SAT-699 "Obesity-Related Pulmonary Hypertension: Insights into Pathogenesis and Treatment Strategies"

Abstract Disclosure: M. Ayman: None. S. Manikonda: None. Introduction: Obesity is a major risk factor for cardiovascular and metabolic diseases, including pulmonary hypertension. Obesity-induced PH is associated with high body mass index (BMI), obstructive sleep apnea (OSA), and increased right ventricular strain. The pathophysiology involves increased cardiac output, hypoxia due to OSA, and the release of adipokines, contributing to pulmonary vascular remodeling. Case Presentation: A 45-year-old woman with a BMI of 42 kg/m² presented with dyspnea on exertion, fatigue, and lower extremity edema. She had a history of obstructive sleep apnea, hypertension, and type 2 diabetes. Despite management of these conditions, her symptoms worsened over the past year. Physical exam showed bilateral lower limb edema, jugular venous distension, and signs of right-sided heart failure (hepatomegaly, peripheral edema). Vital signs: heart rate 98 bpm, BP 130/85 mmHg, oxygen saturation 94% on room air. Lung auscultation revealed bilateral crackles. Investigations:Chest X-ray: Right heart enlargement and pulmonary congestion.Echocardiography: Right ventricular dilation with tricuspid regurgitation jet velocity of 3.8 m/s, RVSP of 55 mmHg, confirming PH.Pulmonary Function Tests (PFTs): Mild restrictive lung pattern, likely secondary to obesity.Sleep Study: Moderate OSA with oxygen desaturation.Right Heart Catheterization: Mean pulmonary artery pressure (mPAP) 45 mmHg and pulmonary vascular resistance (PVR) 5.2 Wood units, confirming obesity-induced PH. Discussion: Obesity-induced PH results from increased cardiac output, pulmonary vascular changes, and right-sided heart failure. OSA contributes to pulmonary vasoconstriction and right ventricular strain. Adipokines play a role in vascular remodeling. In this patient, obesity and OSA were key factors in PH development. Early diagnosis is crucial to prevent severe complications. PH progresses slowly and requires a comprehensive management approach addressing underlying factors. Management: Obesity Management: Referral to a weight management program, including diet, exercise, and bariatric surgery consideration. CPAP Therapy: Initiated to manage OSA and improve nocturnal oxygenation. Diuretics: Furosemide 40 mg daily to manage fluid overload and heart failure symptoms. Conclusion: Obesity-induced pulmonary hypertension is a serious condition requiring early recognition and multidisciplinary management. This case highlights the importance of addressing both obesity and OSA in PH treatment. Weight loss, CPAP therapy, and pulmonary vasodilators significantly improved the patient's symptoms and prognosis. Timely intervention can prevent further complications and improve outcomes. Presentation: Saturday, July 12, 2025