hipertension arterial, hipertension pulmonar, tromboembolia pulmonar
TRANSCRIPT
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HIPERTENSIN
ARTERIAL
HOSPITAL REGIONAL DE ALTA ESPECIALIDADDR. GUSTAVO A. ROVIROSA PREZ
Coordinador del curso:Dr. Rogelio Garca Pacheco
Expositores:Dr. Francisco Cauich Baza R3RDr. !u"#erto $zuara %i"nez R&'(
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OBJETIVOS
Revisin de !s G"#!s de P$!%&i%!C#ni%!
!%&"!i'!d!s (!$! e )!ne*+ de !Hi(e$&ensin A$&e$i!,Hi(e$&ensin P")+n!$ -
T$+)+e)+i! P")+n!$.
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HIPERTENSIN ARTERIAL.
His&+$i!. S&e(/en H!es 012334 ($i)e$! )edi%in de ($esin
!$&e$i!, 0-e5"!4.
J"es He$$is+n 016334 %+ns&$"- e ($i)e$ins&$")en&+ %!(!' de )edi$ ! ($esin !$&e$i! de)!ne$! indi$e%&!.
7!$ Vie$+$&d 0 16884 ($i)e$ es95))e&$+. :$ede$i; A. &+d+ de
($esi+n!$ ! !$&e$i! $!di! (!$! )edi$ ! ($esin!$&e$i!. RC Ed+"!$d P+&!in 0 16?@4 )+di9%! e
es95)+)!n+)e&$+ - + in&$+d"%e en ! %#ni%!.
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HIPERTENSIN ARTERIAL.
His&+$i!. S%i(i+ne Riv!R+%%i 016?4, (e$e%%i+n+ e )>&+d+
(!$! )edi$ ! TA. Ni%+!i S. 7+$+&;+ 01?@84, s+nid+s de ! !$&e$i! !
se$ %+)($i)id!. :$!n; 01?114, e !)! esseen&iee /-(e$&+nie. J!ne!- 01?134, ene$)ed!d /i(e$&ensiv!
%!$di+v!s%"!$. B$!"n - P!5e 01?F@4 des%"$en !
0/i(e$&ensin!!n5i+&+nin!4 !n5i+&ensin!. Ini%i! e es&"di+ de :$!)in5/!) 01?F64, "e
es&!e%e ! $e!%in en&$e /i(e$&ensin !$&e$i! -$ies5+ %!$di+v!s%"!$.
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HIPERTENSIN ARTERIAL.
Gene$!id!des. En e )"nd+ ?@ )i+nes de (e$s+n!s. En i%+ =@=8 )i+nes de (e$s+n!s.
NHANES II 1?6@, 81 di!5n+s&i%!d+s, 31&$!&!)ien&+ - 1@ %+n&$+. NHANES III 1???, 23 di!5n+s&i%!d+s, 88
&$!&!)ien&+, =? %+n&$+. ENSA =@@@, 3? di!5n+s&i%!d+s, %+n&$+!d+s 1?.F.
E&i++5#! des%+n+%id! en e ?@ de +s %!s+s. Se%"nd!$i! en /!s&! e 1@ de +s %!s+s. Ae%&! /!s&! e =8 de ! (+!%in !d"&!.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
Gene$!id!des. Ene$)ed!d
C!$di+v!s%"!$ =!.%!"s! de )+$&!id!d!n"! en e )"nd+.
Hi(e$&ens+s 18 =@ de! (+!%in 5ene$! -8@ de ! (+!%in
en&$e 8 - 2F !K+s.
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Hi(e$&ensin A$&e$i!Sis&>)i%!. Ries5+ !s+%i!d+ !
/i(e$&ensin sis&i%!!is!d!.
ECV even&+%!$di+v!s%"!$.
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HIPERTENSIN ARTERIAL.
De9ni%in de %!s+. S"*e&+s "e %"$sen %+n !5"n! de !s
si5"ien&es %!$!%&e$#s&i%!sM
Ci$!s de &ensin !$&e$i! sis&i%! i5"!es +)!-+$es ! 1F@ ))H5. Ci$!s de &ensin !$&e$i! di!s&i%! i5"!es +
)!-+$es ! ?@ ))H5. Se en%"en&$e !*+s &$!&!)ien&+ !$)!%+5i%+
!n&i/i(e$&ensiv+ !"n"e %"$sen %+n %i$!s de($esin !$&e$i! n+$)!es.
