For many patients with advanced pulmonary hypertension who no longer respond to medical management, a lung transplant is the only hope for survival. Patients with severe cardiomyopathy and pulmonary hypertension will need heart and lung transplants. Many transplant centers have patients attend a pulmonary rehabilitation program while awaiting transplantation to preserve function for as long as possible. He states that his cough and lower leg and ankle edema are unchanged from his last physician's office visit, but he is concerned about an increasing thickness in his abdomen. His breathing problems have made sleeping difficult for the last few nights.
Chest auscultation reveals crackles in the lower half of both lung fields.
Because Mr. K. has a history of COPD, the nurse will assess the type of cough and sputum characteristics to determine if the problem is worsening COPD, heart failure, or an infection. To rule out sleep apnea, the nurse will ask Mr. K. if he experiences sleep disturbances or falls asleep during the day. Diagnosis depends on a combination of medical history and physical examination findings and laboratory and diagnostic testing. After testing, Mr. K. is diagnosed with right ventricular failure secondary to pulmonary hypertension. Treatment goals for right-sided heart failure include optimization of right ventricular filling pressure and volume and minimization of peripheral vascular congestion.