1
|
Roset-Altadill A, Wat D, Radike M. Cardiovascular and pulmonary complications of recreational drugs: A pictorial review. Eur J Radiol 2024; 178:111648. [PMID: 39089058 DOI: 10.1016/j.ejrad.2024.111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/03/2024]
Abstract
Recreational drug abuse constitutes a serious health problem worldwide. Consumption of cocaine, amphetamine-type stimulants, opioids and cannabis can lead to multiple acute and chronic cardiopulmonary complications, resulting in high morbidity and mortality. These complications may be first detected at imaging, since clinical presentation is usually non-specific. Cardiovascular complications include myocardial infarction, endocarditis, aortic dissection, infectious pseudoaneurysm, retained needle fragments, cardiomyopathy and pulmonary arterial hypertension. Pulmonary complications encompass pulmonary oedema, crack lung, pneumonia, septic emboli, barotrauma, airway disease, emphysema and excipient lung disease. Knowledge of the cardiopulmonary imaging manifestations of illicit drug use in conjunction with clinical history and a high grade of suspicion enable an accurate diagnosis and appropriate management plan. In this article we aim to provide a pictorial review of the most frequent cardiopulmonary manifestations of recreational drugs, emphasizing the underlying pathophysiologic mechanisms and the various imaging appearances.
Collapse
Affiliation(s)
- Adria Roset-Altadill
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain.
| | - Dennis Wat
- Respiratory Medicine Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom.
| | - Monika Radike
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom; Cardiovascular Research Center-ICCC, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| |
Collapse
|
2
|
Zhou J, Guo D, Xu ZZ, Liao JS, Li XT, Duan K, Chen SY, Xie WB. Nupr1-mediated vascular smooth muscle cell phenotype transformation involved in methamphetamine induces pulmonary hypertension. Cell Biol Toxicol 2024; 40:13. [PMID: 38347241 PMCID: PMC10861617 DOI: 10.1007/s10565-024-09849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
AIMS Nuclear protein 1 (Nupr1) is a multifunctional stress-induced protein involved in the regulation of tumorigenesis, apoptosis, and autophagy. However, its role in pulmonary hypertension (PH) after METH exposure remains unexplored. In this study, we aimed to investigate whether METH can induce PH and describe the role and mechanism of Nupr1 in the development of PH. METHODS AND RESULTS Mice were made to induce pulmonary hypertension (PH) upon chronic intermittent treatment with METH. Their right ventricular systolic pressure (RVSP) was measured to assess pulmonary artery pressure. Pulmonary artery morphometry was determined by H&E staining and Masson staining. Nupr1 expression and function were detected in human lungs, mice lungs exposed to METH, and cultured pulmonary arterial smooth muscle cells (PASMCs) with METH treatment. Our results showed that chronic intermittent METH treatment successfully induced PH in mice. Nupr1 expression was increased in the cultured PASMCs, pulmonary arterial media from METH-exposed mice, and METH-ingested human specimens compared with control. Elevated Nupr1 expression promoted PASMC phenotype change from contractile to synthetic, which triggered pulmonary artery remodeling and resulted in PH formation. Mechanistically, Nupr1 mediated the opening of store-operated calcium entry (SOCE) by activating the expression of STIM1, thereby promoting Ca2+ influx and inducing phenotypic conversion of PASMCs. CONCLUSIONS Nupr1 activation could promote Ca2+ influx through STIM1-mediated SOCE opening, which promoted METH-induced pulmonary artery remodeling and led to PH formation. These results suggested that Nupr1 played an important role in METH-induced PH and might be a potential target for METH-related PH therapy.