)*'+,3,+--$+&///.
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HIPERTENSIN ARTERIAL.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
C!si9%!%in.
JNC 7, JAMA
2003;19:2560-72
EtapaEtapa PA sistlicaPA sistlica
mmHgmmHgPA diastlicaPA diastlica
mmHgmmHg
NormalNormal
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
C!si9%!%in e&i+5i%!. P$i)!$i! + esen%i!. Se%"nd!$i!.
Ren!. End+%$in!s. C!$di+v!s%"!$es. Sis&e)! ne$vi+s+ %en&$!.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
De9ni%i+nes. Hi(e$&ensin esen%i!.
Eev!%in de ! ($esin !$&e$i! "e $es"&! de"n! in!($+(i!d! $e5"!%in de +s )e%!nis)+s
de %+n&$+ /+)e+s&&i%+ n+$)!es, en !"sen%i!de "n! %!"s! de&e%&!e.
Hi(e$&ensin sis&i%! !is!d!. P$esin sis&i%! (+$ !$$i! de 1F@, %+n TA
di!s&i%! den&$+ de i)i&es n+$)!es.
JNC 7, JAMA 2003;19:2560-72
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
De9ni%i+nes. Hi(e$&ensin de !&! !n%!.
Ci$!s !&!s de ($esin !$&e$i! en )edi+!)ien&e %#ni%+ + de %+ns"&+$i+, (e$+ n+$)!
de )!ne$! !)"!&+$i!. Pse"d+/i(e$&ensin.
Hi(e$&ensin )edid! (+$ es95)+)!n+)e&$+,(e$+ n+$)! %"!nd+ se )ide in&$!!$&e$i!.
Hi(e$&ensin A$&e$i!
%+n d!K+ v!s%"!$ %+)+ $e&in+(!! /i(e$&ensiv!5$!d+ F 0/e)+$$!5i!s, e"d!d+s, (!(iede)!4.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
:isi+(!&++5#!. An+$)!id!des de sis&e)! ne$vi+s+
si)(&i%+. Sis&e)! ne$vi+s+ !"&n+)+ - ne"$+end+%$in+,
s+n ! v#!s de $e5"!%in de %e$e$+ (!$! !($esin !$&e$i!.
SNS $e5"! ! ($esin !$&e$i! ! %+$&+ (!'+. :!%ii&!d+$ de ! HTAS %$ni%!, (+$ dis)in"%in
de %+n&$+ !$+$$ee*+ - s+$e!%&ivid!d de +s
ne$vi+s si)(&i%+s. A%&ivid!d si)(&i%! ! nive $en! $e5"! !ie$!%in de $enin!.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
:isi+(!&++5#!. Dis"n%in end+&ei!.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
:isi+(!&++5#!. A&e$!%i+nes )e&!i%!s.
Dee%&+ 5en>&i%+ "e )+d"! e )e&!+is)+ de#(id+s, %!$+/id$!&+s - %id+ Q$i%+.
Se )!ni9es&! (+$ /i(e$ins"ine)i! - $esis&en%i!! ! ins"in!.
Nivees eev!d+s de ins"in! in%$e)en&!n !$e!%&ivid!d v!s%"!$ - ($+d"%e $e&en%in des+di+ - !5"!.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
:isi+(!&++5#!. A&e$!%in de ! $e!%in ($esindi"$esis.
P>(&id+s n!&$i"$>&i%+s. A&$i!, %e$e$! - &i(+ C n!&$i"$esis,
v!s+di!&!%in !$&e$i! - ven+s!, sis&e)!si)(&i%+, - de ! ($+d"%%in de end+&ein!,!")en&+ de ! (e$)e!iid!d %!(i!$,!n&i)i&+5>nesis.
En !5"n!s (+!%i+nes de /i(e$&ens+s
dis)in"-e ! !%%in de es&+s (>(&id+s.
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Hi(e$&ensin A$&e$i!Sis&>)i%!.
$)G0*1E)-0)2GE)*.
$)G0*1E)-0)$ 0
$)G0*1E)-0)$ 00
$D*-1ER*)$
RE)0)$
EC$
SISTEMA RENINA-ANGIOTENSINA-
ALDOSTERONA.
