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Increased resistance across the pulmonary vascular system due to primary pulmonary vascular disease:.Abnormalities in any of the following three key hemodynamic components can cause elevated pulmonary artery pressures.Pearl 3: Physiologic framework for pulmonary hypertension Acute anemia can increase cardiac output, increasing PASP.Volume overload can lead to increased tricuspid regurgitation, increasing PASP.This may include disease states such as pneumonia, pleural effusion, or pneumothorax.Hypoxia and acute respiratory illness can lead to pulmonary vasoconstriction via autoregulation or loss of the vascular bed, increasing PASP.When interpreting a PASP, remember other clinical variables during acute illness that may alter results.Assessing changes in RV function is is helpful for monitoring disease progression and treatment response.Though, one study found that about 50% of the time, echocardiography over- or under-estimates the PASP by at least 10mmHg compared to right heart catheterization measurements.When compared to the PASP measured on right heart catheterization, the gold standard, echo estimated PASP has been shown to have at most a moderate correlation.Estimating a PASP requires identifying the TRV on the echo, which can be difficult in patients where getting good echo windows is challenging.Using the Bernoulli equation, the mean pressure difference from the RV to the RA is proportional to 4 x (TRV)2.The PASP is an estimate based on the tricuspid regurgitant jet velocity (TRV).Pearl 1: Interpreting the pulmonary artery systolic pressure (PASP) on ECHO
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