Collapse
Affiliation(s)
- Jie Zhou
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Dan Guo
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Zhen-Zhen Xu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jia-Shun Liao
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Xiao-Ting Li
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Ke Duan
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Shi-You Chen
- Department of Surgery, Medical Pharmacology & Physiology, University of Missouri, Columbia, MO, 65212, USA
| | - Wei-Bing Xie
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China.
| |
Collapse
|
3
|
Rommel KP, Hobohm L, Rothman AM, Lurz P. Radiation to Illuminate the Path of Neuromodulation for Pulmonary Hypertension. JACC Basic Transl Sci 2024; 9:257-259. [PMID: 38510722 PMCID: PMC10950396 DOI: 10.1016/j.jacbts.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Karl-Philipp Rommel
- Department of Cardiology, Heart Center at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
- Cardiovacular Research Foundation, New York, New York, USA
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander M.K. Rothman
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Division of Clinical Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
4
|
Xu W, Zhao SX. Cases of Phenotypic Switching From Dilated Cardiomyopathy to Pulmonary Arterial Hypertension in Chronic Methamphetamine Users. JACC. ADVANCES 2023; 2:100650. [PMID: 38938713 PMCID: PMC11198281 DOI: 10.1016/j.jacadv.2023.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | - Susan X. Zhao
- Santa Clara Valley Medical Center, 751 S. Bascom Avenue, Suite # 340, San Jose, California 95128, USA.
| |
Collapse
|
5
|
Cook CM, Craddock VD, Ram AK, Abraham AA, Dhillon NK. HIV and Drug Use: A Tale of Synergy in Pulmonary Vascular Disease Development. Compr Physiol 2023; 13:4659-4683. [PMID: 37358518 PMCID: PMC10693986 DOI: 10.1002/cphy.c210049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Over the past two decades, with the advent and adoption of highly active anti-retroviral therapy, HIV-1 infection, a once fatal and acute illness, has transformed into a chronic disease with people living with HIV (PWH) experiencing increased rates of cardio-pulmonary vascular diseases including life-threatening pulmonary hypertension. Moreover, the chronic consequences of tobacco, alcohol, and drug use are increasingly seen in older PWH. Drug use, specifically, can have pathologic effects on the cardiovascular health of these individuals. The "double hit" of drug use and HIV may increase the risk of HIV-associated pulmonary arterial hypertension (HIV-PAH) and potentiate right heart failure in this population. This article explores the epidemiology and pathophysiology of PAH associated with HIV and recreational drug use and describes the proposed mechanisms by which HIV and drug use, together, can cause pulmonary vascular remodeling and cardiopulmonary hemodynamic compromise. In addition to detailing the proposed cellular and signaling pathways involved in the development of PAH, this article proposes areas ripe for future research, including the influence of gut dysbiosis and cellular senescence on the pathobiology of HIV-PAH. © 2023 American Physiological Society. Compr Physiol 13:4659-4683, 2023.
Collapse
Affiliation(s)
- Christine M Cook
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Vaughn D Craddock
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anil K Ram
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ashrita A Abraham
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Navneet K Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
6
|
Liu CR, Heid CA, Hauptmann E, Ali M, Pruszynski J, Pillai A, Banga A, Wait MA, Huffman LC, Peltz M, Hackmann AE, Jessen ME, Ring WS, Murala JS. Donor substance use and lung transplantation: A single center experience. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
Middlekauff HR, Cooper ZD, Strauss SB. Drugs of Misuse: Focus on Vascular Dysfunction. Can J Cardiol 2022; 38:1364-1377. [DOI: 10.1016/j.cjca.2022.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/02/2022] Open
|
8
|
Padhye AA, Sahay S. An Adult Case of NOTCH3 Mutation in Pulmonary Artery Hypertension. Pulm Circ 2022; 12:e12050. [PMID: 35506080 PMCID: PMC9052997 DOI: 10.1002/pul2.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/04/2021] [Accepted: 02/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Sandeep Sahay
- Houston Methodist Lung Center, Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Hospital Houston Texas
- Assistant Professor, Weill Cornell Medical College New York NY
| |
Collapse
|
9
|
Xu J, Zhu Z, Liang X, Huang Q, Zheng T, Li X. Effects of moderate-intensity exercise on social health and physical and mental health of methamphetamine-dependent individuals: A randomized controlled trial. Front Psychiatry 2022; 13:997960. [PMID: 36213929 PMCID: PMC9539410 DOI: 10.3389/fpsyt.2022.997960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Methamphetamine (MA)-dependent individuals' health problems are widespread and need to be solved urgently. Exercise is considered a potential treatment for MA dependents. The study aimed to determine the effects of a 12-week aerobic exercise on the social, physical, and mental health of MA-dependent individuals. MATERIALS AND METHODS Sixty MA-dependent individuals were randomly assigned into two groups. Subjects in the exercise group (n = 30) received an exercise intervention five days a week for 60 min each for 12 weeks. Subjects in the control group (n = 30) received regular corrective rehabilitation without exercise in the same setting. Outcome measures, including questionnaires [quality of life scale for drug addiction (QOL-DA), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI)] and physical fitness, were arranged the day before the start of the intervention and the day after the end of the intervention. Two-factor repeated measures ANOVA was used to compare the treatment differences between the two groups. RESULTS After 12 weeks of the intervention period, social health was significantly improved in the exercise group (P < 0.01), and there was a statistically significant difference in mental health scores between exercise group and control group, with a greater impact in exercise group.