Date:
Patient:
Reason for Visit:
Follow-up for pulmonary hypertension (PH)
Evaluation of symptoms (e.g., dyspnea, fatigue, chest pain, right heart failure)
Assessment of response to treatment and hemodynamic status
History:
Present Illness:
Onset, duration, and severity of symptoms suggestive of PH:
Dyspnea (shortness of breath) – progressive, worse with exertion
Fatigue
Chest pain (angina-like)
Syncope (fainting) – in severe cases
Right heart failure symptoms (ankle swelling, jugular venous distention)
Functional limitations due to symptoms
World Health Organization (WHO) Functional Class (assessment of exercise tolerance)
Past Medical History (PMH):
Underlying conditions associated with PH (e.g., idiopathic pulmonary arterial hypertension (IPAH), chronic obstructive pulmonary disease (COPD), connective tissue disease, congenital heart disease)
Prior hospitalizations for PH complications
Social History:
Smoking history (can worsen PH)
Family history of PH (rare)
Occupational exposures (塵埃 chén’ēi – dust, fumes)
Physical Exam:
Vital Signs: Assess for tachypnea (rapid breathing), jugular venous distention (JVD), and hypotension (low blood pressure).
General: Look for signs of cyanosis (bluish skin discoloration) and peripheral edema (swelling in legs).
Cardiovascular:
Palpate for a palpable pulmonic second heart sound (suggestive of right ventricular strain).
Assess for peripheral pulses (weak or absent pulses suggest severe PH).
Pulmonary:
Auscultate for breath sounds (presence of crackles).
Diagnostic Tests (may be ordered depending on clinical presentation):
Chest X-ray: May show signs of enlarged pulmonary arteries.
Electrocardiogram (ECG): May show signs of right heart strain.
Echocardiogram: Non-invasive assessment of right ventricular function and pulmonary artery pressures.
Right heart catheterization: The gold standard for diagnosing PH and measuring pulmonary artery pressures directly.
Blood tests: To assess for underlying conditions associated with PH and rule out other causes of symptoms.
Assessment:
Type of PH: Based on diagnostic workup (e.g., IPAH, PH secondary to COPD)
Functional class: WHO Functional Class for exercise tolerance.
Hemodynamic status: Severity of pulmonary artery pressure elevation.
Response to treatment: Evaluate effectiveness of current medications and identify any side effects.
Plan:
Treatment plan based on type and severity of PH, and individual patient factors:
Pulmonary vasodilators: Medications to relax blood vessels in the lungs and improve blood flow (e.g., calcium channel blockers, endothelin receptor antagonists, prostacyclin analogs)
Diuretics: To manage fluid buildup (common complication of right heart failure).
Other medications: Oxygen therapy for hypoxemia, digitalis for heart rhythm control (if indicated).
Non-pharmacological measures: Weight management, smoking cessation, exercise rehabilitation (tailored to individual capabilities).
Referral to a pulmonologist or cardiologist specializing in PH: For complex cases or consideration of advanced therapies (e.g., balloon pulmonary angioplasty, lung transplantation).
Patient education: Provide information about PH, the specific type diagnosed, importance of medication adherence, healthy lifestyle modifications, signs and symptoms to watch for, and the importance of regular follow-up.
Follow-up:
Schedule for regular follow-up appointments to monitor symptoms, assess response to treatment with clinical evaluation and imaging studies (e.g., echocardiogram), and adjust medications as needed.
Discuss the importance of long-term management for PH, as it is a chronic condition.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pulmonary hypertension