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{"project":"2_test","denotations":[{"id":"23829793-19749199-81675495","span":{"begin":850,"end":852},"obj":"19749199"},{"id":"23829793-19749199-81675496","span":{"begin":1069,"end":1071},"obj":"19749199"},{"id":"23829793-12411973-81675497","span":{"begin":1359,"end":1362},"obj":"12411973"},{"id":"23829793-15915025-81675498","span":{"begin":1363,"end":1366},"obj":"15915025"},{"id":"23829793-19749199-81675499","span":{"begin":1464,"end":1466},"obj":"19749199"},{"id":"23829793-12411973-81675500","span":{"begin":1616,"end":1619},"obj":"12411973"},{"id":"23829793-15915025-81675501","span":{"begin":1620,"end":1623},"obj":"15915025"},{"id":"23829793-19749199-81675502","span":{"begin":1982,"end":1984},"obj":"19749199"},{"id":"23829793-19897552-81675503","span":{"begin":2514,"end":2517},"obj":"19897552"},{"id":"23829793-16387943-81675504","span":{"begin":2945,"end":2948},"obj":"16387943"},{"id":"T46812","span":{"begin":850,"end":852},"obj":"19749199"},{"id":"T93022","span":{"begin":1069,"end":1071},"obj":"19749199"},{"id":"T46749","span":{"begin":1359,"end":1362},"obj":"12411973"},{"id":"T57886","span":{"begin":1363,"end":1366},"obj":"15915025"},{"id":"T49055","span":{"begin":1464,"end":1466},"obj":"19749199"},{"id":"T39213","span":{"begin":1616,"end":1619},"obj":"12411973"},{"id":"T3151","span":{"begin":1620,"end":1623},"obj":"15915025"},{"id":"T80671","span":{"begin":1982,"end":1984},"obj":"19749199"},{"id":"T5624","span":{"begin":2514,"end":2517},"obj":"19897552"},{"id":"T52669","span":{"begin":2945,"end":2948},"obj":"16387943"}],"text":"General measures\n\nPhysical activities \nPeripheral vasodilatation or increased cardiac demand will put PAH patient at risk of acute cardiac failure and syncope. Thus, we traditionally advise against extreme physical activity. Patients are taught to stay active while adapting effort according to their symptoms. Nevertheless, the appropriate level of physical activity is difficult to define. To date, only few studies have evaluated to effect of cardio-respiratory rehabilitation in PAH. One of this program involved three weeks of inpatient rehabilitation followed by three month training at home with phone call supervision. No modification on cardiac hemodynamic was observed on echocardiography but 6-MWD and quality of life were improved. As proposed in ERS/ESC guidelines, more data are required before appropriate recommendations can be made [15].\n\nAltitude and hypoxia \nAs hypoxic vasoconstriction may be an aggravating factor in PAH, stays at altitude above 1500-2000 meters without supplemented oxygen and air flight in unpressurized cabin should be avoided [15]. Chronic hypoxia (PaO2 \u003c60 mmHg) warrants oxygen therapy for symptoms and to avoid PAH deterioration.\n\nPregnancy and contraception \nThe hemodynamic and hormonal modifications occurring during pregnancy and peripartum period can lead to severe, and sometimes fatal, right heart failure [197,198]. Pregnancy is considered to be associated with high rate of mortality (30-50%) in PAH patients [15]. Thus, pregnancy is contraindicated in women affected by PAH. Consequently, contraception is strongly recommended in PAH women of childbearing age [197,198]. Combined estrogen-progestin oral contraceptive is theoretically contraindicated because their pro-thrombotic activity. Therefore, mechanical contraception (intra-uterine device for example) or surgical sterilization should be proposed. Nethertheless, pregnancy should be managed with specific PAH therapies and planned elective delivery in expert centres [15].\n\nAnaesthesia and surgery \nHypotension induced by anaesthetic drugs, and hemodynamic insults following surgical and anaesthetic interventions are generally poorly tolerated by PAH patients, with a high procedural morbidity and mortality. Consequently, it is recommended in general that PAH patients avoid unnecessary procedures. When required, these should be highly planned with the multidisciplinary team, either within, or in close liaison with, the expert centers, in order to coordinate surgical and medical interventions [199].\n\nProscribed drugs \nVasoconstrictors used in cold medication to relieve nasal congestion should be avoided in PAH patients. Beta-blockers have been shown to be deleterious to PAH patients because they prevent the important adaptive physiologic response that allows preservation of adequate cardiac output. To discontinue such drugs in a patient with PAH may lead, by itself, to important clinical and hemodynamic improvement [200].\n"}

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PMC:3750932 / 69850-72801 JSON TXT