Talk:Pulmonary hypertension/Archive 1

Nile Rvier?
I am a layman but can someone verfiy or make clearer the following statement in the article? Is the Nile revier an endemic area? I am confused by the statement. "Schistosomiasis is a very common cause of pulmonary hypertension in endemic areas such as the Nile river due to obstruction of pulmonary vessels with the parasite." —Preceding unsigned comment added by 151.207.240.4 (talk) 15:01, 13 February 2008 (UTC)


 * I don't know how common it is, but as a cause it is certainly reported. JFW | T@lk  15:28, 28 March 2008 (UTC)

Causes of pulmonary hypertension
There may be a bit of confusion as to the causes of pulmonary hypertension. Whlie the most common cause of right-sided heart failure is left-sided heart failure, the most common cause of pulmonary hypertension is chronic lung disease (ie: COPD). Ksheka 13:57, May 24, 2004 (UTC)


 * Yes, re-reading it did seem confusing. I was trying to be general by just referring to the collective term of obstructive lung disease, but the update makes it read much better. --Lacrimosa 08:33, 26 May 2004 (UTC)

Those interested in the pathogenesis of pulmonary hypertension and the latest research on this disease may want to read this: Pulmonary Arterial Hypertension - Future Directions: Report of a National Heart, Lung and Blood Institute/Office of Rare Diseases Workshop by Newman et al., [http://circ.ahajournals.org/cgi/content/full/109/24/2947 Circulation. 2004;109:2947-2952] -- PFHLai 22:18, 2004 Jun 22 (UTC)

Here's another: Cellular and molecular pathobiology of pulmonary arterial hypertension by Humbert et al., Journal of the American College of Cardiology, 43(12 Supp.1):S13-S24 -- PFHLai 07:07, 2004 Jul 29 (UTC)


 * Ehh, PFHLai, if that is from a supplement, then the whole supplement is probably worth reading (a personal rule of thumb). JFW | T@lk  12:52, 29 Jul 2004 (UTC)


 * Oh, yeah... thanks for reminding. Here's the table of contents of the supplement.  There are indeed many relevant reviews. -- PFHLai 19:04, 2004 Jul 29 (UTC)

Someone removed my mention of n-acetyl-cysteine as a cause. Wikipedia does list http://en.wikipedia.org/wiki/Acetylcysteine#Possible_toxicity

http://www.ncbi.nlm.nih.gov/pubmed/17786245

And the reference does suggest that n-acetyl-cysteine can induce PAH in animals. Undoubtedly someone is going to be reading this article because they have PAH and they may be taking n-acetyl-cysteine. I think its important the article mention it. —Preceding unsigned comment added by 69.155.225.190 (talk) 05:52, 21 March 2009 (UTC)

Units
Writing millimetres of mercury as "mmHg" is incorrect. The rules for SI units (as expressed in ISO 31 and ISO 1000) make it clear that information should not be mixed with units. See #11 at

http://physics.nist.gov/cuu/Units/checklist.html

I've changed it to mm except when it is introduced.

The conversion of Woods Units to CGS (i.e. obsolete metric) instead of SI is pretty strange, so I've converted it to SI. Blaise 15:20, 7 May 2006 (UTC)

Lung transplant survival time
"Lung transplantation ... leaves the patient with ... a survival of about 5 years." Not anymore? I believe significant advances have been made in this area so that the survival after a transplant is typically much longer (as much as 15 - 20 years). I'm not 100% so I won't edit the page at this point, but if someone could verify this with a source that'd be good, or verify the current contents and cite it. —Preceding unsigned comment added by 63.163.61.3 (talk • contribs)
 * The latest statistics I can easily find are a 5 year survival rate of 45% for all transplants, from the latest Merck Manual, as mentioned in Lung transplantation, but there is a certain lag time too in how current information gets into the book. -- Kyok o  12:13, 1 March 2007 (UTC)

