Cardiology>>>>>Pulmonary Hypertension And Pericardium
Question 10#

With respect to pulmonary hypertension patients with congenital heart disease:

a. Pregnancy is well tolerated, making counselling on the topic unnecessary
b. Venesection is recommended to reduce hyperviscosity relating to high hematocrit
c. Eisenmenger syndrome describes reversal of a right to left shunt due to the development of pulmonary hypertension
d. Transthoracic echocardiography inadequately images the upper septum and so sinus venous defects may be missed
e. The six-minute walk test is an infallible measure of disease severity

Correct Answer is D

Comment:

Pulmonary hypertension is an important complication in congenital heart disease. At the most extreme end of the spectrum is Eisenmenger syndrome, defined by reversal of a left to right shunt due to the development of pulmonary hypertension. Venesection for patients with Eisenmenger syndrome is now avoided. A sinus venosus defect (and aberrant pulmonary venous drainage) should be considered in patients with a dilated right heart and PH but no other explanation. A transoesophageal echocardiogram can visualize the upper inter-atrial septum well. The development of PAH can make pregnancy hazardous, and the oral contraceptive pill can interact with bosentan. Therefore family planning is vital. The six-minute walk test has recognized limitations. Therefore a number of factors are looked at when trying to prognosticate.