35 55 kg

CC : 3

PI : 3 hours PTA

PMH Hypertension 4 GERD 3 Asthma
FH : 57 pulmonary
hypertension 4
SH : amphetamine 20
Medication history :
HCTZ (25 mg) tab OD, Salbutamol MDI 1-2 puff PRN
for dyspnea
All : NKDA
Review of system
9

6



2-3


Physical examination :

GA : A man looked illness, dyspnea and moderate stress

V/S : BP130/80, BT 37.5 C, HR 120 bpm, RR 26 tpm, O2
sat 88% on room air
Neck/lymph nodes : (+) JVD
CVS : tachycardia, split S2, loud P2, S3 gallop
Lung : Clear
Abdominal : liver slightly enlarged
Ext : 2+ edema to both lower extremities, pulses palable
Neuro : A&O x 3, normal DTRs bilaterally

ECG : Sinus tachycardia (rate 120 bpm), right-axis deviation,

ST-segment depression in right precordial leads, tall P waves in
lead 2,3 and aVF
Chest X-ray : Cardiomegaly, prominent main pulmonary artery
Two-Dimensional Echocardiogram : Right ventricular and
atrial hypertrophy, tricuspid regurgitation, estimated mPAP 55
mm Hg
Ventilation/Perfusion scan : negative for pulmonary
embolism
Impression : Pulmonary Arterial Hypertension

Assessment
35 55 kg Hypertension,
GERD Asthma
3

amphetamine 2+ edema to
both lower extremities, Jugular Venous Distension, O2 sat

88% Two-Dimensional Echocardiogram Right ventricular

and atrial hypertrophy, tricuspid regurgitation, estimated mPAP
55 mm Hg

Pulmonary Hypertension

Oxygen therapy
O2 sat oxygen saturation 90%
Diuretic Peripheral edema liver
congestion Furosemide
Pharmacologic Therapy for Pulmonary Arterial

Hypertension in Adults Vasoreactivity

Testing vasoreactivity testing

WHO Function Assessment of PAH Class II

endothelin receptor antagonist (ETRA), phosphodiesterase-5

(PDE5) inhibitor, or the soluble guanylate cyclase stimulator
riociguat

 Anticoagulant therapy
Warfarin 3 mg OD
INR 1.5-2.5
Plan
Ambrisentan 5 mg 1x1
Warfarin 3 mg 1x1
Furosemide 40 mg 1x3
Goal : -

-
Monitor efficacy : WHO Function Assessment of PAH
Class I, Oxygen Sat>90%, no pitting edema
Monitor side effect : Ambrisentan : Flushing,edema,Hb
decrease,liver enz. increase
Clinical course

Right-heart catheterization vasoreactivity testing
short-acting vasodilator epoprostenol
pulmonary arterial pressure cardiac output
(mPAP 55 mm Hg 35 mm Hg)


1.
- Pharmacologic Therapy for Pulmonary Arterial

Hypertension in Adults Vasoreactivity

Testing Right-heart

catheterization vasoreactivity testing

short-acting vasodilator epoprostenol
pulmonary arterial pressure cardiac output
(mPAP 55 mm Hg 35 mm Hg)
CCB Diltiazem
Tachycardia
30 mg tid
Clinical course (continue)
6
Echocardiogram
mPAP 45 mm Hg

1.
- Pharmacologic Therapy for Pulmonary Arterial
Hypertension in Adults
CCB WHO Function Assessment of PAH Class II
endothelin receptor antagonist (ETRA),

phosphodiesterase-5 (PDE5) inhibitor, or the soluble guanylate

cyclase stimulator riociguat Ambrisentan 5 mg 1x1