(Psychology: P < 0.01; SAS: P < 0.01; SDS: P < 0.01; PSQI: P < 0.01), physical health improved in the exercise group, physiology (P < 0.01), symptom (P < 0.01), heart rate (P < 0.01), systolic blood pressure (P < 0.01), systolic blood pressure (P < 0.01), vital capacity (P < 0.05), grip (P < 0.01), vertical jump (P < 0.001), sit and reach (P < 0.01), 50-meter run (P < 0.01), and reaction time (P < 0.01). CONCLUSION Aerobic exercise intervention is an effective treatment for MA-dependent individuals, and the 12-week intervention improved the social, physical, and mental health of MA-dependent individuals. We recommend that future studies focus more on drug-dependent individuals' overall health status rather than just relapse.Clinical trial registration: [https://www.chictr.org.cn/hvshowproject.aspx?id=131048], identifier [ChiCTR2200055348].
Collapse
Affiliation(s)
- Jisheng Xu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Zhicheng Zhu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Xin Liang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Qiuyue Huang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - TianZhen Zheng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Xue Li
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| |
Collapse
|
10
|
Kennedy EN. Caring for Patients Using Methamphetamines: An Interprofessional Collaborative Approach. MISSOURI MEDICINE 2022; 119:494-499. [PMID: 36588648 PMCID: PMC9762214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Methamphetamine use is increasing in the U.S. and in Missouri, as are the number of deaths associated with its use. Many systemic and mental health issues are associated with methamphetamine use or methamphetamine use disorder (MUD). Given the range of health issues associated with methamphetamine use or MUD, a collaborative approach to the care of patients can improve outcomes. This article provides an overview of a collaborative approach to caring for patients using or have used methamphetamine, from the perspective of the primary care, behavioral and dental clinician.
Collapse
|
11
|
Shyu BC, Gao ZY, Wu JJS, He ABH, Cheng CN, Huang ACW. Methamphetamine and Modulation Functionality of the Prelimbic Cortex for Developing a Possible Treatment of Alzheimer's Disease in an Animal Model. Front Aging Neurosci 2021; 13:751913. [PMID: 34744692 PMCID: PMC8564002 DOI: 10.3389/fnagi.2021.751913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative condition that causes cognitive impairment and other neuropsychiatric symptoms. Previously, little research has thus far investigated whether methamphetamine (MAMPH) can enhance cognitive function or ameliorate AD symptoms. This study examined whether a low dose of MAMPH can induce conditioned taste aversion (CTA) learning, or can increase plasma corticosterone levels, neural activity, and neural plasticity in the medial prefrontal cortex (mPFC) (responsible for cognitive function), the nucleus accumbens (NAc) and the amygdala (related to rewarding and aversive emotion), and the hippocampus (responsible for spatial learning). Furthermore, the excitations or lesions of the prelimbic cortex (PrL) can affect MAMPH-induced CTA learning, plasma corticosterone levels, and neural activity or plasticity in the mPFC [i.e., PrL, infralimbic cortex (IL), cingulate cortex 1 (Cg1)], the NAc, the amygdala [i.e., basolateral amygdala (BLA) and central amygdala (CeA)], and the hippocampus [i.e., CA1, CA2, CA3, and dentate gyrus (DG)]. In the experimental procedure, the rats were administered either saline or NMDA solutions, which were injected into the PrL to excite or destroy PrL neurons. Additionally, rats received 0.1% saccharin solution for 15 min, followed by intraperitoneal injections of either normal saline or 1 mg/kg MAMPH to induce CTA. A one-way ANOVA was performed to analyze the effects of saccharin intake on CTA, plasma corticosterone levels, and the expression of c-Fos and p-ERK. The results showed that the MAMPH induced CTA learning and increased plasma corticosterone levels. The mPFC, and particularly the PrL and IL and the DG of the hippocampus, appeared to show increased neural activity in c-Fos expression or neural plasticity in p-ERK expression. The excitation of the PrL neurons upregulated neural activity in c-Fos expression and neural plasticity in p-ERK expression in the PrL and IL. In summary, MAMPH may be able to improve cognitive and executive function in the brain and reduce AD symptoms. Moreover, the excitatory modulation of the PrL with MAMPH administration can facilitate MAMPH-induced neural activity and plasticity in the PrL and IL of the mPFC. The present data provide clinical implications for developing a possible treatment for AD in an animal model.