$cti4aci5n de -)- incre"enta la li#eraci5n6in4olucrando a receptores B& adrenergicos.
Pul"5n6 retina6 cere#ro6 4asos sanguneos.
$1& 7$16 $189
$u"ento de 4olu"en intra4ascular6 rea#sorci5n desodio agua6 au"ento del gasto cardiaco
"odi;icaci5n del e
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HIPERTENSIN ARTERIAL.
Di!5ns&i%+.
:"nd!)en&!)en&e %#ni%+. Es&!e%e$ si ! /i(e$&ensin es ($i)!$i! +
se%"nd!$i!. Es&!e%e$ ! $e(e$%"sin +$5ni%!. Hi(e$&ensin de !&!
!n%!(se"d+/i(e$&ensin.
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HIPERTENSIN ARTERIAL.
D!K+ ! $5!n+ !n%+. C+$!'n.
Hi(e$&$+9! ven&$i%"!$ i'"ie$d!.
Dis"n%in ven&$i%"!$ i'"ie$d!.
Ce$e$+v!s%"!$. Ene$)ed!d v!s%"!$ %e$e$! is">)i%!. Ene$)ed!d v!s%"!$ %e$e$! /e)+$$5i%!. Is"e)i! %e$e$! &$!nsi&+$i!.
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HIPERTENSIN ARTERIAL.
D!K+ ! $5!n+ !n%+. Re&in+(!! /i(e$&ensiv!.
He)+$$!5i!s - e"d!d+s %+n + sin (!(iede)!.
V!s%"!$ (e$i>$i%+. Ane"$is)!s. A"sen%i! de ("s+s.
Ren!. Ins"9%ien%i! $en!. P$+&ein"$i!.
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HIPERTENSIN ARTERIAL.
C"!d$+ %#ni%+. Ines(e%#9%+. V!$#! se5Qn ed!d, se+, &i(+ de HTA - &ie)(+ de
ev+"%in. P"ede se$ !sin&+)&i%! + ($esen&!$se %+n)!nies&!%i+nes %#ni%!s de !5"n! de s"s%+)(i%!%i+nes.
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Hi(e$&ensin A$&e$i!Sis&>)i%!. C+)(i%!%i+nes.
E e%es+ de )+$iid!d - )+$&!id!d($+d"%id! (+$ ! HTA, se $e!%i+n!
di$e%&!)en&e %+n +s nivees de ($esin!$&e$i! sis&i%! - di!s&i%!. Ne"$+5i%!s. C!$di+v!s%"!$es. Ren!es.
O&$!s.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!. C+)(i%!%i+nes. C!$di+v!s%"!$es.
Hi(e$&$+9! de ven&$#%"+ i'"ie$d+.
:!%&+$ de $ies5+ )+$iid!d - )+$&!id!d%!$di+v!s%"!$. In!$&+ !5"d+ de )i+%!$di+, (+$ !")en&+ en !
de)!nd! de +#5en+ e in%$e)en&+ en ! )!s!ven&$i%"!$.
Dis"n%in di!s&i%! (+$ in%$e)en&+ en ! )!s!
ven&$i%"!$, 9$+sis )i+%$di%! - !&e$!%i+nes en! 5e+)e&$#! de ! %!vid!d.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!. C+)(i%!%i+nes. Ren!es.
Ne$+es%e$+sis.
Lesin $en! )!s %!$!%&e$#s&i%! de ! ene$)ed!d/i(e$&ensiv!. H!s&! 16 de +s /i(e$&ens+s des!$$+!$!n IRC. PAS es ($edi%&+$ )!s "e$&e de dis"n%in $en!.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!. C+)(i%!%i+nes. Ne"$+5i%!s.
En%e!+(!! de Bis!n5e$.
De)en%i! en&!)en&e ($+5$esiv!, !s+%i!d! ! "n!!e%%in !&e$+es%e$&i%! de (e"eK+s v!s+s en !s"s&!n%i! !n%! %e$e$!.