'the survival after a transplant is typically much longer (as much as 15 - 20 years' As i understand it i think that this is true, but statistics are still lower because they cant get mortality statistics if the people who had the transplants five years ago are still alive now. They have recently developed more efficient anti-rejection drugs and so long term statistics for these will not be available for a while. Also they have developed a machine that keeps the lungs to be transplanted pumping before an operation so longer can be spent on testing to see whether they are a good match for the persons body, this only was introduced this year i think so again improvements in survival. Im not 100per cent sure if im right though

needs better explanation of venous vs. arterial hypertension
Hello, I believe that the article needs a better explanation of the difference between pulmonary venous hypertension vs. pulmonary arterial hypertension, and I don't feel capable of doing that myself. Thanks for any help. -- Kyok o  12:15, 1 March 2007 (UTC)

I was reading about how there was question to the validity of lung transplant mortality being 50% at five years. This is in fact the truth, and not just 10 years ago, five years ago, or even 1-2 years. It is the most recent and ongoing data tracking from UNOS, the United Network for Organ Sharing, that continues to support this mortality rate. Different diseases that lead to transplant are associated with slightly different outcome, ie Cystic Fibrosis patients have the best outcomes and Pulmonary Fibrosis the poorest. Taking all diseases into account, the average is roughly 50% mortality at 5 years. This is an important point to share with patients, as it highlights that Lung Transplant is not a cure but rather the exchange of one set of problems for another. Hopefully, those problems can be controlled and add years of life to the individual, and in a select few (roughly 25%) may end up in greater than or equal to a 10 year survival.

With regards to the difference between venous and arterial pulmonary hypertension, this is easier to understand if one thinks of a garden hose. If water is being pumped into one end of the hose and running out the other, there is a steady amount of pressure inside the house. If you impede or make it more difficult for the water to empty out, but do not change the amount being pumped in, the hose will want to expand and possibly rupture from the pressure being built up with the increased volume trying to be stored in the hose. Similarly, venous pulmonary hypertension originates at the "outlet" (the left heart, which the pulmonary veins empty into) of the pulmonary vasculature. Decreased compliance of the left heart leads to less volume being able to empty out of the pulmonary veins, which then backs up into the pulmonary arteries and finally right heart. This overall increased volume in the circuit is observed as an increase in pressure. Whereas, arterial hypertension originates not from decreased outflow, but rather is a function of the pulmonary arteries themselves. The left heart is working fine, but there is a problem with the relaxation of the arteries. Arteries in the body are made up of smooth muscle, and constriction or hypertrophy (thickening) of arteries raises the pressure within the vessels by making the"tube" smaller. If there is a certain amount of fluid in a container, and you don't change the amount of fluid but make the container smaller, there will be more pressure in that system. Thus, arterial pulmonary hypertension is like a garden hose having no outflow obstruction, but rather having the hose exchanged with a different hose that has a smaller diameter. If the amount of volume that was being pumped through the system did not change and the hose is now smaller, the pressure will be greater in that system. Therefore, arterial hypertension is a dysfunction in the arteries themselves rather than a dysfunction in the "outflow" i.e. left heart or pulmonary veins. —Preceding unsigned comment added by 76.182.95.46 (talk) 03:46, 16 September 2009 (UTC)

I read the "Causes" section, and I still had no idea what causes this condition. To summarize the comment above, "Pulmonary Hypertension is caused by restricted blood flow through the lungs". If that is an accurate summary, maybe somebody could write it in the main article. 130.167.102.90 (talk) 14:56, 27 December 2010 (UTC)

"New approach to pulmonary hypertension shows promise"
A number of abnormalities, formerly thought to be unrelated, do have a common denominator: nuclear-factor-of-activated-T-lymphocytes (NFAT). "...Therefore, by attacking NFAT, the 'common denominator' of these abnormalities, you might be able to treat them all at once..." Brian Pearson 03:15, 4 July 2007 (UTC)

Pathogenesis link question
Hello, currently the first sentence of this section links to vasoconstrictor and not vasoconstriction. While I think the article should link to vasoconstrictor, I was reluctant to change this because the latter article is not yet well developed. Neither article has much content anyway. Which do you think is a better link? Thanks. -- Kyok o  05:25, 29 October 2007 (UTC)
 * I forgot to say: I had asked this in a hidden comment in the article but I decided to ask it here. I forgot to change my edit summary for my last edit to the article. -- Kyok o  05:34, 29 October 2007 (UTC)