Collapse
Affiliation(s)
- Bai-Chuang Shyu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Zhi-Yue Gao
- Yuanshan Branch, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Alan Bo Han He
- Department of Psychology, Fo Guang University, Yilan, Taiwan
| | - Cai-N Cheng
- Department of Psychology, Fo Guang University, Yilan, Taiwan.,Department of Life Sciences, National Central University, Taoyuan City, Taiwan
| | | |
Collapse
|
12
|
Shortened leukocyte telomere length in young adults who use methamphetamine. Transl Psychiatry 2021; 11:519. [PMID: 34628468 PMCID: PMC8502172 DOI: 10.1038/s41398-021-01640-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
Methamphetamine (METH) use, most prevalent in young adults, has been associated with high rates of morbidity and mortality. The relationship between METH use and accelerated biological aging, which can be measured using leukocyte telomere length (LTL), remains unclear. We examined whether young adult METH users have shorter LTL and explored the relationship between characteristics of METH use and LTL by using Mendelian randomization (MR) analysis. We compared the LTL for 187 METH users and 159 healthy individuals aged between 25 and 34 years and examined the relationship of LTL with METH use variables (onset age, duration, and maximum frequency of METH use) by using regression analyses. In addition, 2-stage-least-squares (2SLS) MR was also performed to possibly avoid uncontrolled confounding between characteristics of METH use and LTL. We found METH users had significantly shorter LTL compared to controls. Multivariate regression analysis showed METH use was negatively associated with LTL (β = -0.36, P < .001). Among METH users, duration of METH use was negatively associated with LTL after adjustment (β = -0.002, P = .01). We identified a single nucleotide polymorphism (SNP) rs6585206 genome-wide associated with duration of METH use. This SNP was used as an instrumental variable to avoid uncontrolled confounding for the relationship between the use duration and LTL shortening. In conclusion, we show that young adult METH users may have shorter LTL compared with controls and longer duration of METH use was significantly associated with telomere shortening. These observations suggest that METH use may accelerate biological senescence.
Collapse
|
13
|
Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry. Ann Am Thorac Soc 2021; 18:613-622. [PMID: 33064950 DOI: 10.1513/annalsats.202007-774oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.Objectives: To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the United States, hemodynamics, health-related quality of life, PAH-specific treatment, and health care use.Methods: The Pulmonary Hypertension Association Registry is a U.S.-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, 6-minute walk distance, therapy, and health care use. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.Results: Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the western United States. The Meth-APAH group was younger and had a poorer socioeconomic status and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater; 95% confidence interval [CI], 0.07 to 0.37) and worse PAH-specific (emPHasis-10) health-related quality of life (-5.4; 95% CI, -8.1 to -2.8). There was no difference in dual combination therapy; however, participants with Meth-APAH were less likely to be initiated on triple therapy (odds ratio [OR], 0.43; 95% CI, 0.24 to 0.77) or parenteral therapy (OR, 0.10; 95% CI, 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (incidence rate ratio, 2.30; 95% CI, 1.71 to 3.11) and more likely to be hospitalized (incidence rate ratio, 1.42; 95% CI, 1.10 to 1.83).Conclusions: Meth-APAH represents a unique clinical phenotype of PAH, most common in the western United States. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH.