Di!5ns&i%+ de %e$&e'!, es !n!&+)+(!&+5i%+. De)en%i! v!s%"!$ - &i(+ A'/ei)e$.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!.T$!&!)ien&+. En!&i'!$ %+n e (!%ien&e s+$e !
i)(+$&!n%i! de se$ %+ns&!n&e en s"
&$!&!)ien&+, ($+(+$%i+n!nd+ sie)($ein+$)!%in e/!"s&iv! s+$e ! ene$)ed!d,ev!nd+ %+n&$+es %#ni%+s $e%"en&es -s+i%i&!$ %+!+$!%in de +&$+s ($+esi+n!esde ! s!"d.
O*e&iv+ ($i)+$di!M evi&!$ %+)(i%!%i+nes -($eveni$ ! )+$iid!d !s+%i!d!.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!.T$!&!)ien&+.T$!&!)ien&+ n+ !$)!%+5i%+.
P!%ien&es %+n HTA eve)+de$!d!, 8@ se %+n&$+!n
%+n es&!s )edid!s. Tienen ee%&+ !/+$$!d+$ de $)!%+s!n&i/i(e$&ensiv+s.
P"ede !v+$e%e$ ! !d/e$en%i! ! )!ne*+. :!v+$e%e ! sens!%in de ien es&!$ #si%+ - (s#"i%+
de (!%ien&e.
Dee se$ ($es%$i&+ ! &+d+ /i(e$&ens+, + "es"(+ne "n! )+di9%!%in s"s&!n%i! de s"es&i+ de vid! ! )+di9%!$ s" die&!, s"s /i&+s- s"s %+s&")$es &$!di%i+n!es.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!.T$!&!)ien&+.T$!&!)ien&+ n+ !$)!%+5i%+.
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Hi(e$&ensin A$&e$i!
Sis&>)i%!.T$!&!)ien&+.T$!&!)ien&+ n+ !$)!%+5i%+.
. Ansied!d - es&$es. Ei)in!%in de $)!%+s.
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
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HIPERTENSIN ARTERIAL.
:$)!%+s. Di"$>&i%+s. Be&! +"e!d+$es. A! +"e!d+$es.
C!%i+!n&!5+nis&!s. In/iid+$es de ECA. In/iid+$es de $e%e(&+$es de
ATII. In/iid+$es !d$ene$5i%+s
(e$i>$i%+s. A5+nis&!s %en&$!es. V!s+di!&!d+$es di$e%&+s.
JAMA 2003;289:2560-2572
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Modificaciones al estilo de vida
No se llega al obetivo de la !A
"#$0%90 & " #30%80 'a(a s)etosdiab*ticos con nef(o'atia+
,lecci&n inicial del f(.aco
/i'e(tensi&n sin enfe(.edad asociada /i'e(tensi&n con enfe(.edad asociada+
/i'e(tensi&n ,ta'a #
!A sist&lica #$0-#591
& !A diast&lica90%991
i)(*ticos ti'o tia4ida 'a(a la .ao(a
!)eden conside(a(se ,A A +
a & co.binaciones+
/i'e(tensi&n ,ta'a 2
!A sist&lica #60 ../g &
!A diast&lica #00 ../g1
o.binaci&n de 2 & .s f(.acos
!a(a la .ao(a+
!o( lo (eg)la( di)(*ticos ti'o tia4ida e ,A& A + & a+
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Hi(e$&ensin A$&e$i! Sis&>)i%!.
Diurticos
$R$ 00
$CC
0EC$
$ Blo
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Hi(e$&ensin A$&e$i!Sis&>)i%!.
4i(r5ticos4i(r5ticos 6-6lo7(ea-6-6lo7(ea-
doresdores
EAEA 6'A6'A 6a6a AntagonistasAntagonistas
4e la4e la
AldosteronaAldosterona0nsu;iciencia0nsu;iciencia
CardiacaCardiacaxx xx xx xx xx
Postin;arto alPostin;arto al
"iocardio"iocardioxx xx xx
Riesgo altoRiesgo altode en;.de en;.Coronaria.Coronaria.
xx xx xx xx
Dia#etesDia#etes xx xx xx xx
)e;ropatia)e;ropatia
cr5nicacr5nicaxx xx
Pre4. En;.C>-Pre4. En;.C>-
Recurrente.Recurrente.xx xx
Frmacos recomendados con patologa agregada
JAMA 2003;289:2560-2572
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Hi(e$&ensin A$&e$i!
Sis&>)i%!. E)e$5en%i! /i(e$&ensiv!. Hi(e$&ensin seve$! %+n de&e$i+$+ sis&>)i%+
!5"d+.
