PULMONARY HYPERTENSION

PRESENTED BY
VAISHNAVI M I
21Q0177
PHARM D II YEAR
DEFINATION
PULMONARY HYPERTENSION

• Pulmonary hypertension (PH) Is a heamodynamic and pathophisiology

condition defined as mean pulmonary artery pressure 25mmhg At rest by
right heart catheterization (RHC).
COR PULMONALE(RIGHT SIDED HEART
FAILURE)

• Cor pulmonale is a condition that causes the right side of the heart to fail.
Long term high blood pressure in the arteries of the lungs and right ventricle
of the heart can lead to cor pulmonale
 EPIDEMIOLOGY

• Pulmonary hypertension (PH) is a progressive disease characterized by

increased pulmonary vascular resistance that ultimately leads to right heart
failure and death
• PatientS usually present with non-specific symptoms such as shortness of
breath, fatigue, angina and syncope.
ETIOLOGY

• Some common underlying causes of pulmonary hypertension include high

blood pressure in the lungs arteries due to some type of congential heart
disease, connective tissue disease, coronary artery disease, high blood
pressure, liver disease (cirrhosis) blood clots to the lungs and chronic lungs
diseases.
PATHOPHISIOLOGY OF HYPERTENSION

• Pulmonary hypertension (PH) is characterized by variable and sometimes

pathologic vasocontriction and by endothelial and smooth muscle
proliferation, hypertrophy and chronic inflammation resulting in vascular
wall remodeling.
FLOW CHART
PATIENT PROFILE

• Pt Name :- XYZ
• Age (yrs) :- 72
• Sex :- Female
• I.P No:- 34127
• Dept :- Medicine
• Unit :- C
• DOA :- 16/4/2022
REASON FOR ADMISSION

• C/O breathelessness since 4 days

• C/O fever1episode yesterday
PAST MEDICAL HISTORY

• Patient was admitted 2 months back for similar complaints at HSK hospital
was advice home oxygen therapy currently on tab vasosure 20 mg/dl.
HISTORY OF PRESENCE ILLNESS

• Patient was apparently alright 4 days back then she developed breathlessness
grades in onset progressive in nature aggravated on exertion relieved on
taking rest. C/O 1 Episode of fever yesterday sudden in onset moderate grade
fever no Aggrvating factor relieved on taking medication C/O chest pain,
no loose stools, no abdomen pain.
FAMILY HISTORY

• Diet – mixed
• Apetite – Normal

• SOCIAL HISTORY
• Habits – nil
ALLERGIES

• No allergies found.
GENERAL PHYSICAL EXAMINATION

• Bp – 140/ 80mmHg
• PR – 104bpm
• Spo2 – 86%
• Systematic Examination
• Cvs – s1s2+
• RS – breath lessness
• CNS – conscious oriented
• P/A – soft non tender
PROVISIONAL DIAGNOSIS

• Pulmonary hypertension with cor pulmonale.

 LABORATARY DATA
•. • Hb – 9.8g/dl
• CBC : WBC – 4400
• Blood glucose : RBS : 112.4mg/dl
• DLC : polymorphs - 70 • Day 1:
• Basophils – 00
• Eosinopils - 01 • Electrolytes : Na : 13.4mEq/L
• Lymphocytes - 21
• Monocytes – 08
• K : 4.8mEq/L
• RBC – 3.33 million/uL • Cl : 95mEq/L
• PLT – 1,69,000
• ESR - 80 •
• Day 2 :
• Electrolytes : Na : 137mEq/L
• K : 3.5mEq/L
• Cl : 97mEq/L
• Ca : 6.1mg/dL
• P : 4.5mEq/L
• RFT : Sr. Urea 48.8mg/dl
• Creatinine : 2.4mg/dL
• LFT : ALT : 15.6U/L
• AST : 27.9u/L
• ALP : 37.3u/L
• Bilirubin :
• T : 0.5MG%
• D : 0.3MG%
• I : 0.2MG%
• Total protein : 6.9mg/dl
• Albumin : 4.0mg/dl
• Globulin : 2.9mg/dl
• AIG ratio : 1:3:1
 TREATMENT CHART
Brand name Generic name Dose Route Frequency Days
D D D D4 DD
1 2 3 5 6
Inj.Pip 20 Piperacillin 4.5g IV 1-1-1 YYYY YY
Tazobactam
Inj.Pan 40 Pantoprazole 40mg IV 1-0-0 YYYY YY

Inj.Emeset Ondansetron 4mg IV 1-1-1 YYYY YY

Inj.lasix Furosemide 20mg IV 1-1-1 YYYY

Tab.Vasosure Sildenafil 20mg P/O 1-0-1 YYYY YY

Tab.Shelcal Calcium 500mg P/O 1-0-0 YYYY YY

Vit.D3
Neb.duolin Levosalbutamol 1-28mg 1-1-1 YYYY YY
Ipratropium
Budecort Budesonide 0.3mg 1-1-1 YYYY YY

Tab A-Z Multivatmin P/O 0-1-0 YY

Inj. Calcium gluconate Czlcium gluconate 10mg IV stat Y

FOLLOW UP SHEET

Day 2 :
• Day 1
Bp : 90/60
• Bp- 140/80
Pulse : 71
• Pulse – 104
On examination : NFC
• On examination – C/O breathless
monitor vital SPO2 -100%
• Treatment advise – APC Treatment Advice : APC
• Day 3 • Day 4 :
• Bp : 94/58 • BP : 94/60
• Pulse : 78 • Pulse : 74
• On Examination : NFC • On examination : NFC
• Treatment advice : APC • Treatment advice : APC
• Day 5 : • Day 6 :
• BP : 98/60 • BP : 100/60
• Pulse : 76 • Pulse : 78
• On examination : NFC • On examination : NFC
• Treatment advice : APC • Spo2 -98%
• Treatment advice : APC
• Day 7 :
• Bp : 120/70
• Pulse : 78
• On examination : NFC
• Treatment advice : APC
FINAL DIAGNOSIS

• Pulmonary Hypertension with cor pulmonate

 DISCHARGE MEDICATION
Brand name of Generation name of Dose Route Frequency Duration
drug drug
Tab vasoscure Sidenafil 20mg P/o 1 – 0- 1

Tab A-Z Multivitamin P/o 0 -1 - 0 15days

Tab.Lasix Furosemide 20mg P/O 1-0-0

PHARMACEUTICAL CARE PLAN

• Subjective evidence : patient was admitted 2 months back for similar complaints at hospital was advice home oxygen
therapy currently on Tab vasosure 20mg/dl.

• Objective evidence : Wbc : 4400

• Monocytes : 08
• Hb : 9.8g/dl
• Ca : 6.1mg/dl
•
• Assessment : subjective and objective evidence the pt Was diagnosed to have pulmonary hypertension with cor
pulmonale.
PATIENT COUNCELLING

• Weight reduction
• Dietary approaches
• Avoid Alcohol consumption
• Smoking should be avoided
• Stress reduction
• Regular aerobic Physical activity.
THANK YOU .