Potentially reversible conditions that can worsen pulmonary hypertension in a patient with Eisenmenger's phyiology:
(1) pregnancy
(2) dehydration
(3) acute vasodilation (hot environment, sauna, hot tub, etc)
(4) fluid overload or a large fluid shift
(5) erythrocytosis
(6) anemia
(7) thrombosis
(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.