SNC. C!$di+v!s%"!$. Ren!.
U$5en%i! /i(e$&ensiv!. Hi(e$&ensin seve$! sin de&e$i+$+ sis&>)i%+
!5"d+.
O(+$&"nid!d de )!ne*+.
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HIPERTENSINPUL
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Defnicin
HTP: Se de9ne (+$ "n! ($esin !$&e$i!(")+n!$ )edi! (PAPm) 25 mmHg enreposo(+$ + 5ene$! confrmadas por
cateterismo cardaco derecho.
/oe'e( MM ogaa(d /J ondliffe et al+ efinitions and diagnosis of ')l.ona( >'e(tension+ J A. oll a(diol 20#3; 62:$2
http://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/abstract/1http://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/abstract/1http://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/abstract/1http://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/abstract/1 -
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Defnicin
P"ede dee$se ! "n! eev!%in ($i)!$i!de ! ($esin de sis&e)! !$&e$i!(")+n!$ (Hipertensin Arterial
Pulmonar) + se%"nd!$i! ! ! eev!%inde sis&e)! ven+s+ %!(i!$ (")+n!$(Hipertensin enosa Pulmonar)!
eBis J )bin M et al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
http://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/contributorshttp://www.uptodate.com/contents/overview-of-pulmonary-hypertension-in-adults/contributors -
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"#A$%&%"A"%'
rupo * Hi(e$&ensin A$&e$i! P")+n!$
rupo 2 HP deid! ! ins"9%ien%i! %!$di!%! i'"ie$d!.
rupo + HP deid! ! Ene$)ed!d P")+n!$ C$ni%!-+ Hi(+e)i!.
rupo , HP deid! ! Hi(e$&ensin P")+n!$
T$+)+e)i%! C$ni%!.
rupo 5 HP deid! ! )e%!nis)+s )"&i!%&+$i!es n+%!$+s.
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rupo * (HAP)
HAP %diop-tica . Hereda/le:
HAP de/ida a drogas . to0inas:
HAP de/ida a 1nermedades del Te3ido "onecti4o:Oi&e$!%in 9$+s! de &e*id+v!s%"!$.
HAP de/ida a %H: ($ev!en%i! @,8 en VIH.
HAP de/ida a Hipertensin portal: +P+$&+(")+n!$!
HAP de/ida a "ardiopata "ong6nita:dee%&+s A"$&i%"!$es + Ven&$i%"!$es %+ns/"n& de i'"ie$d! ! de$e%/!.
HAP de/ida a ineccin por 1s7uistosomiasisM P$in%i(!)en&e !e%%in/e(!&+es(>ni%!, %+n e)+i'!%in (")+n!$ - $e!%%in 5$!n"+)!&+s! de !s!$&e$i+!s (")+n!$es.
eBis J )bin Met al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
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rupo 2 (%" i87uierda)
Se !s+%i! ! ($esin eev!d! en aurcula i87uierda -!")en&+ de presin4enosapulmonar.
Aumento de la Presin $istlica de la Arteria
Pulmonar "e se $e"ie$e para mantener una uer8amotri8 s"9%ien&e ! &$!v>s de ! v!s%"!&"$! (")+n!$.
Se 5ene$!n respuesta 4asoconstrictora . remodelacinde &e$$i&+$i+ v!s%"!$.
P"ede se$ (+$M Dis"n%in diastlica, sistlica, 4al4ular,miocardiopatas %+n5>ni&!s + !d"i$id!s %+n +s&$"%%inde &$!%&+ de s!id!.
eBis J )bin Met al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
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rupo + (1n Pulmonares .9oHipo0emia) En (!%ien&es 1P"se !s+%i! ! ma.ormortalidad.
Es )s $e%"en&e - )s 5$!ve en (!%ien&es %+n 1nfsemaasociado a &i/rosis pulmonar!
L! Apnea /structi4a del $ue;o, %"!nd+ se !%+)(!K!de $ndrome de Hipo4entilacin por o/esidad ("ede5ene$!$ HTP 5$!ve, !")en&!nd+ ! )+$&!id!d.
eBis J )bin Met al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
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rupo , (HT PulmonarTrom/oem/lica "rnica)
Deid! ! oclusin trom/oem/lica crnica de! v!s%"!&"$! (")+n!$ ($+i)! + dis&!.
