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    2015/2016 ESC/ESR Preporuke za dijagnozu i leenje plune hipertenzijeRadna grupa za dijagnozu i leenje plune hipertenzije Evropskog uduenja kardiologa i Evropskog respiratornog drutva prihvaene od strane Evropske asocijacije za pedijatrijsku i kongenitalnu kardiologije (AEPC), Meunarodno udruenje za transplantaciju srca i plua (ISHLT)The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)

    Eur Heart J 2009;30:2369-2413. doi:10.1093/eurheartj/ehp285

    Authors/Task Force Members: Nazzareno Gali * (ESC Chairperson) (Italy), Marc Humbert*a (ERS Chairperson) (France), Jean-Luc Vachieryc (Belgium), Simon Gibbs (UK), Irene Lang (Austria), Adam Torbicki (Poland), Grald Simonneaua (France), Andrew Peacocka (UK), Anton Vonk Noordegraafa (The Netherlands), Maurice Beghettib (Switzerland), Ardeschir Ghofrania (Germany), Miguel Angel Gomez Sanchez (Spain), Georg Hansmannb (Germany), Walter Klepetkoc (Austria), Patrizio Lancellotti (Belgium), Marco Matuccid (Italy), Theresa McDonagh (UK), Luc A. Pierard (Belgium), Pedro T. Trindade (Switzerland), Maurizio Zompatorie (Italy) and Marius Hoepera (Germany) * Corresponding authors: Nazzareno Gali, Department of Experimental, Diagnostic and Specialty MedicineDIMES, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy, Tel: +39 051 349 858, Fax: +39 051 344 859, Email: [email protected] Published on behalf of the European Society of Cardiology. All rights reserved. & 2015 European Society of Cardiology & European Respiratory Society. This article is being published concurrently in the European Heart Journal (10.1093/eurheartj/ehv317) and the European Respiratory Journal (10.1183/13993003.01032-2015). The articles are identical except for minor stylistic and spelling differences in keeping with each journals style. Either citation can be used when citing this article. Marc Humbert, Service de Pneumologie, Hopital Bicetre, Universit Paris-Sud, Assistance Publique Hopitaux de Paris, 78 rue du Gnral Leclerc, 94270 Le Kremlin-Bicetre, France, Tel: +33 145217972, Fax: +33 145217971, Email: [email protected] ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in Appendix a Representing the European Respiratory Society; b Representing the Association for European Paediatric and Congenital Cardiology; c Representing the International Society for Heart and Lung Transplantation; d Representing the European League Against Rheumatism; and e Representing the European Society of Radiology. ESC entities having participated in the development of this document: ESC Associations: Acute Cardiovascular Care Association (ACCA), European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). ESC Councils: Council for Cardiology Practice (CCP), Council on Cardiovascular Nursing and Allied Professions (CCNAP), Council on Cardiovascular Primary Care (CCPC). ESC Working Groups: Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Grown-up Congenital Heart Disease, Pulmonary Circulation and Right Ventricular Function, Valvular Heart Disease. The content of these European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC/ERS Guidelines may be translated or reproduced in any form without written permission from the ESC and/or ERS. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal or from the European Respiratory Journal and the party authorized to handle such permissions on behalf of the ESC and ERS. Disclaimer: The ESC/ERS Guidelines represent the views of the ESC and ERS and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC and ERS are not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC/ERS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC/ERS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC/ERS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patients health condition and in consultation with that patient and, where appropriate and/or necessary, the patients caregiver. Nor do the ESC/ERS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patients case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professionals responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. European Heart Journal (2016) 37, 67119 doi:10.1093/eurheartj/ehv317 by guest on November 10, 2016 http://eurheartj.oxfordjournals.org/ Downloaded from Document Reviewers: Victor Aboyans (CPG Review Coordinator) (France), Antonio Vaz Carneiro (CPG Review Coordinator) (Portugal), Stephan Achenbach (Germany), Stefan Agewall (Norway), Yannick Allanored (France), Riccardo Asteggiano (Italy), Luigi Paolo Badano (Italy), Joan Albert Barbera (Spain), Hlne Bouvaist (France), Hctor Bueno (Spain), Robert A. Byrne (Germany), Scipione Carerj (Italy), Graca Castro (Portugal), etin Erol (Turkey), Volkmar Falk (Germany), Christian Funck-Brentano (France), Matthias Gorenflob (Germany), John Grantonc (Canada), Bernard Iung (France), David G. Kiely (UK), Paulus Kirchhof (Germany/UK), Barbro Kjellstrom (Sweden), Ulf Landmesser (Switzerland), John Lekakis (Greece), Christos Lionis (Greece), Gregory Y. H. Lip (UK), Stylianos E. Orfanosa (Greece), Myung H. Parkc (USA), Massimo F. Piepoli (Italy), Piotr Ponikowski (Poland), Marie-Pierre Revele (France), David Rigaua (ERS methodologist) (Switzerland), Stephan Rosenkranz (Germany), Heinz Voller (Germany), and Jose Luis Zamorano (Spain) The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines Online publish-ahead-of-print 29 August 2015

