الفهرس 
o Physiology of pulmonary circulationOnly 14 pages are availabe for public view
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Abstract
Pulmonary hypertension (PH) is a devastating disease leading to right heart failure and death. Since PH is a rare disease, information about epidemiology, follow-up and prognosis are difficult to obtain, but are invaluable to improve therapy and assess outcome parameters.
In this study, the aim was to record retrospectively the demographic and clinical characteristics of PH cases admitted to Abbasia chest hospital during the period from 2011 till 2012. It is important to note that although current guidelines recommended right heart catheterization (RHC) for the diagnostic evaluation of patients with PH, the diagnostic approach in this study was established mainly on clinical suspicion and transthoracic echocardiography as the RHC wasn’t available.
As regards the demographic characteristics, the study included 52 patients, their mean age was (55.8±13.25) , most of the patients (53.8%) were females. Most of the studied patients (50%) were housewives, (61.5%) living in Cairo and (44.2%) of them were smokers.
As regards the clinical characteristics, hypertension and diabetes were the most prevalent co-morbid conditions (46.2% and 17.3% respectively).
PH due to lung diseases and/or hypoxia (group 3 according to the updated classification of PH) constituted the majority of cases 43/52 (82.6%) mostly chronic obstructive pulmonary disease (COPD) 28/52 (53.8%). PH due to left sided heart failure (group 2) was the second common cause 5/52 (9.6%) followed equally by patients with chronic thromboembolism (CTEPH) (group 4) 2/52 (3.8%) and patients with idiopathic pulmonary hypertension (group 1) 2/52 (3.8%). The cases in this study were classified according to the NYHA FC into two groups. The majority fitted in FC III 40/52 (76.9%) and only 12/52 (23.1%) into FC IV.
Among the cardinal chest symptoms, the study showed that dyspnea was the most prevalent symptom being manifested by all patients (100%), followed by chest wheeze (40.4%), cough (28.8%) orthopnea (23.1%), chest pain (3.8%), hemoptysis (3.8%), and elevated body temperature (7.7%).
General clinical assessment showed that lower limb oedema (90.4%) was the most prevalent sign followed by congested neck vein (77%). Local chest examination showed that wheeze (76.9%) was the most prevalent sign, and cardiac examination revealed that murmur of TR was the most prevalent(46.2%), followed by audible S3 (23.1%), accentuated S2 (21.2%) and Splitting of S2.
As for the investigations, thesis estimation of the pulmonary artery systolic pressure was based on the guidelines of the British society of echocardiography in 2011 stated that echocardiographic evaluation of pulmonary artery systolic pressure (PASP) relies on the fact that PASP approximates right ventricular systolic pressure (RVSP) in the absence of right ventricular outflow obstruction. Analysis of the data provided by ECHO studies, showed that the right systolic ventricular pressure (RSVP) ranged from 40 to 90 mmHg with mean of (61.4±12.4mm Hg), all of the patients had dilated right ventricle. ECG findings varied from right axis deviation (36.5%) and P pulmonale (63.5%). chest X ray showed enlarged main and hilar pulmonary artery in (28.8%) of the patients.
The most effective treatments (eg, epoprostenol and bosentan) are not affordable for Egyptian patients, and this has led to difficulty in the treatment of pulmonary hypertension in Egypt.
Regarding the treatment, all of the patients received nonspecific combination therapy of two or more drugs. Diuretics were used in most of the patients (90.4%), CCBs (67.3%) followed by PDEIs (32.7%).
Also this study aimed to evaluate the awareness of the treating physicians at Abbassia chest hospital about their awareness of pulmonary hypertension through a questionnaire which included 18 questions about the prevalence (Q1,12 & 2), caring about pulmonary hypertension as a disease (Q11), clinical picture (Q 3), investigations (Q8, 4-9 & 13) and treatment of pulmonary hypertension (Q10, 14-18). And the answers reflected acceptable awareness about pulmonary hypertension as regards all the items except for the pulmonary vaso-reactivity testing using right heart catheterization and new specific drugs in treatment. Also most the physicians didn’t attend educational meeting regarding pulmonary hypertension in the last 2 years