Collapse
|
14
|
Abstract
Rationale: Pulmonary hypertension (PH) has been described in patients treated with leflunomide. Objectives: To assess the association between leflunomide and PH. Methods: We identified incident cases of PH in patients treated with leflunomide from the French PH Registry and through the pharmacoVIGIlAnce in Pulmonary ArTerial Hypertension (VIGIAPATH) program between September 1999 to December 2019. PH etiology, clinical, functional, radiologic, and hemodynamic characteristics were reviewed at baseline and follow-up. A pharmacovigilance disproportionality analysis using the World Health Organization's global database was conducted. We then investigated the effect of leflunomide on human pulmonary endothelial cells. Data are expressed as median (min-max). Results: Twenty-eight patients treated with leflunomide before PH diagnosis was identified. A total of 21 (75%) had another risk factor for PH and 2 had two risk factors. The median time between leflunomide initiation and PH diagnosis was 32 months (1-120). Right heart catheterization confirmed precapillary PH with a cardiac index of 2.37 L⋅min-1 ⋅m-2 (1.19-3.1) and elevated pulmonary vascular resistance at 9.63 Wood Units (3.6-22.1) without nitric oxide reversibility. Five patients (17.9%) had no other risk factor for PH besides exposure to leflunomide. No significant hemodynamic improvement was observed after leflunomide withdrawal. The pharmacovigilance disproportionality analysis using the World Health Organization's database revealed a significant overrepresentation of leflunomide among reported pulmonary arterial hypertension-adverse drug reactions. In vitro studies showed the dose-dependent toxicity of leflunomide on human pulmonary endothelial cells. Conclusions: PH associated with leflunomide is rare and usually associated with other risk factors. The pharmacovigilance analysis suggests an association reinforced by experimental data.
Collapse
|
15
|
Maidman SD, Sulica R, Freedberg RS, Bamira D, Vainrib AF, Ro R, Latson LA, Saric M. Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use. CASE 2021; 5:239-242. [PMID: 34430775 PMCID: PMC8370868 DOI: 10.1016/j.case.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
HIV and frequent methamphetamine use are two known risk factors for PAH development. HIV and methamphetamine are both associated with higher rates of mortality in PAH. Echocardiography is an effective noninvasive modality for assessing PAH severity.
Collapse
|
16
|
Mukherjee D, Konduri GG. Pediatric Pulmonary Hypertension: Definitions, Mechanisms, Diagnosis, and Treatment. Compr Physiol 2021; 11:2135-2190. [PMID: 34190343 PMCID: PMC8289457 DOI: 10.1002/cphy.c200023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pediatric pulmonary hypertension (PPH) is a multifactorial disease with diverse etiologies and presenting features. Pulmonary hypertension (PH), defined as elevated pulmonary artery pressure, is the presenting feature for several pulmonary vascular diseases. It is often a hidden component of other lung diseases, such as cystic fibrosis and bronchopulmonary dysplasia. Alterations in lung development and genetic conditions are an important contributor to pediatric pulmonary hypertensive disease, which is a distinct entity from adult PH. Many of the causes of pediatric PH have prenatal onset with altered lung development due to maternal and fetal conditions. Since lung growth is altered in several conditions that lead to PPH, therapy for PPH includes both pulmonary vasodilators and strategies to restore lung growth. These strategies include optimal alveolar recruitment, maintaining physiologic blood gas tension, nutritional support, and addressing contributing factors, such as airway disease and gastroesophageal reflux. The outcome for infants and children with PH is highly variable and largely dependent on the underlying cause. The best outcomes are for neonates with persistent pulmonary hypertension (PPHN) and reversible lung diseases, while some genetic conditions such as alveolar capillary dysplasia are lethal. © 2021 American Physiological Society. Compr Physiol 11:2135-2190, 2021.