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    Sadraj:Skraenice i akronimi1. Predgovor2. Uvod3. Definicije i klasifikacije 3.1 Definicije 3.2 Klasifikacije4. Epidemiologija i genetika plune hipertenzije 4.1 Epidemiologijqa i faktori rizika 4.2 Genetika5. Dijagnoza plune hipertenzije 5.1 Dijagnoza 5.1.1 Klinika slika 5.1.2 Elektrokardiogram 5.1.3 Radigrafija plua 5.1.4 Testovi za procenu plune funkcije i gasova iz

    arterijske krvi 5.1.5 Ehokardiografija 5.1.6 Ventilaciono/perfuzioni skener plua 5.1.7 Kompjuterizovana tomografija visoke rezolu-

    cije, kontrastna kompjuterizovana tomografija i pluna angiografija

    5.1.8 Magnetna rezonanca srca 5.1.9 Laboratorijske analize krvi i imunologija 5.1.10 Ultrazvuk abdomena 5.1.11 Kateterizacija desnog srca i vazoreaktivnost 5.1.12 Genetiko testiranje 5.2 Dijagnostiki algoritam6. Pluna arterijska hipertenzija (grupa 1) 6.1 Klinike karakteristike 6.2 Procena ozbiljnosti 6.2.1 Kliniki parametri, imiding i hemodinamika 6.2.2 Kapacitet vebanja 6.2.3 Biohemijski markeri 6.2.4 Sveobuhvatna prognostika procena i procena

    rizika 6.2.5 Definicija statusa pacijenta 6.2.6 Ciljevi leenja i strategija praenja 6.3 Terapija 6.3.1 Opte mere 6.3.1.1 Fizika aktivnost i nadgledana rehabilitacija 6.3.1.2 Trudnoa, kontrola raanja, i postmeno-

    pauzalna hormonska terapija 6.3.1.3 Elektivna hirurgija 6.3.1.4 Prevencija infekcije 6.3.1.5 Psihosocijalna podrka 6.3.1.6 Pridravanje terapije 6.3.1.7 Putovanja 6.3.1.8 Genetiko savetovanje 6.3.2 Suportivna terapija 6.3.2.1 Oralna antikoagulantna terapija 6.3.2.2 Diuretici 6.3.2.3 Kiseonik 6.3.2.4 Digoksin i drugi kardiovaskularni lekovi 6.3.2.5 Anemija i nivo gvoa 6.3.3 Specifina terapija lekovima 6.3.3.1 Blokatori kalcijumskih kanala 6.3.3.2 Antagonisti endotelinskih receptora 6.3.3.3 Inhibitori 5-fosfodiesteraze i stimulatori

    guanil-ciklaze 6.3.3.4 Analozi prostaciklina i agonisti receptora za

    prostaciklin

    6.3.3.5 Eksperimentalna jedinjenja i strategije 6.3.4 Kombinovana terapija 6.3.5 Interakcije lekova 6.3.6 Balon atrijalna septostomija 6.3.7 Uznapredovala insuficijencija desne komore 6.3.7.1 Leenje u jedinicama intenzivne nege 6.3.7.2 Pumpa za desnu komoru 6.3.8 Transplantacija 6.3.9 Terapijski algoritam 6.3.10 Dijagnoza i leenje komplikacija plune

    arterijske hipertenzije 6.3.10.1 Aritmije 6.3.10.2 Iskaljavanje krvi 6.3.10.3 Mehanike komplikacije 6.3.11 Terminalna nega i etiki problemi7. Specifina pluna (arterijska) hipertenzija podgrupe 7.1 Pluna arterijska hipertenzija kod dece 7.1.1 Dijagnoza 7.1.2 Terapija 7.2 Pluna arterijska hipertenzija udruena sa

    kongenitalnim sranim manama odraslih 7.2.1 Dijagnoza 7.2.2 Terapija 7.3 Pluna arterijska hipertenzija udruena sa

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