Lungs vascular diseases

Contract JAo. N01 -HH-8-1388, National Heart, Lung and Blood Institute, Division of Heart and Vascular Diseases, Bethesda, Md. 

Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Eanarow GC et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease 2006 update endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006 May 16 113(19) 2363-72. Erratum Circulation 2006 Jun 6 113(22) e847. 

Metoprolol, atenolol, and several other drugs (see Table 10-2) are members of the Di-selective group. These agents may be safer in patients who experience bronchoconstriction in response to propranolol. Since their Bi selectivity is rather modest, they should be used with great caution, if at all, in patients with a history of asthma. However, in selected patients with chronic obstructive lung disease the benefits may exceed the risks, eg, in patients with myocardial infarction. Betai-selective antagonists may be preferable in patients with diabetes or peripheral vascular disease when therapy with a 6-blocker is required since B2 receptors are probably important in liver (recovery from hypoglycemia) and blood vessels (vasodilation). 

Subsets of the hypertensive population The (3-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. [Note Conditions that discourage the use of 3-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.]... 

The diffusing capacity will be reduced in aU clinical situations in which there is impairment of gas transfer from the alveoli to capillary blood. Common conditions that reduce the Dlco include lung resection, emphysema (loss of functioning alveolar-capillary units), and interstitial lung disease (thickening of the alveolar-capiUary membrane). Normal PFTs with a reduced Dlco should suggest the possibility of pulmonary vascular disease (e.g., pulmonary embolus) but also can be seen with anemia, early interstitial lung disease, and mUd Pneumocystis carinii (PCP) infection in AIDS patients. 

Collagen vascular disease Pneumoconiosis Drug-induced lung disease Pulmonary edema Infiltrative lung diseases Granulomatosis Tumor... 

Concomitant disease states may influence the selection of therapy. Certain diseases wfll predispose patients to a particular infectious disease or wfll alter the type of infecting organism. For example, patients with diabetes mellims and the resulting peripheral vascular disease often develop infections of the lower extremity soft tissue. Moreover, the alterations in peripheral blood flow associated with the disease and perhaps altered immunity make such infections more difficult to treat than in nondiabetics. Patients with chronic lung disease or cystic fibrosis develop frequent pulmonary infections that may be caused by somewhat different microorganisms than are found in otherwise normal hosts. 

Usually the cause of pulmonary hypertension can be assigned to related parenchymal lung disease, heart disease, thromboembolism, or pulmonary, vascular disease. Pulmonary hypertension is termed idiopathic (or primary), however, when it occurs in patients in the absence of associated cardiopulmonary disease and when no other apparent cause for the disease is discernible. Primary pulmonary hypertension is a very rare disease that occurs predominantly in young female patients between the ages of 20 to 40 years (Wood, 1956). It is usually progressive and fatal, with the average survival time from the onset of symptoms being 2 to 3 years (Bourdillon and Oakley, 1976). 

Stinson, E. B., and Shumway, N. E. Heart-lung transplantation. Successful therapy for patients with pulmonary vascular disease. N. Engl. J. Med. 306, 557-564 (1982). 

Adatia et al. (1993) exposed a patient with chronic obstructive pulmonary disease (COPD) to 80 ppm NO, observing a considerable improvement of oxygen exchange and a reduction in lung vascular constriction. Adnot et al. (1993) examined a larger group of COPD patients, substantiating... 

In our initial studies we used inhaled nitric oxide as a probe to test the effect of cardiopulmonary bypass on pulmonary endothelial function. Cardiopulmonary bypass may result in damage to the pulmonary endothelium, and the degree of pulmonary hypertension is correlated with the extent of such damage. Acetylcholine-induced vasodilation is attenuated in a number of vascular diseases that impair endothelial function,and preconstricted pulmonary artery rings from explanted lungs of patients with... 

Elevated pulmonary vascular resistance is a risk factor prior to cardiac transplantation which is manifested by an increased risk of right ventricular failure postoperatively. " Nevertheless, patients with left atrial hypertension may have a reversible component to their pulmonary hypertension if the underlying cause can be relieved. Therefore, assessment of the degree of pulmonary vasoconstriction assumes importance prior to transplantation. The limited number of donor organs dictates that accurate assessment of pulmonary vascular disease be made in order to limit combined heart-lung transplantation and ensure more effective use of scarce resources. 

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