Tiene e potencial de me3ora + %"$!%in %+ntrom/oendarterectoma pulmonar.
T+d+s +s (!%ien&es %+n HP, in%"-end+ es&e 5$"(+,es&n en $ies5+ de e)+i! (")+n!$.
eBis J )bin Met al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
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rupo 5 ("!s !%i+$)es, ese$+%i&+sis !)ii!$4.
Trastornos mieloprolierati4os.
Trastornos sist6micos 0s!$%+id+sis4.
Trastornos meta/licos 0ene$)ed!d (+$
de(si&+ de 5"%5en+, Ene$)ed!d de G!"%/e$4.
1nermedad renal crnica en Hemodi-lisis.
eBis J )bin Met al+ C=ve(vieB of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
id i l
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1pidemiologa P$ev!en%i! desconocida 0)Q&i(es e&i++5#!s, %!si9%!%in
dive$s!4.
P$esen&e en todas las edades, en todos los grupos raciales, enam/os se0os.
L! m-s estudiada es la HAP 5$"(+ 1 0=araM 8 ! 18 %!s+s (+$
)in de !d"&+s4.
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D%A'$T%"
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$>T'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent
t>(o)g>: Ma 20#5+
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1?P#=A"%' &>$%"A AUSCULTACIN CARDACA
= $"id+ (")+n!$ $e+$'!d+.
S+(+ /++sis&i%+ de Ins"9%ien%i! &$i%"s(ide! 0"n%i+n!4. S+(+
di!s&i%+ de ins"9%ien%i! (")+n!$.
3e$ R"id+ (!&+5i%+.
AUSCULTACIN PUL'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((ent
t>(o)g>: Ma 20#5+
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1#1"T="A=D%=A
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1""A=D%=A(o)g>: Ma 20#5+
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P=@1A$ D1 &@"%'P@#
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P#%$A
S+i%i&!$ $en&e ! s+s(e%/! %#ni%! deA(ne! Os&$"%&iv! de S"eK+.
eBis J )bin M et al+ Clinical feat)(es and diagnosis of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((entt>(o)g>: Ma 20#5+
>
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A(o)g>: Ma 20#5+
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Test de la/oratorioespecfcos
Se5Qn s+s(e%/! %#ni%!MVIH HP (+$ VIH.:"n%in He(&i%! HP (+$&+(")+n!$.ANA, ANCA, :!%&+$ Re")!&+ide HPEne$)ed!des de &e*id+ %+ne%&iv+.He)+5$!)!, LDH, Bii$$"in! Indi$e%&!
HP !ne)i!s /e)+#&i%!s.ANP NTP$+BNP Ins"9%ien%i! %!$di!%!0!%&+$ ($+ns&i%+4.
eBis J )bin M et al+ Clinical feat)(es and diagnosis of ')l.ona( >'e(tension in ad)ltsD+ E!F=AF,+ ite(at)(e (evieB c)((entt>(o)g>: Ma 20#5+
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"AT1T1=%$(o)g>: Ma 20#5+Hoeper et al. efinition and iagnosis of PH!.A"" ol! E2F o! 25F $uppl DF Dicem/er 2G*+!
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T=ATA
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"onsideracionesT$!&!)ien&+ dee se$ preco8 0es&!d+s !v!n'!d+s
s+n )en+s sensies ! ! &e$!(i!4.
Terapia primaria: Di$i5id! ! ! causasu/.acente!
Terapia a4an8ada: C"!nd+ ($+5$es! !ene$)ed!d !v!n'!d!, ! &e$!(i! v! di$i5id! ! !Hi(e$&ensin P")+n!$ en s#.
Dee es&!e%e$se ! C!(!%id!d "n%i+n! de !se,! P$esin A$&e$i! P")+n!$ 'e(tension in ad)ltsD+ ite(at)(e
(evieB c)((ent t>(o)g>: Ma 20#5+
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Terapia Primaria(causa su/.acente)
rupo * (HAP): Re"ie$en &e$!(i! !v!n'!d! ($e%+'.
rupo 2 (%" i87F Disuncin $ist Diast al4ular):T$!&!)ien&+ %!$di+(!! de !se.
