Plicní hypertenze je definována jako syndrom charakterizovaný zvýšením středního tlaku v plicnici > 20 mm Hg. Nejčastěji se vyskytuje u onemocnění srdce nebo plic. Vzácněji je plicní hypertenze důsledkem primárního postižení plicních cév (zejména plicní arteriální hypertenze, při postižení plicních arteriol a chronická tromboembolická plicní hypertenze související s nekompletní reperfuzí po akutní plicní embolii). V léčbě plicní arteriální hypertenze dominuje farmakoterapie. Nemocní s pozitivním vazodilatačním testem jsou indikováni k léčbě vysokými dávkami blokátorů kalciových kanálů. V případě negativního testu (většina nemocných) je indikována farmakoterapie prostanoidy a agonisty prostacyklinových receptorů, antagonisty endotelinových receptorů, inhibitory fosfodiesterázy 5 a stimulátory solubilní guanylátcyklázy (iniciální kombinační léčba u pacientů bez kardiopulmonálních komorbidit, iniciální monoterapie u pacientů s kardiopulmonálními komorbiditami, opakovaná reevaluace během sledování a adekvátní modifikace léčby). U pacientů s plicní hypertenzí asociovanou se srdečními a plicními onemocněními se zvláštní pozornost soustředí na pacienty se závažnou prekapilární komponentou, respektive těžkou plicní hypertenzí (plicní cévní rezistence > 5 Woodových jednotek). U těchto pacientů, kteří se klinicky manifestují významnou hypoxemií, opakovanými epizodami pravostranné kardiální dekompenzace a echokardiografickým nálezem dilatované a dysfunkční pravé komory, je nutno vyloučit možnou koincidující příčinu prekapilární plicní hypertenze. Tito pacienti mají být diskutováni se specializovanými centry pro plicní hypertenzi s otázkou individualizované terapeutické intervence. U chronické tromboembolická plicní hypertenze je indikována doživotní antikoagulační léčba. O dalším způsobu léčby rozhoduje operabilita. U operabilní pacientů je indikována plicní endarterektomie. U inoperabilních pacientů a u nemocných s reziduální plicní hypertenzí po plicní endarterektomii je indikována balónková plicní angioplastika a/nebo farmakoterapie.
Pulmonary hypertension is defined as a syndrome characterized by an increase in mean pulmonary artery pressure > 20 mm Hg. It is most commonly found in diseases of the heart or lungs. More rarely, pulmonary hypertension results from primary pulmonary vascular involvement (particularly pulmonary arterial hypertension, when pulmonary arterioles are affected, and chronic thromboembolic pulmonary hypertension associated with incomplete reperfusion after acute pulmonary embolism). The treatment of pulmonary arterial hypertension is dominated by pharmacotherapy. Patients with a positive vasodilation test are indicated for treatment with high-dose calcium channel blockers. In the case of a negative test (the majority of patients), pharmacotherapy with prostanoids and prostacyclin receptor agonists, endothelin receptor antagonists, phosphodiesterase 5 inhibitors and soluble guanylate cyclase stimulators is indicated (initial combination therapy in patients without cardiopulmonary comorbidities, initial monotherapy in patients with cardiopulmonary comorbidities, repeated reevaluation during follow-up and adequate modification of treatment). In patients with pulmonary hypertension associated with cardiopulmonary disease, special attention should be focused on patients with a severe precapillary component or severe pulmonary hypertension (pulmonary vascular resistance > 5 Wood units). In these patients who clinically manifest significant hypoxemia, repeated episodes of right-sided cardiac decompensation and échocardiographie findings of a dilated and dysfunctional right ventricle, a possible concomitant cause of pre-capiiiary pulmonary hypertension should be excluded. These patients should be discussed with specialized pulmonary hypertension centers with the question of individualized therapeutic intervention. In chronic thromboembolic pulmonary hypertension, lifelong anticoagulation therapy is indicated. Further treatment is decided by operability. In operable patients, pulmonary endarterectomy is indicated. In inoperable patients and in patients with residual pulmonary hypertension after pulmonary endarterectomy, balloon pulmonary angioplasty and/or drug therapy is indicated.
