HIV-Associated Pulmonary Hypertension and Right Ventricular Dysfunction
Pulmonary embolism should be considered in HIV-positive patients with risk factors for pulmonary embolism (cancer, lower limb fractures, prolonged immobilization, recent surgery, infective endocarditis of the right-sided heart valves), the onset of acute paroxysmal dyspnea with jugular venous distension and normal physical examination of the chest with an ECG not suggestive of acute myocardial infarction as well as chest radiograms negative for acute pulmonary infiltrate.
The onset of hemoptysis days after dyspnea, associated with fever, stabbing chest pain (exacerbated by deep inspiration and coughing), and pleural friction rub, should suggest pulmonary infarction. Oxygen and steroids are generally used with conflicting results in the ED for HIV-infected patients with pulmonary hypertension. Calcium channel blockers (e.g., nifedipine and diltiazem), epoprostenol, and nitric oxide have been suggested in the treatment of HIV-associated pulmonary hypertension; however, controlled clinical trials have not been performed to confirm their efficacy. Studies on the effects of HAART therapy on pulmonary artery endothelial cells have shown contradictory results. Further information about the treatment of HIV-associated pulmonary hypertension is reported by G. Bar- baro in a separate chapter in this volume.
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