Iillia. /o'Gins Met al+ F(eat.ent of ')l.ona( >'e(tension in ad)ltsD+ ite(at)(e
(evieB c)((ent t>(o)g>: Ma 20#5+
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Terapia Primaria(causa su/.acente)
rupo + (1n Pulmonar): C+$$e%%in de ! Hi(+e)i!. Us+ de O= s"(e)en&!$i+ en P!O= X88 ))H5,
+ 888? ))H5 %+n P+i5+"i! + Ins"9%ien%i!C!$di!%! de$e%/! 0)e*+$! ! s+$evid!,dis)in"-e ! RVP - PAP) en EPOC4.
Iillia. /o'Gins Met al+ F(eat.ent of ')l.ona( >'e(tension in ad)ltsD+ ite(at)(e
(evieB c)((ent t>(o)g>: Ma 20#5+
T i P i i
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Terapia Primaria(causa su/.acente) rupo , (HT Pulmonar Trom/oem/licacrnica):
An&i%+!5"!%inM &$!&!)ien&+ ($i)!$i+, !"n"eene9%i+ de ! eviden%i! es d>i.
&!$'!en#ateect!$a ()i*%icaM &$!&!)ien&+de ee%%in en +s&$"%%in ($+i)!. Re()ieenantic!a%)laci"n pe+ia #e 3 $eses.
rupo 5 (multiactorial)M se5Qn %!"s!.
Iillia. /o'Gins M et al+ F(eat.ent of ')l.ona( >'e(tension in ad)ltsD+ ite(at)(e (evieB c)((ent t>(o)g>: Ma 20#5+
Keog> AM et al+ nte(ventional and .odalities of t(eat.ent in ')l.ona( >'e(tension+ J A. oll a(diol 2009 5$:H67+
Terapia A4an8ada
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Terapia A4an8ada Agentes especfcosM
B+"e!d+$es de +s %!n!es de %!%i+ 0Di&i!'e), Niedi(in+4. An&!5+nis&!s de $e%e(&+$ de end+&ein! 1 0B+sen&!n,
Iillia. /o'Gins M et al+ F(eat.ent of ')l.ona( >'e(tension in ad)ltsD+ ite(at)(e (evieB c)((ent t>(o)g>:E!F=AF, Ma 20#5+
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TRO
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L! TEP es "n! %+)(i%!%in de !&$+)+sis ven+s! ($+"nd! 0TVP4.
Se ($+d"%e %+)+ %+nse%"en%i! de !)i5$!%in /!s&! e $+ !$&e$i! (")+n!$de "n &$+)+ ($+%eden&e, 5ene$!)en&ede sis&e)! ven+s+ ($+"nd+.
L! )i&!d de +s (!%ien&es %+n TVPsin&+)&i%! des!$$+!n TEP, )"%/+s dee!s sien&es.
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:!%&+$es de $ies5+ Eis&en dive$s+s !%&+$es !d"i$id+s %+)+ 5en>&i%+s, en&$ee+sM
Vi!*es !>$e+s ($++n5!d+s Oesid!d T!!"is)+
ACO E)!$!'+ Res&i&"%in /+$)+n! T$!")!&is)+s In&e$ven%i+nes "i$Q$5i%!s
HTA.
&i%!s s+nM !%&+$ V deLeiden - ! de 5en de ! ($+&$+)in!.
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:isi++5#! L! e)+i! ("ede &ene$ +s si5"ien&es ee%&+sM
1.A")en&+ de ! $esis&en%i! v!s%"!$ (")+n!$
deid! ! ! +s&$"%%in v!s%"!$.
=.A&e$!%in de in&e$%!)i+ 5!se+s+M deid+ !!")en&+ de es(!%i+ )"e$&+ !ve+!$ (+$
+s&$"%%in, /i(+e)i! 0%+)+ %+nse%"en%i!de /i(+ven&i!%in !ve+!$ en (")n n++s&$"id+4
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3. Hi(e$ven&i!%in !ve+!$ deid! ! !es&i)"!%in $ee*! de +s $e%e(&+$es dei$$i&!%in.
F. A")en&+ de ! $esis&en%i! de !s v#!s$es(i$!&+$i!sM (+$ %+ns&$i%%in dis&!)en&e! +s $+n"i+s.
8. Dis&ensiiid!d (")+n!$ $ed"%id! (+$ede)! + /e)+$$!5i! (")+n!$.
Di i t i l
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Disuncin 4entricularderecha
L! ins"9%ien%i! ($+5$esiv! de %+$!'nde$e%/+ s"ee se$ ! %!"s! de )"e$&e (+$
TEP.