- MeSH
- Angioplasty, Balloon classification methods MeSH
- Calcium Channel Blockers pharmacology classification therapeutic use MeSH
- Endarterectomy classification methods MeSH
- Drug Therapy * classification MeSH
- Medication Therapy Management MeSH
- Hypertension, Pulmonary * diagnosis drug therapy classification therapy MeSH
- Thromboembolism drug therapy classification complications MeSH
- Publication type
- Review MeSH
- MeSH
- Diagnosis, Differential MeSH
- Cardiovascular Agents classification therapeutic use MeSH
- Contraindications MeSH
- Humans MeSH
- Pulmonary Embolism diagnosis drug therapy pathology therapy MeSH
- Heart Disease Risk Factors MeSH
- Thromboembolism * diagnosis drug therapy classification therapy MeSH
- Thrombophilia genetics classification complications pathology MeSH
- Thrombosis prevention & control MeSH
- Venous Thromboembolism diagnosis drug therapy complications physiopathology pathology therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Medical History Taking MeSH
- Contraception adverse effects MeSH
- Blood Coagulation Disorders, Inherited complications MeSH
- Contraceptive Agents, Female adverse effects therapeutic use MeSH
- Contraindications, Drug MeSH
- Humans MeSH
- Risk Factors MeSH
- Thromboembolism * epidemiology etiology classification complications MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
- Keywords
- chronická tromboembolická plicní hypertenze, antikoagulační léčba,
- MeSH
- Survival Analysis MeSH
- Angiography methods MeSH
- Angioplasty, Balloon MeSH
- Diagnostic Techniques and Procedures MeSH
- Diagnosis, Differential MeSH
- Endarterectomy history methods MeSH
- Physical Examination MeSH
- Hemodynamic Monitoring MeSH
- Hemorrhage etiology prevention & control therapy MeSH
- Humans MeSH
- Extracorporeal Circulation MeSH
- Pericardial Effusion MeSH
- Hypertension, Pulmonary * surgery diagnosis epidemiology drug therapy classification complications physiopathology pathology rehabilitation therapy MeSH
- Postoperative Complications classification prevention & control therapy MeSH
- Postoperative Care classification MeSH
- Preoperative Care MeSH
- Prognosis MeSH
- Reoperation MeSH
- Risk Factors MeSH
- Statistics as Topic MeSH
- Hypothermia, Induced methods MeSH
- Walk Test statistics & numerical data MeSH
- Thromboembolism * surgery diagnosis epidemiology drug therapy classification complications physiopathology pathology rehabilitation therapy MeSH
- Respiration, Artificial nursing instrumentation MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Angiocardiography methods MeSH
- Anticoagulants therapeutic use MeSH
- Echocardiography methods MeSH
- Pacemaker, Artificial adverse effects MeSH
- Humans MeSH
- Heart Valve Prosthesis adverse effects MeSH
- Heart Ventricles pathology ultrasonography MeSH
- Heart Atria pathology ultrasonography MeSH
- Thrombectomy methods MeSH
- Thromboembolism * etiology drug therapy classification ultrasonography MeSH
- Check Tag
- Humans MeSH
- MeSH
- Anticoagulants administration & dosage adverse effects MeSH
- Atrial Fibrillation drug therapy complications MeSH
- International Normalized Ratio standards MeSH
- Congresses as Topic MeSH
- Humans MeSH
- Thromboembolism drug therapy classification prevention & control MeSH
- Warfarin administration & dosage adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- MeSH
- Aneurysm MeSH
- Arterial Occlusive Diseases diagnosis classification MeSH
- Arteriosclerosis MeSH
- Arteritis diagnosis classification MeSH
- Diabetic Angiopathies MeSH
- Humans MeSH
- Vascular Diseases diagnosis classification MeSH
- Thromboembolism diagnosis classification MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
