During orientation today, Dr. Kelly Chin of the Division of Pulmonary and Critical Care Medicine gave the incoming interns an introduction to pulmonary hypertension.
- There are five groups of PH: (1) PAH, (2) PH from left sided heart disease, (3) PH from lung disease, (4) PH from chronic thromboembolisms, and (5) miscellaneous
- Left-sided heart disease and lung disease are by far the most common causes of PH
- Findings concerning for PH are present in 1% of the population, 10% of patients receiving an echocardiogram for another reason
- Suspect PH if RVSP >40 mmHg with RA or RV dilation or dysfunction on echocardiogram
- PH is confirmed if mean PAP>/= 25 mmHg
Below are some key points regarding bronchiectasis:
- Damage to the airways causing them to widen and become scarred. This causes impaired clearance of mucous resulting in buildup and recurrent lung infections.
- Congenital etiologies (cystic fibrosis, primary ciliary dyskinesia, alpha-1 antitrypsin deficiency) versus acquired (post-infection, idiopathic, aspiration, immunodeficiency, auto-immune, ABPA).
- Patients presents with chronic cough and sputum production. Affects women more than men.
- Typically diagnosed by high resolution CT scan.
- At risk for chronic colonization by Pseudomonas.
- Typical infectious organisms include H. influenzae, Pseudomonas, Moraxella catarrhalis, Mycobacterium, Staph.
- Treatment: Treat underlying condition, antimicrobrial therapy, surgical resection, lung transplant for end stage disease.
O’Donnell. CHEST. 2008.
What antibiotic should I give if I’m concerned my patient has pneumonia? Do I need to send them to the floor, ICU, or outpatient? Should I even check a procalcitonin?
Today Dr. Eric Mortensen from the division of general internal medicine at UT Southwestern addressed these questions in a fantastic lecture on pneumonia. Check out his slides below as well as an earlier blog post in which Dr. Mortensen did a Q&A regarding his recent article from JAMA looking at azithromycin use for pneumonia.
This week, Julie Lin (PGY-02) gave a great talk on high altitude sickness of her resident update talk. Below are her slides from the presentation. Also, click on the click below to read the article from NEJM by Bartsch and Swenson about acute high altitude illness.
Acute High-Altitude Illnesses
Dr. Biff Palmer, Professor of Internal Medicine and Division of Nephrology at UTSW, authored the following articles below regarding high altitude illness. Specifically, he discusses the role of hypoxia inducible factor (HIF) in causing reduced appetite and increased energy expenditure as well as an overview of the condition. Of note, Dr. Palmer has reached the “Seven Summits” so he definitely knows a thing or two about this topic! Click on the links below!
Ascent to Altitude as a Weight Loss Method: The Good and Bad of Hypoxia Inducible Factor Activation
Physiology and pathophysiology with ascent to altitude