#294 Pulmonary Hypertension Update

Pulmonary hypertension, particularly chronic thromboembolic pulmonary hypertension (CTEPH), is the focus of this episode featuring Dr. Estefania Oliveros, a heart failure cardiologist. The discussion clarifies the updated definition of pulmonary hypertension (mean PA above 20 mmHg) and emphasizes the importance of distinguishing between pre-capillary and post-capillary causes to guide diagnosis and treatment. A key point highlights the often-delayed diagnosis of CTEPH, averaging 14 months, despite its treatable nature. The podcast underscores the significance of VQ scans in diagnosing CTEPH, noting their high negative predictive value, and details treatment options ranging from pulmonary endarterectomy—a potentially curative surgery—to medical management with medications like riociguat.

Outlines

Part 1: Introduction, Guest Background, and Recommendations

Part 2: Definitions, Classifications, and Pathophysiology

Part 3: Clinical Evaluation and Diagnostic Testing

Part 4: Treatment Strategies and Medication Management

Part 5: Case Resolution and Key Takeaways

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The Curbsiders Internal Medicine Podcast

Part 1: Introduction, Guest Background, and Recommendations

Pulmonary Hypertension and CTEF: An Introduction to the Curbsiders Podcast

Painting, Book Recommendations, and Career Reflections with Dr. Oliveros

Picks of the Week and Sponsor Message

Part 2: Definitions, Classifications, and Pathophysiology

Defining Pulmonary Hypertension: Mean PA, PVR, and Pre- vs. Post-Capillary

Pulmonary Hypertension Groups, a Case Presentation, and Diagnostic Delays

Pathophysiology of CTEF: In-Situ Changes and Pulmonary Vascular Obstruction

Part 3: Clinical Evaluation and Diagnostic Testing

History Taking and Physical Exam Findings in Pulmonary Hypertension

Initial Testing and the Role of VQ Scans in Diagnosing CTEF

Interpreting VQ Scans and Referral to Specialized Centers

Echocardiography, Referral Guidelines, and the Rarity of CTEF

Part 4: Treatment Strategies and Medication Management

Treatment Options for CTEF: Surgery, Medication, and Angioplasty

Side Effects and Classes of Pulmonary Hypertension Medications

Medication Use in Different PH Groups and Avoiding Calcium Channel Blockers

Part 5: Case Resolution and Key Takeaways

Case Resolution, Key Takeaways, and Episode Wrap-Up

#294 Pulmonary Hypertension Update

The Curbsiders Internal Medicine Podcast

Part 1: Introduction, Guest Background, and Recommendations

00:00Pulmonary Hypertension and CTEF: An Introduction to the Curbsiders Podcast

Pulmonary Hypertension and CTEF: An Introduction to the Curbsiders Podcast

02:46Painting, Book Recommendations, and Career Reflections with Dr. Oliveros

Painting, Book Recommendations, and Career Reflections with Dr. Oliveros

07:22Picks of the Week and Sponsor Message

Picks of the Week and Sponsor Message

Part 2: Definitions, Classifications, and Pathophysiology

10:32Defining Pulmonary Hypertension: Mean PA, PVR, and Pre- vs. Post-Capillary

Defining Pulmonary Hypertension: Mean PA, PVR, and Pre- vs. Post-Capillary

14:40Pulmonary Hypertension Groups, a Case Presentation, and Diagnostic Delays

Pulmonary Hypertension Groups, a Case Presentation, and Diagnostic Delays

23:00Pathophysiology of CTEF: In-Situ Changes and Pulmonary Vascular Obstruction

Pathophysiology of CTEF: In-Situ Changes and Pulmonary Vascular Obstruction

Part 3: Clinical Evaluation and Diagnostic Testing

25:38History Taking and Physical Exam Findings in Pulmonary Hypertension

History Taking and Physical Exam Findings in Pulmonary Hypertension

29:37Initial Testing and the Role of VQ Scans in Diagnosing CTEF

Initial Testing and the Role of VQ Scans in Diagnosing CTEF

33:52Interpreting VQ Scans and Referral to Specialized Centers

Interpreting VQ Scans and Referral to Specialized Centers

37:34Echocardiography, Referral Guidelines, and the Rarity of CTEF

Echocardiography, Referral Guidelines, and the Rarity of CTEF

Part 4: Treatment Strategies and Medication Management

42:03Treatment Options for CTEF: Surgery, Medication, and Angioplasty

Treatment Options for CTEF: Surgery, Medication, and Angioplasty

47:04Side Effects and Classes of Pulmonary Hypertension Medications

Side Effects and Classes of Pulmonary Hypertension Medications

51:15Medication Use in Different PH Groups and Avoiding Calcium Channel Blockers

Medication Use in Different PH Groups and Avoiding Calcium Channel Blockers

Part 5: Case Resolution and Key Takeaways

55:26Case Resolution, Key Takeaways, and Episode Wrap-Up

Case Resolution, Key Takeaways, and Episode Wrap-Up