally correct low arterial oxygen saturation in all patients, it can produce sufficient improvement in many to yield a substantial functional benefit, and therefore should not be overlooked. Moreover,oxygen is a pulmonary vasodilator and may contribute to reduce pulmonary vascular resistance, though this has not been shown to be f definite long term benefit.
Mortality related to PAH is frequently due to right ventricular failure or arrhythmias presumably related to high right ventricular wall stress. Once right ventricular failure intervenes, aggressive management is required. Sodium restriction sparing agents are necessary in many patients but must be used judiciously in order to balance reduced intravascular volume and control of edema and ascites with adequate preload to maintain systemic arterial pressure and cardiac output. Inotropic support with digoxin, though not systematically evaluated in PAH and not recommended by all authorities is reasonable to consider. Advanced right ventricular decompensation may require in patient management with intravenous inotropic support using dopamine or milrinone.
Some adjunctive measures can be considered preventive or precautionary in nature.Pregnancy poses extremely high risks for the patient and fetus and should be prevented at all costs, including consideration of sterilization or dual contraceptive measures.Oral contraceptives reportedly may provoke a prothrombotic state, but have not been unequivocally demonstrated to exacerbate the risks of thrombosis in patients with PAH, particularly when anticoagulation is used. Travel to high altitudes or air travel should be avoided for hypoxemic patients, at least unless there is near normalization of arterial oxygen saturation with supplemental oxygen. Air travel with oxygen often requires prior arrangements with the airline. While activity is encouraged to maintain fitness, attempting aggressive exercise or weight resistance activities is inadvisable. Avoidance of pulmonary infections by influenza and pneumococcal vaccinations should be undertaken. Early antibiotic treatment of upper respiratory infections is warranted.
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