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Reversible Pulmonary Hypertension Associated with Uncontrolled Asthma
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A6988 - Reversible Pulmonary Hypertension Associated with Uncontrolled Asthma
Author Block: I. Oriaku, Z. Safdar, G. Noureddine; Houston Methodist Hospital/Weil Cornell College of Medicine, Houston, TX, United States.
Introduction: Pulmonary hypertension (PH) has a high morbidity and mortality rate and is often diagnosed late due to nonspecific presentation. We report a case that supports evaluation for reversible causes of PH such as asthma. Literature review resulted in no case report of uncontrolled asthma resulting in PH nor a case in which controlling asthma resulted in reversal of PH.
Case Presentation: 18-year-old Arabic athletic man with past medical history of seasonal allergies and moderate persistent asthma with initial FEV1/FVC of 60% on albuterol and fluticasone-vilanterol, presented with new complaints of chest pain, shortness of breath and tachycardia resulting in three emergency department visits within 10 days. On examination, heart rate was 68 beats/min, respiratory rate was 18/min, oxygen saturation was 99%, lung exam was clear and cardiovascular exam revealed accentuated P2, 2/6 systolic murmur in left sternal border. Arterial blood gas showed pH of 7.51, CO2 of 30 mmHg, paO2 of 109 mmHg and oxygen saturation of 99%. Patient was seen at the Houston Methodist PH Center where a right heart catheterization was recommended but the patient and his mother declined. An electrocardiogram showed normal sinus rhythm and an echocardiogram (ECHO) showed left ventricular ejection fraction (LVEF) of 65-69%, enlarged right ventricular (RV) size, moderately depressed RV function, estimated right ventricle systolic pressure (RVSP) of 48 mmHg, and right atrial pressure (RAP) of 5 mmHg. Ventilation perfusion scan revealed normal perfusion. Cardiac magnetic resonance imaging showed LVEF of 59%, mildly depressed RV systolic function (RVEF 50%) with mild tricuspid valve regurgitation (TR). Connective tissue disease was unremarkable. Patient was prescribed oral steroids, budesonide inhaler, advised to avoid heavy exercise and sports. During his follow up visit, his asthma symptoms were adequately controlled and he had returned to his previous activities such as playing football without recurrent symptom or need for rescue inhaler. Repeat ECHO showed LVEF of 67%, normal RV size, and RVEF and TR jet insufficient to estimate RVSP and repeat FEV1/FVC had improved to 78%.
Discussion: A connection between asthma and PH that has not been previously described. Although PH is characterized by pulmonary vascular remodeling, bronchoconstriction associated with asthma may contribute to hypoxic pulmonary vasoconstriction leading to mild PH. Asthma needs to be considered as a possible cause of reversible PH, and should be aggressively treated when identified in patients with suspected or confirmed PH.
Author Block: I. Oriaku, Z. Safdar, G. Noureddine; Houston Methodist Hospital/Weil Cornell College of Medicine, Houston, TX, United States.
Introduction: Pulmonary hypertension (PH) has a high morbidity and mortality rate and is often diagnosed late due to nonspecific presentation. We report a case that supports evaluation for reversible causes of PH such as asthma. Literature review resulted in no case report of uncontrolled asthma resulting in PH nor a case in which controlling asthma resulted in reversal of PH.
Case Presentation: 18-year-old Arabic athletic man with past medical history of seasonal allergies and moderate persistent asthma with initial FEV1/FVC of 60% on albuterol and fluticasone-vilanterol, presented with new complaints of chest pain, shortness of breath and tachycardia resulting in three emergency department visits within 10 days. On examination, heart rate was 68 beats/min, respiratory rate was 18/min, oxygen saturation was 99%, lung exam was clear and cardiovascular exam revealed accentuated P2, 2/6 systolic murmur in left sternal border. Arterial blood gas showed pH of 7.51, CO2 of 30 mmHg, paO2 of 109 mmHg and oxygen saturation of 99%. Patient was seen at the Houston Methodist PH Center where a right heart catheterization was recommended but the patient and his mother declined. An electrocardiogram showed normal sinus rhythm and an echocardiogram (ECHO) showed left ventricular ejection fraction (LVEF) of 65-69%, enlarged right ventricular (RV) size, moderately depressed RV function, estimated right ventricle systolic pressure (RVSP) of 48 mmHg, and right atrial pressure (RAP) of 5 mmHg. Ventilation perfusion scan revealed normal perfusion. Cardiac magnetic resonance imaging showed LVEF of 59%, mildly depressed RV systolic function (RVEF 50%) with mild tricuspid valve regurgitation (TR). Connective tissue disease was unremarkable. Patient was prescribed oral steroids, budesonide inhaler, advised to avoid heavy exercise and sports. During his follow up visit, his asthma symptoms were adequately controlled and he had returned to his previous activities such as playing football without recurrent symptom or need for rescue inhaler. Repeat ECHO showed LVEF of 67%, normal RV size, and RVEF and TR jet insufficient to estimate RVSP and repeat FEV1/FVC had improved to 78%.
Discussion: A connection between asthma and PH that has not been previously described. Although PH is characterized by pulmonary vascular remodeling, bronchoconstriction associated with asthma may contribute to hypoxic pulmonary vasoconstriction leading to mild PH. Asthma needs to be considered as a possible cause of reversible PH, and should be aggressively treated when identified in patients with suspected or confirmed PH.
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