Collapse
Affiliation(s)
- Devashis Mukherjee
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, 53226 USA
| | - Girija G. Konduri
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, 53226 USA
| |
Collapse
|
17
|
Labazi H, Nilsen M, MacLean MR. Sex-dependent right ventricular hypertrophic gene changes after methamphetamine treatment in mice. Eur J Pharmacol 2021; 900:174066. [PMID: 33789156 PMCID: PMC8111419 DOI: 10.1016/j.ejphar.2021.174066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
Methamphetamine (MA) abuse is associated with the development of pulmonary arterial hypertension (PAH) and subsequent right ventricular failure. A recent clinical study demonstrated that female sex is a major risk factor for MA-induced PAH. The mechanisms associated with increased prevalence and severity of MA-induced PAH in females are still unclear. We hypothesized that MA may promote changes in gene expression in the right ventricle contributing to the development and/or worsening of PAH in females. Male and female C57BL/6 mice were treated with either MA or vehicle. Right and left ventricular systolic pressures (RVSP and LVSP, respectively) were assessed and tissue samples were collected for gene expression and histology. LVSP and RVSP were not affected by MA in either males or females. Right ventricular hypertrophy was significantly increased by MA in females but it was not affected by MA in males. In the female mice, MA-induced right ventricular hypertrophy was associated with increased expression of brain natriuretic peptide gene and members of the TGF-β receptor signaling pathway such as TGF-β receptor-1, smad3 and smad7. In male mice, there were no changes in right ventricular gene expression. Our results suggest that MA caused right ventricular hypertrophy in female mice, but not in males and that this was associated with an increase in hypertrophic genes. The right ventricular hypertrophy was not dependent on increased RVSP suggesting a direct effect of MA on the right ventricle. If this translates to PAH patients, it might explain the poor outcome observed in MA-associated female PAH patients.
Collapse
Affiliation(s)
- Hicham Labazi
- Institute of Cardiovascular & Medical Sciences and College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
| | - Margaret Nilsen
- Institute of Cardiovascular & Medical Sciences and College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Margaret R MacLean
- Institute of Cardiovascular & Medical Sciences and College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| |
Collapse
|
18
|
Regional Variation in Methamphetamine-associated Pulmonary Arterial Hypertension: Who'd Better Call Saul? Ann Am Thorac Soc 2021; 18:584-585. [PMID: 33792520 PMCID: PMC8009004 DOI: 10.1513/annalsats.202011-1415ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: a review. J Intern Med 2021; 289:450-462. [PMID: 33020988 PMCID: PMC7675448 DOI: 10.1111/joim.13184] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic affecting all levels of health systems. This includes the care of patients with noncommunicable diseases (NCDs) who bear a disproportionate burden of both COVID-19 itself and the public health measures enacted to combat it. In this review, we summarize major COVID-19-related considerations for NCD patients and their care providers, focusing on cardiovascular, pulmonary, renal, haematologic, oncologic, traumatic, obstetric/gynaecologic, operative, psychiatric, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic and endocrine disorders. Additionally, we offer a general framework for categorizing the pandemic's disruptions by disease-specific factors, direct health system factors and indirect health system factors. We also provide references to major NCD medical specialty professional society statements and guidelines on COVID-19. COVID-19 and its control policies have already resulted in major disruptions to the screening, treatment and surveillance of NCD patients. In addition, it differentially impacts those with pre-existing NCDs and may lead to de novo NCD sequelae. Likely, there will be long-term effects from this pandemic that will continue to affect practitioners and patients in this field for years to come.
Collapse
Affiliation(s)
- Andrew Y Chang
- From the, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.,Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| | - Mark R Cullen
- Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | | | - Michele Barry
- Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Innovation in Global Health, Stanford University, Stanford, CA, USA
| |
Collapse
|
20
|
Rodriguez EA, Yamamoto BK. Toxic Effects of Methamphetamine on Perivascular Health: Co-morbid Effects of Stress and Alcohol Use Disorders. Curr Neuropharmacol 2021; 19:2092-2107. [PMID: 34344290 PMCID: PMC9185763 DOI: 10.2174/1570159x19666210803150023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
Methamphetamine (Meth) abuse presents a global problem and commonly occurs with stress and/or alcohol use disorders. Regardless, the biological causes and consequences of these comorbidities are unclear. Whereas the mechanisms of Meth, stress, and alcohol abuse have been examined individually and well-characterized, these processes overlap significantly and can impact the neural and peripheral consequences of Meth. This review focuses on the deleterious cardio- and cerebrovascular effects of Meth, stress, alcohol abuse, and their comorbid effects on the brain and periphery. Points of emphasis are on the composition of the blood-brain barrier and their effects on the heart and vasculature. The autonomic nervous system, inflammation, and oxidative stress are specifically highlighted as common mediators of the toxic consequences to vascular and perivascular health. A significant portion of the Meth abusing population also presents with stress and alcohol use disorders, prompting a need to understand the mechanisms underlying their comorbidities. Little is known about their possible convergent effects. Therefore, the purpose of this critical review is to identify shared mechanisms of Meth, chronic stress, and alcohol abuse that contributes to the dysfunction of vascular health and underscores the need for studies that directly address their interactions.
