Grup 2; Sol Kalp Hastalığına Bağlı Pulmoner Hipertansiyon
Özet
Sol kalp hastalığına bağlı pulmoner hipertansiyon , pulmoner hipertansiyonun en sık görülen formudur ve kalp yetmezliği , valvüler kalp hastalıkları ve diğer sol kalp patolojileri ile ilişkilidir. 2022 ESC/ERS kılavuzlarına göre ortalama pulmoner arter basıncı >20 mmHg ve pulmoner arter kama basıncı >15 mmHg ile tanımlanır. Hemodinamik olarak izole post-kapiller pulmoner hipertansiyon ve kombine pre- ve post-kapiller pulmoner hipertansiyon olarak ayrılır. Korunmuş ejeksiyon fraksiyonlu kalp yetmezliğinde pulmoner hipertansiyon sıklığı yüksektir ve prognozu kötüleştirir; Düşük ejeksiyon fraksiyonlu kalp yetmezliğinde ise sol ventrikül disfonksiyonu baskındır. Valvüler hastalıklarda (özellikle mitral ve aort kapak hastalıkları) post-kapiller basınç artışı ön plandadır. Tanısal zorluklar, doğru pulmoner arter kama basıncı ölçümü, provokatif testler ve komorbiditelerden kaynaklanır. Tedavi prensibi, altta yatan sol kalp hastalığının optimizasyonudur; pulmoner arteryel hipertansiyon-spesifik tedaviler rutin olarak önerilmez ve güvenlik kaygıları vardır. Multidisipliner yaklaşım, erken tanı ve bireyselleştirilmiş yönetim ile mortalite ve morbidite azaltılabilir. Bu bölüm, güncel literatür ve kılavuzlar ışığında klinik pratiğe yön verecek şekilde yapılandırılmıştır.
Pulmonary hypertension due to left heart disease is the most common form of pulmonary hypertension and is associated with heart failure, valvular heart disease, and other left-sided cardiac pathologies. According to the 2022 ESC/ERS guidelines, it is defined by a mean pulmonary artery pressure >20 mmHg together with a pulmonary artery wedge pressure >15 mmHg. Hemodynamically, it is divided into isolated post-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension. In heart failure with preserved ejection fraction, pulmonary hypertension is highly prevalent and worsens prognosis, whereas in heart failure with reduced ejection fraction, left ventricular dysfunction predominates. In valvular diseases—particularly mitral and aortic valve disease—post-capillary pressure elevation is the leading feature. Diagnostic challenges arise from accurate measurement of the pulmonary artery wedge pressure, provocative testing, and comorbidities. The treatment principle is optimization of the underlying left heart disease; pulmonary arterial hypertension–specific therapies are not routinely recommended and carry safety concerns. With a multidisciplinary approach, early diagnosis, and individualized management, mortality and morbidity can be reduced. This chapter is structured to guide clinical practice in light of the current literature and guidelines.
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