Cteph
Does anyone know why Cteph isn't a simple redirect to this article? WhatamIdoing (talk) 06:29, 9 December 2007 (UTC)


 * It is now. JFW | T@lk  07:51, 13 January 2008 (UTC)

Need for structure
The article is quite well-referenced, but the "causes" section is just an unorganised pile of stuff. I see no reason why we can't use the WHO/Venice classification as a starting point for a useful list of causes. We should also list in a more useful way the kind of tests clinicians use when faced with a new diagnosis of PAH. I realise that this is a very individual thing, but we should mention the use of a right-sided heart catheterisation, HRCT and CTPA (or invasive pulmonary angiography), autoantibody tests and possibly genetic studies. JFW | T@lk  07:51, 13 January 2008 (UTC)

Emphasis on HIV and haemolysis
With patients with HIV and sickle-cell disease surviving their illness much longer, PAH as a long-term complication has come to the foreground - http://jama.ama-assn.org/cgi/content/full/299/3/324 JFW | T@lk  17:20, 23 January 2008 (UTC)

Useful review
The following review in Am J Resp Crit Care Med is very recent and free:. I'm not sure if it should be the main background source (it is almost entirely built on citations from other reviews and some primary research studies). The comments on the poverty of epidemiology data are sobering. JFW | T@lk  15:28, 28 March 2008 (UTC)


 * stands a better chance. Me read. JFW | T@lk  14:53, 26 June 2008 (UTC)

The 2008 classification makes only small modifications of 2003. No primary source yet. JFW | T@lk  13:47, 2 July 2008 (UTC)

Epidemiology
this probably goes to issues of wikipedia policy re. citing satistics as they are in the studies, but it would seem to me preferable to state all the stats in the same terms. i.e., as it is, half are in % and half are in incidence per million. wouldn't it be much better to use one or the other? i was briefly confused on the phenfen numbers, as i'm sure are many casual readers. (i missed the 'per', and thought for an instant it said 25-50 million cases per annum.)Toyokuni3 (talk) 14:44, 26 September 2008 (UTC)

Consensus statement
UK/Ireland consensus statement: PMID 18276826. JFW | T@lk  11:32, 5 December 2008 (UTC)


 * PMID 18381346 is a review in children (2008). JFW | T@lk  13:02, 28 June 2010 (UTC)

Classification
The WHO/Venice classification system (2003) as currently shown has been superceded by the Dana Point classification system (2008). The new system shares the same basic structure as the older system, but possible etiologies are spelled out in more specific detail. The Dana Point system was published in: Simonneau G, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009;54:S43–S54, and utilized in Guidelines for the diagnosis and treatment of pulmonary hypertension, European Heart Journal (2009) 30, 2493–2537 (doi:10.1093/eurheartj/ehp297). —Preceding unsigned comment added by StevenTiger (talk • contribs) 17:34, 22 August 2010 (UTC)

significant findings...
''A detailed family history is established to determine whether the disease might be familial. A history of exposure to drugs such as cocaine, methamphetamine, alcohol leading to cirrhosis, and tobacco leading to emphysema are considered significant. A physical examination is performed to look for typical signs of pulmonary hypertension, including a loud S2 (pulmonic valve closure sound), (para)sternal heave, jugular venous distension, pedal edema, ascites, hepatojugular reflux, clubbing etc. Evidence of tricuspid insufficiency is also sought and, if present, is consistent with the presence of pulmonary hypertension.''

From the WHO:
 * Definite causal relationship
 * Aminorex
 * Fenfluramine
 * Dexfenfluramine
 * Toxic rapeseed oil
 * Very likely causal relationship
 * Amphetamines
 * l-Tryptophan
 * Possible causal relationship
 * Meta-amphetamines
 * Cocaine
 * Chemotherapeutic agents
 * Unlikely causal relationship
 * Antidepressants
 * Oral contraceptives
 * Estrogen therapy
 * Cigarette smoking

Demographic factors and medical conditions
 * Definite causal relationship
 * Gender
 * Possible causal relationship
 * Pregnancy
 * Systemic hypertension
 * Unlikely causal relationship
 * Obesity