Collapse
Affiliation(s)
- Eric A. Rodriguez
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bryan K. Yamamoto
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
21
|
Hendrickson K, Strauss W. Characterization and treatment challenges of pulmonary hypertension in methamphetamine users. Respir Med Case Rep 2020; 31:101275. [PMID: 33294354 PMCID: PMC7683342 DOI: 10.1016/j.rmcr.2020.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
The World Health Organization pulmonary hypertension classification scheme provides a framework for evaluation and management of patients with pulmonary vascular disease. Methamphetamine is a recreational stimulant which causes cardiac and pulmonary vascular toxicity. We discuss three cases of methamphetamine users who presented with left ventricular systolic failure but on heart failure therapy developed features more consistent with pulmonary arterial hypertension (PAH) or combined pre-capillary and post-capillary pulmonary hypertension. All three were started on PAH treatment and showed clinical improvement in symptoms. These cases illustrate the difficulty with treating methamphetamine users with pulmonary hypertension who have been left out of randomized controlled trials. Consideration should be given to creating a clinical registry for patients with methamphetamine associated pulmonary hypertension to assist with best treatment strategies.
Collapse
Affiliation(s)
- Kathryn Hendrickson
- Division of Pulmonary, 26 North 1900 East, Wintrobe Building, Room 701, Salt Lake City, UT, 84132, USA
| | - Wayne Strauss
- The Oregon Clinic, Division of Pulmonary, Sleep and Critical Care Medicine, 1111 NE 99th Avenue, Suite 200, Portland, OR, 97220, USA
| |
Collapse
|
22
|
Shi L, Liu BY, Wang X, Zhu MJ, Chen L, Zhou MY, Gu YJ, Cheng L, Wang Y. RUNX3-dependent oxidative epithelial-to-mesenchymal transition in methamphetamine-induced chronic lung injury. Cell Stress Chaperones 2020; 25:793-802. [PMID: 32681471 PMCID: PMC7479662 DOI: 10.1007/s12192-020-01133-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
Lung toxicity is the main cause of the death from methamphetamine (MA) abuse, but its mechanism has remained unclear. The purpose of our study was to investigate if MA can induce epithelial-to-mesenchymal transition (EMT) and if RUNX3 is involved in oxidative EMT in MA-induced chronic lung injury. The rats were divided into the control group and MA group. Extracted lungs were used for morphological measurements and Western blot. The alveolar epithelial cells were cultured or transfected and then treated with MA or/and N-acetyl cysteine (NAC) followed by flow cytometry, Western blot, and immunohistochemistry. Chronic exposure to MA resulted in the lower growth ratio of weight, increased right ventricular index, thickened alveolar walls, and reduced number of alveolar sacs. Long-term administration with MA caused oxidative stress and pulmonary EMT. NAC increased RUNX3 and alleviated EMT. However, after knockdown of RUNX3, reactive oxygen species (ROS) levels were significantly upregulated, indicating that RUNX3 was closely related to oxidative stress. Knockdown of RUNX3 aggravated MA-induced EMT by activating RUNX3-dependent TGF-β signaling. Therefore, RUNX3 may be the key to oxidative EMT in methamphetamine-induced chronic lung injury.
