Sinus Node Dysfunction and Pulmonary Hypertension—“Double Trouble” with Lithium Therapy

Lithium is considered a gold standard drug for the management of bipolar disorder and is a widely used mood-stabilizing drug in psychiatry practice. However, its side effects are of important concern. The narrow therapeutic index of lithium predispose it to toxicity/side effects, but various case reports in literature have shown that adverse drug reactions can occur even in the therapeutic range. We present the case of a 56-year-old woman with no history of cardiac illness presenting with tachycardia-bradycardia syndrome along with moderate pulmonary hypertension. Patient reverted to sinus rhythm after withholding lithium therapy for 1 week while her mean pulmonary artery pressure remained the same at day 10 of drug withdrawal.

Palliative Care and Pulmonary Hypertension

Guest editors Christopher Barnett, MD, and Hunter Groninger, MD, conducted a roundtable discussion on March 23, 2018, with Keith Swetz, MD, Associate Professor of Medicine at the University of Alabama School of Medicine, Section Chief of Palliative Care at the Birmingham VA Medical Center and Medical Director of its Safe Harbor Palliative Care Unit; pulmonary hypertension patient Donna Hershey, RN, Children's National Medical Center, Washington, DC; and Anne Kinderman, MD, Associate Clinical Professor of Medicine at the University of California, San Francisco, and Director of the Supportive & Palliative Care Service at Zuckerberg San Francisco General. Their wide-ranging conversation about the role and status of palliative care for pulmonary hypertension patients follows.

Diagnostic Assessment of the Pulmonary Hypertension Patient

A methodical approach to pulmonary hypertension (PH) assessment in clinical practice is critical to ensure the correct diagnosis, determine disease severity, and initiate appropriate therapy. Data from epidemiological, clinical, and survey studies suggest that practice patterns vary widely across geographic regions, hospitals, and even within the expert community despite international consensus recommendations on the appropriate strategy for PH diagnosis.1–4 This knowledge gap is an important contributor to misdiagnosis, delayed treatment, inappropriate treatment, and potentially suboptimal outcome in at-risk or affected patients.5 Therefore, a discussion on the approach to diagnosing and staging PH remains timely and important. This review will outline current understanding that informs PH clinical practice with emphasis on data gathering and interpretation at point of care.