Pulmonary hypertension: the bete noire of diffuse connective tissue diseases
Article Abstract:
Connective tissue diseases (CTD) may be complicated by blood vessel disorders, such as pulmonary hypertension, or high blood pressure in the pulmonary artery, which supplies the lung. Pulmonary hypertension is the major vascular complication of systemic sclerosis (SSc), the hardening of organs and tissues throughout the body, and systemic lupus erythematosus (SLE), an inflammatory disease of connective tissue. Patients with SSc may also develop interstitial lung disease, characterized by inflammation and disruption of the walls of the alveoli, the gas-exchanging sacs of the lungs. Supplemental oxygen therapy may be required by SSc patients with both pulmonary hypertension and interstitial lung disease. Pulmonary hypertension in patients with normal ventilation and few signs and symptoms may be difficult to detect. Various factors can cause pulmonary hypertension, which is often preceded by a decreased ability to tolerate exercise, and increased breathlessness. A recent study showed that nifedipine and other agents, such as prostaglandins, hydralazine, and phentolamine, reduced the resistance of the pulmonary artery, improving blood flow. Adverse side effects resulted from the ability of these drugs to decrease heart contraction and cardiac output, the amount of blood discharged from the heart ventricle in a given time. Another study showed that patients with SSc do not show the normal increase in lung diffusing capacity upon lying down, and this abnormality is not improved by a prostacyclin analog, which dilates blood vessels. Agents that dilate blood vessels (and thus reduce pressure) may be injected directly into the pulmonary circulation, and their effects to reduce pulmonary pressure and vascular resistance monitored. Various drugs have been assessed for treatment of pulmonary hypertension, and heart/lung or lung transplantation should be considered in managing CTD-related lung disease. Early detection and subsequent treatment of pulmonary vascular complications of SSc is essential for control of lung disease and prevention of tissue damage. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Effect of New York State's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice
Article Abstract:
On April 1, 1988, a law was enacted in New York State regarding the conditions under which cardiopulmonary resuscitation (CPR) may be withheld. According to the law, every patient is entitled to CPR unless the patient consents to a do-not-resuscitate (DNR) order which is obtained by an attending physician in the presence of two witnesses. If the patient is unable to make a decision, two physicians determine whether: (1) the patient has a terminal condition; (2) the patient is irreversibly comatose; (3) resuscitation would be futile; and (4) resuscitation would impose a burden in light of the expected outcome. Notice of the written determination is then given to both the patient and a legal guardian or next of kin, who may then consent to the DNR order. The effects of this law on in-hospital resuscitation practices were examined in the cases of 245 adult patients who died during three-month periods before and after the law took effect. CPR was attempted at time of death in 59 of 119 patients in 1987 and 57 of 126 patients in 1988. DNR orders were issued for 13 of 60 patients who died without CPR in 1987, and for 64 of 69 patients who died without CPR in 1988. The involvement of patients and families in decisions to withhold CPR was similar before and after the enactment of the law. The findings indicate that the legislation did not affect the frequency of CPR or the degree to which patients are involved in these decisions. The legislation did promote documentation of DNR orders. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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