Thread by @ucsdim

#Pulmonary Hypertension (pHTN) can really take your breath away!

For today's #MTC, Chief @photon_ick, PGY3 Dr. Armando Martinez, & #CTEPH expert Dr. Demos Papamatheakis reviewed a super cool case of a legit #SPY diagnosed with pHTN & CTEPH, flown to #UCSD for management!

1. pHTN is increased pressure in the #pulmonaryarteries
2. Most common symptoms include: EXERTIONAL #dyspnea, fatigue, pleuritic chest pain, and even #hemoptysis🩸
3. It's typically diagnosed on #ECHO showing dilated arteries, right❤️strain, & elevated RV systolic pressure!

4. There are 5 #WHO Classes of pHTN, distinguished based on physiology and treatment options:
1⃣ Pulmonary Arterial Hypertension
2⃣ pHTN 2/2 LV failure
3⃣ pHTN 2/2 Respiratory/Lung disease
4⃣ CTEPH
5⃣ Other causes

5. You can start with an #ECHO, #PFTs, & #VQScan to evaluate for WHO Classes 2-4. If these don't show abnormalities, it might be time for a #RightHeartCath. @ucsdpccm @UCSDCardFellows

6. CTEPH is diagnosed by V/Q scan! Or occasionally by CT (or other Angiography). Below you can see normal (top left), and abnormal V/Q scans!!

Proximal & large vessel clots can knock out huge portions of lung perfusion, distal disease takes little pieces, but they can add up!!

7. This disease can be treated #surgically!! Check out how varied these clots can be! They're even graded, with grade 1 being the largest (top left), and grade 4 (bottom right) being those distal little shark teeth.

That's it for now!! Thanks!!

@DirkGainesMD @LukewebsterMd @daniellemunceMD @AlexCypro @JennyYangMD @ericalinMD @abdur833 @erica_b_feldman @JRRaphelson @atigges1 @Alexcours @magicindark @LizzyHastie

#InternalMedicine #PulmonaryVascularMedicine #PCCM #CriticalCare #MedEd