Pulmonary arterial hypertension in women - 19/10/10
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Summary |
Introduction |
Pulmonary arterial hypertension (PAH) is a rare condition characterized by sustained elevation in pulmonary arterial resistance leading to right heart failure.
Background |
PAH afflicts predominantly women. Echocardiography is the initial investigation of choice for non-invasive detection of PAH but right-heart catheterization is necessary to confirm the diagnosis. Conventional treatment includes non-specific drugs (warfarin, diuretics, oxygen). The endothelin-1 receptor antagonist bosentan, the phosphodiesterase-5 inhibitor sildenafil, and prostanoids have been shown to improve symptoms, exercise capacity and haemodynamics. Intravenous prostacyclin is the first-line treatment for the most severely affected patients. Despite the most modern treatment, the overall mortality rate of pregnant women with severe PAH remains high. Therefore, pregnancy is contraindicated in women with PAH and an effective method of contraception is recommended in women of childbearing age. Therapeutic abortion should be offered, particularly when early deterioration occurs. If this option is not accepted, intravenous prostacyclin should be considered promptly.
Viewpoints and conclusion |
Recent advances in the management of PAH have markedly improved prognosis and have resulted in more women of childbearing age considering pregnancy. A multidisciplinary approach should give new insights into cardiopulmonary, obstetric and anaesthetic management during pregnancy, delivery and the postpartum period.
Le texte complet de cet article est disponible en PDF.Keywords : Pulmonary arterial hypertension, Diagnosis, Pregnancy, Treatment
Plan
![]() | To cite the present paper, use exclusively the following reference: Sanchez O, Marié E, Lerolle U, Wermert D, Israël-Biet D, Meyer G. Hypertension artérielle pulmonaire feminine (full text in english on rmr). Rev Mal Respir 2008;25:451–60. Doi: RMR-04-2008-25-4-0761-8425-101019-200803264. |
Vol 27 - N° 8
P. e79-e87 - octobre 2010 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.