Failure to Diagnose & Delay in Treatment of Pulmonary Hypertension

Evaluate breaches in the standard of care in cases where the issues are, possibly among other things, Failure to Diagnose & Delay in Treatment of Pulmonary Hypertension

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Dyspnea
    Unexplained persistent fatigue
    Chest pain
    Hoarseness
    Palpitations
    Syncope
    Edema
    Symptoms not elicited
    Patient was asymptomatic
    Answer unknown
    Why is this important?
    The most common symptoms associated with patients with pulmonary hypertension are shortness of breath and persistent fatigue.
    (2004) 22 ECARDC 3 367-373

  • Was pulmonary hypertension recognized in the asymptomatic patient? Why is this important?
    Answer this question
    
Pulmonary hypertension must be considered in any patient with persistent dyspnea, fatigue, or exercise intolerance without a readily attributable cause.

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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Did the clinician perform a physical examination? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.

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  • Was a preliminary chest x-ray and electrocardiogram performed? Why is this important?
    Answer this question
    
The clinician needs to perform a preliminary chest x-ray and electrocardiogram on any patient presenting with shortness of breath and increased fatigue.

    (2004) 22 ECARDC 3 367-373 



  • Were diagnostic lab investigations performed? Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to diagnosis.

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  • Which of the following diagnostic studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    
An echocardiograph and pulmonary function are required to confirm the diagnosis of pulmonary hypertension.

    (2004) 22 ECARDC 3 367-373 



  • Was the patient referred to a cardiologist/pulmonologist? Why is this important?
    Answer this question
    
Once priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.

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  • Was a lung ventilation–perfusion scan performed? Why is this important?
    Answer this question
    
Once an isolated vascular cause of pulmonary hypertension is suspected, a ventilation-perfusion scan must be obtained.

    (2004) 22 ECARDC 3 367-373 



  • Was the patient diagnosed with pulmonary hypertension? Why is this important?
    Answer this question
    
The clinician needs to correctly diagnose and categorize the type of pulmonary hypertension suffered by the patient as the management of each type varies.

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  • Was a right heart catheterization performed? Why is this important?
    Answer this question
    
Right heart catheterization is central to the evaluation of pulmonary hypertension.

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  • Was acute vasodilator testing performed? Why is this important?
    Answer this question
    
Acute vasodilator testing is performed to establish which patients will have improved survival with long-term use of calcium-channel blockers or other vasodilating agents.
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  • Was the six-minute walk test performed? Why is this important?
    Answer this question
    
Once the diagnosis has been established, exercise capacity can be measured using the six-minute walk test to help determine functional class and appropriate therapy.

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  • What type of pulmonary hypertension was diagnosed? Why is this important?
    Answer this question
    
The clinician is required to categorize the type of pulmonary hypertension suffered by the patient because management of each type varies.

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  • Were the underlying conditions treated? Why is this important?
    Answer this question
    
For patients with pulmonary hypertension (PH) associated with another condition, treatment of the primary condition is required to prevent progression of the pulmonary hypertension. 

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  • Did the clinician advise follow-up evaluations? Why is this important?
    Answer this question
    
Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in the patients cardiac output and respiratory function are quickly assessed and remedied.

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  • Was the patient with group II pulmonary hypertension treated for left heart disease? Why is this important?
    Answer this question
    
For patients with pulmonary hypertension due to underlying left heart disease, the underlying left heart disease treatment must be initiated.

    (2004) 29 ECPCAR 10 575-634 



  • Which of the following treatments were initiated in a patient with group IV pulmonary hypertension? (Choose all that apply) Why is this important?
    Answer this question
    
Thromboendarterectomy (surgical clot removal) can effectively cure certain patients with pulmonary hypertension associated with chronic thromboembolic disease.

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  • Were an antibody profiles and enzyme-linked immunosorbent assay (ELISA) for HIV obtained? Why is this important?
    Answer this question
    
Autoantibody profile is needed if connective tissue disease (eg, scleroderma or SLE) is a possible cause of the pulmonary hypertension. HIV status can be determined by enzyme-linked immunosorbent assay (ELISA) for HIV.

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