Pulmonary hypertension (PH) in a patient with Eisenmenger physiology may get worse for a number of reasons. Some of these reasons can be predicted and/or treated.
Potentially reversible conditions that can worsen pulmonary hypertension in a patient with Eisenmenger's phyiology:
(3) acute vasodilation (hot environment, sauna, hot tub, etc)
(4) fluid overload or a large fluid shift
(8) acute infection
(9) cardiac arrhythmia
(10) deterioration in renal function
(11) deterioration in hepatic function
(12) chronic environmental hypoxia (? erythrocytosis) and/or high altitude exposure
(13) left ventricular diastolic dysfunction
(14) systemic hypertension AND increased left ventricular afterload
(15) obstructive congenital heart disease causing an increased left-sided filling pressure
(16) myocardial restriction
(17) extreme fatigue
(18) cigarette smoking and/or exposure to smoke
(19) electrolyte disturbances
(20) excessive catecholamine release
(21) stimulant drugs (amphetamines, etc)
These situations should be avoided if possible in a patient with Eisenmenger's physiology. They should be targeted for intervention if the patient develops worsening of pulmonary hypertension.
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Specialty: Pulmonology, Cardiology