Diseases
 * Definite causal relationship
 * Human immunodeficiency virus infection
 * Very likely causal relationship
 * Portal hypertension and/or liver disease
 * Collagen vascular diseases
 * Congenital systemic-to-pulmonary cardiac shunts
 * Possible causal relationship
 * Thyroid disorders

Interesting choice of significant factors to mention... 84.197.184.6 (talk) 00:02, 7 November 2011 (UTC)

Irrevesibility of Pulmonary Hypertension
The article correctly states (from what I have read in textbooks) that pulmonary hypertension is an irreversible condition, however I think it does not state where the irrevesibility is located in this disease. Is the fibrosis of the blood vessels irrevesible? Is the hypertrophy of the heart on one side irreversible or is the damage on lung tissue after chronic pulmonary hypertension irrevesible? ...or something else? Thank you U1012738 (talk) 00:49, 25 December 2012 (UTC)

CTEPH
Review on, Circulation 10.1161/CIRCULATIONAHA.114.009309 JFW &#124; T@lk  19:55, 5 August 2014 (UTC)

Guideline
10.1378/chest.14-0793 JFW &#124; T@lk  11:36, 8 September 2014 (UTC)

Circulation
10.1161/CIRCULATIONAHA.114.006971 review of clinical diagnosis. JFW &#124; T@lk  00:22, 12 November 2014 (UTC)


 * 10.1161/CIRCULATIONAHA.114.006974 review of treatment. JFW &#124; T@lk  21:50, 9 December 2014 (UTC)


 * 10.1161/CIRCULATIONAHA.114.006977 Review of altitude-related pulmonary vascular disease. JFW &#124; T@lk  22:46, 10 February 2015 (UTC)

wikiproject med

 * posted at talk page for editing help, last 2 weeks of October (signs/symptoms and pathogenesis needs referencing),--Ozzie10aaaa (talk) 14:42, 31 October 2015 (UTC)
 * references that could be useful; --Ozzie10aaaa (talk) 13:52, 3 December 2015 (UTC)

PHA Europe
I've been in correspondence with PHA Europe about this article. They have emailed me a proposed update of the article. I have suggested that edits to this article should be made like any other, and that wholesale replacement of the content is not the recommended approach.

We may therefore soon see quite extensive edits to this article. Please let me know if there are significant problems with any particular contribution. JFW &#124; T@lk  15:10, 21 February 2016 (UTC)


 * I started these edits yesterday for PHA Europe. Note that I'm their technical support in this matter and not an expert on the topic myself. I will be happy to relay any comments and concerns about the edits to them Mattb2314 (talk) 08:06, 11 July 2016 (UTC)

high blood pressure
OK, a very simple question whose answer I cannot see clearly in this technical and detailed article: Is pulmonary hypertension a subset of what is commonly known as "high blood pressure"? Does it show up as a high reading on a arm-band blood pressure reading? Or is it something different - ie, could you have a "good" "blood pressure" (as usually measured) but still have pulmonary hypertension? 115.64.142.162 (talk) 07:44, 27 April 2016 (UTC)

CRASH report
UK PAH experts pronounce on emergencies 10.1136/thoraxjnl-2016-209725 JFW &#124; T@lk  11:11, 24 October 2017 (UTC)
 * very useful for the article--Ozzie10aaaa (talk) 19:38, 12 March 2018 (UTC)

The "Mahammedi technique" for measuring the main pulmonary artery diameter on CT scan.
It can be challenging to reproducibly measure the main PA in axial sections on CT scan, as the main PA is often elevated or may take a mildly tortuous course on axial images. In an attempt to standardize the axial dimension used for measurement of the PAD, the adjacent aorta was used as a reference. The proposed technique (method 1) was as follows:https://journals.lww.com/thoracicimaging/Abstract/2013/03000/Pulmonary_Artery_Measurements_in_Pulmonary.5.aspx

1. When the main PA had a straight appearance at the level of the PA bifurcation on the axial section, a line was drawn from the center of the aorta such that it passed perpendicular to the axis of the main PA (Fig. 1A).

