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Pulmonary Vascular Diseases (Moores) Figure 2. Multiple-hit hypothesis of pathogenesis of PAH: BMPR-II, bone morphogenic protein receptor type 2. From Gabbay E, Reed A, Williams TJ. Assessment and treatment of pulmonary arterial hypertension: an Australian perspective in 2006. Intern Med J 2006; 37:38−48. PAH related to risk factors or associated conditions is a heterogeneous group of disorders, including connective tissue disease, congenital systemic pulmonary shunt, portal hypertension, HIV infection, drugs and toxin, and those conditions such as hemoglobinopathies and myeloproliferative disorders.
Galie N, Rubin LJ, eds. Pulmonary arterial hypertension: epidemiology, pathobiology, assessment, and therapy. J Am Coll Cardiol 2004; 43(suppl):1S−90S 34 This entire supplement is devoted to PH, with articles by noted authorities. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. American College of Chest Physicians evidence-based clinical practice guidelines. 8th ed. Chest 2008; 133:381S−453S Evidence-based recommendations on prevention of VTE in all surgical and medical populations.
Dilated small vessels border the airway above the artery. From Newman JH, Phillips JA, Loyd JE. Pulmonary hypertension. Ann Intern Med 2008; 148:278−283. 29 is a key contributor. Platelets likely play an important role as procoagulants by increasing the platelet release of serotonin, vascular endothelial growth factor, and platelet-derived growth factor. Clinical Features PH frequently presents with nonspecific symptoms (Table 5). The most common symptoms are dyspnea on exertion, fatigue, and syncope, resulting from reduced cardiac output during activity.