A !")en&!$ ! $esis&en%i! v!s%"!$(")+n!$ s"e ! &ensin de ! (!$ed
ven&$i%"!$ de$e%/! - (e$(e&Q! )s !di!&!%in - ! dis"n%in ven&$i%"!$de$e%/!.
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SINTO
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Di!5n+s&i%+ Die$en%i! S#nd$+)e %+$+n!$i+ !5"d+, in%"s+ !n5in!
ines&!e e in!$&+ !5"d+ de )i+%!$di+ Ne")+n#!, $+n"i&is, e!%e$!%in de
!s)! + ne"$+(!! +s&$"%&iv! %$ni%! Ins"9%ien%i! %!$d#!%! %+n5es&iv! Pe$i%!$di&is :$!%&"$!s %+s&!es, ne")+&$! Hi(e$&ensin (")+n!$ ($i)!$i!
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TECNICAS DIAGNOSTICAS
L! %+n%en&$!%in de d#)e$+ D )edid+)edi!n&e ($"e! de in)"n+ !s+$en&e
i5!d+ ! en'i)!s es&! eev!d! 8@@ n5)en )!s de ?@ de +s %!s+s, + "e $ee*!! $+&"$! de ! 9$in! (+$ ! (!s)in!. 0sine)!$5+, n+ es es(e%i9%! %!$e%e de"&iid!d (!$! (!%ien&es "e se en%"en&$!n/+s(i&!i'!d+s4.
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E7GT!"i%!$di! sin"s! 9$i!%in + !e&e+
!"$i%"!$
S+$e%!$5! ven&$i%"!$ A$$i&)i!s
?3
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RADIOGRA:IA DE TORA L+ )s $e%"en&e en ! e)+i! (")+n!$
es "n! $!di+5$!#! de &$! n+$)!
De$$!)e (e"$!
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1cocardiograma Ev!"!$ ! )+$++5#! - "n%in de VD Es&i)!$ ! ($esin sis&i%! de !$&e$i!
(")+n!$
Vis"!i'!$ &$+)+s in&$!")in!$es ein&$!%!vi&!$i+s Des%!$&!$ ! ($esen%i! de +&$!s
ene$)ed!des %!$di+v!s%"!$es "e si)"!n
"n! TEP. 0C/+"e %!$di+5>ni%+, in!$&+ deVD, dise%%in !$&i%! !5"d!, &!(+n!)ien&+%!$d#!%+, v!v"+(!! !5"d! 4.
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TRATA
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HEPARINAM
Se "ne ! ! !n&i&$+)in! III - !%ee$! s" !%&ivid!din/ie +s !%&+$es de %+!5"!%in de &$+)in!i)(ide ! +$)!%in !di%i+n! de &$+)+s.
D+sisM ++ IV 8@@@1@@@@ IU se5"id!s de "n!in"sin %+n&in"! de 1@@@ ! 18@@ IU/ . 0B++ 6@"7G, 16U;5/.
Des(">s de 82 d, e &$+)+ $esid"! e)(ie'! !es&!ii'!$se en e end+&ei+ n+ dis"evedi$e%&!)en&e e &$+)+.
H1PA=%A$ D1 A
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H1PA=%A$ D1 AP1$
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T$+)+#&i%+s
L! !%%in de +s$)!%+s &$+)+#&i%+s%+nsis&e en (+&en%i!$
! 9$inisis9si+5i%! )edi!n&e !!%&iv!%in de(!s)in5en+ (!$!!")en&!$ !($+d"%%in de(!s)in! - !s# is!$$(id!)en&e +s&$+)+s $e%ien&es
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ilt!s #e la +ena ca+a
P$in%i(!es indi%!%i+nesM1.He)+$$!5i! !%&iv! "e
i)(ide e &$!&!)ien&+!n&i%+!5"!n&e
=. T$+)+sis ven+s!$e%idiv!n&e (ese !&$!&!)ien&+ !n&i%+!5"!n&e
in&ensiv+.
Tratamiento
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Tratamientocomplementario
Aivi+s de d++$ 0AINES4, +s s"(e)en&+sde +#5en+
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