2. The mPAD was measured along this specific perpendicular line to the axis of the main PA, with the axis of the main PA being defined as the lines between the midpoint of the origin of the main PA and the bifurcation of the right pulmonary artery (RPA) and LPA. The PA bifurcation point was considered at the level at which the LPA and RPA appeared to be of equal sizes. However, it can sometimes be difficult to determine the main axis of the PA on axial images as the main PA can take a tortuous course. It is easiest when the PA has a straight appearance on CT (Fig. 1A).

However, in scenarios in which the PA appeared curved at the level of the bifurcation, an attempt to determine the main axis of the PA was not made. Rather, steps 1 and 2 in method 1 above were replaced as follows:

A line was drawn from the center of the AA to the midpoint of the course of the main PA, halfway between the origin of the PA and its bifurcation. The diameter of the PA was then measured along this line (Fig. 1B); in method 2 the widest short-axis diameter of the PA perpendicular to the long axis of the main PA at the level of the PA bifurcation, as defined by Edwards and colleagues,3,5 was measured; in method 3 the widest short-axis diameter of the main PA on the sagittal section was measured (Fig. 1C); in method 4 the diameter along the line that joins the origin point of the LPA and the center of the AA on axial section at the level of the PA bifurcation was measured (Fig. 1D).

Method 1 revealed the best reproducibility for PAD measurements, in which the intraobserver variability bias had the lowest mean difference of 0.17mm (95% confidence interval: _0.36 to 0.62; ratio of SD=1.1), and the interobserver variability bias had a difference of 0.28mm. Results were published my Mahammedi et al and this method of measurment is known as the "Mahammedi technique".

FIGURE 1. A, Axial CT image: mPAD measured along the line that originates from the center of the AA and passes perpendicular to the long axis of the main PA, at the level of the PA bifurcation on axial section (method 1). B, Measurement of mPAD where the PA is not straight. C, Contrast-enhanced CT scan: mPAD measured on the widest short-axis diameter of the main PA on the sagittal section (method 3). D, mPAD measured on the line that joins the origin of the LPA and the center of the AA on axial section at the level of PA bifurcation (method 4).

Mahammedi, A, Oshmyansky, A, Hassoun, PM, Thiemann, DR, Siegelman, SS. Pulmonary artery measurements in pulmonary hypertension: the role of computed tomography. J Thorac Imaging. 2013;28:96–103.


 * (in the future please sign your post)...what is the "bottom line" you are trying to achieve in regards to Mahammedi A?--Ozzie10aaaa (talk) 10:03, 18 May 2018 (UTC)

Contradiction on the curability of the disease
I have noticed an apparent discrepancy in this article regarding the curability of this condition. The lead states that that the condition is currently incurable, which is more or less confirmed by its source, which states that "there is no cure for pulmonary hypertension unless chronic blood clots in the lungs are the cause." However, in the "Treatment" section—specifically the "Surgery" subsection—it is stated that lung transplantation cures the condition, but leaves the patient with other complications related to transplantation, though the source in this case does not specifically mention a cure for pulmonary hypertension in particular, as it refers to the survival rates of transplants in general, and does not deal specifically with pulmonary hypertension. I am not an expert in the medical field, so I am unwilling to alter the aforementioned discrepancy, but I believe that something needs to be done to clarify the contradiction.

203.164.39.5 (talk) 14:34, 27 October 2019 (UTC)
 * will look--Ozzie10aaaa (talk) 17:37, 28 February 2020 (UTC)

Source for definition
added the pressure cutoffs for diagnosis based on 10.1111/bcp.13508. It is a secondary source which is fine, but I think it is better to base this on a key guideline of review. The paper in question discusses a very specific cause (dasatinib as the cause of PAH). Also, the definition contradicts in part the one given in the NIH source. It cites 10.1016/j.jacc.2013.10.032 which discusses the criteria in great detail but it's now seven years old. Would anyone happy to know if there is a more recent source? JFW &#124; T@lk  14:30, 11 August 2020 (UTC)
 * will look--Ozzie10aaaa (talk) 13:06, 12 August 2020 (UTC)

Updated defenition
From 25mmg of mPAP it's changed to 20mmg mPAP for diagnosing pulmonary hypertension. But it is not there is Wikipedia Usha RT (talk) 09:20, 12 February 2023 (UTC)
 * what is your reference....--Ozzie10aaaa (talk) 02:50, 13 February 2023 (UTC)