Collapse
Affiliation(s)
- Lin Shi
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Bing-Yang Liu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xin Wang
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Mei-Jia Zhu
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Lei Chen
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Ming-Yuan Zhou
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Ying-Jian Gu
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Lin Cheng
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Yun Wang
- Department of Clinical Pharmacology, School of Pharmacy, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China.
| |
Collapse
|
23
|
Xiong Q, Tian X, Li W, Chen L, Zhou M, Xu C, Ru Q. Sulforaphane alleviates methamphetamine-induced oxidative damage and apoptosis via the Nrf2-mediated pathway in vitro and in vivo. FOOD AGR IMMUNOL 2020. [DOI: 10.1080/09540105.2020.1784099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Qi Xiong
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Xiang Tian
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Weiling Li
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Lin Chen
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Mei Zhou
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Congyue Xu
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| | - Qin Ru
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, PR People’s Republic of China
| |
Collapse
|
24
|
Dunlop A, Lokuge B, Masters D, Sequeira M, Saul P, Dunlop G, Ryan J, Hall M, Ezard N, Haber P, Lintzeris N, Maher L. Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J 2020; 17:26. [PMID: 32375887 PMCID: PMC7201394 DOI: 10.1186/s12954-020-00370-7] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/24/2020] [Indexed: 12/18/2022] Open
Abstract
The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across all substance types including withdrawal and counselling services. Drug and alcohol hospital consultation-liaison clinicians support emergency departments and other services provided in hospital settings in efficiently managing patients who use drugs and present with other health problems.COVID-19 will impact on staff availability for work due to illness. Patients may require home isolation and quarantine periods. Ensuring ongoing supply of opiate treatment during these periods will require significant changes to how treatment is provided. The use of monthly depot buprenorphine as well as moving from a framework of supervised dosing will be required for patients on sublingual buprenorphine and methadone. Ensuring ready access to take-home naloxone for patients is crucial to reduce overdose risks. Delivery of methadone and buprenorphine to the homes of people with confirmed COVID-19 infections is likely to need to occur to support home isolation.People who use drugs are likely to be more vulnerable during the COVID-19 epidemic, due to poorer health literacy and stigma and discrimination towards this group. People who use drugs may prioritise drug use above other health concerns. Adequate supply of clean injecting equipment is important to prevent outbreaks of blood-borne viruses. Opiate users may misinterpret SARS-CoV2 symptoms as opiate withdrawal and manage this by using opioids. Ensuring people who use drugs have access to drug treatment as well as access to screening and testing for SARS-CoV2 where this is indicated is important.
Collapse
Affiliation(s)
- Adrian Dunlop
- Drug & Alcohol Clinical Services, Newcastle, NSW, Australia.
- Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia.
- John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia.
| | - Buddhima Lokuge
- Drug & Alcohol Clinical Services, Newcastle, NSW, Australia
- Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Debbie Masters
- Drug & Alcohol Clinical Services, Newcastle, NSW, Australia
| | - Marcia Sequeira
- Drug & Alcohol Clinical Services, Newcastle, NSW, Australia
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia
| | - Peter Saul
- John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Grace Dunlop
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia
| | - John Ryan
- Penington Institute, Carlton, Victoria, Australia
| | - Michelle Hall
- Drug & Alcohol Clinical Services, Newcastle, NSW, Australia
| | - Nadine Ezard
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia
- St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Paul Haber
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia
- Drug Health Services, Camperdown, NSW, Australia
- Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Nicholas Lintzeris
- Drug & Alcohol Clinical Research & Improvement Network, Surry Hills, NSW, Australia
- Discipline of Addiction Medicine, University of Sydney, Camperdown, NSW, Australia
- Drug & Alcohol Services, Sydney South East Local Health District, Surry Hills, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW, Kensington, NSW, Australia
| |
Collapse
|
25
|
Abstract
Pulmonary hypertension (PH) is a chronic and progressive disease that presents like many other lung diseases, often leading to a delay in diagnosis, and therefore a delay in optimal therapy. This article provides a review of PH for internists, covering clinical presentation, diagnostic algorithm, different types of PH, and overview of treatments. In addition, it emphasizes the importance of early referral to, and partnership between, PH specialists and physicians on the front lines to improve early diagnosis and optimize management of these complex patients.
Collapse
Affiliation(s)
- Darlene Kim
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver CO 80206, USA
| | - M Patricia George
- Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver CO 80206, USA.
| |
Collapse
|