Signs and symptoms of pulmonary arterial hypertension

Common presenting symptoms of pulmonary arterial hypertension include^*1:

Dyspnea on exertion

Fatigue

Chest pain

Syncope

*Tracleer is not indicated to treat all of these symptoms

Physical examination features and implications

Physical signs and implications2
Sign	Implication
Accentuated pulmonary component of S2	High pulmonary pressure increases force of pulmonic valve closure
Early systolic click	Sudden interruption of opening of pulmonary valve into high-pressure artery
Midsystolic ejection murmur	Turbulent transvalvular pulmonary outflow
Left parasternal lift	High right ventricular pressure and hypertrophy
Right ventricular S4 (in 38%)	High right ventricular pressure and hypertrophy
Increased jugular a wave	Poor right ventricular compliance
Holosystolic murmur that increases with inspiration	Tricuspid regurgitation
Diastolic murmur	Pulmonary regurgitation
Hepatojugular reflux	High central venous pressure
Increased jugular v waves	—
Pulsatile liver	—

Adapted from ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension.²

Tracleer is indicated for the treatment of pulmonary arterial hypertension (PAH, WHO Group I) in patients with WHO Class II-IV symptoms, to improve exercise ability and decrease the rate of clinical worsening. Patients with WHO Class II symptoms showed reduction in the rate of clinical deterioration and a trend for improvement in walk distance. Physicians should consider whether these potential benefits are sufficient to offset liver injury in WHO Class II patients, which may preclude future use as their disease progresses.

Important safety information

Because of the associated risks, Tracleer may be prescribed only through the Tracleer Access Program.

Potential for serious liver injury (including, after prolonged treatment, rare cases of liver failure and unexplained hepatic cirrhosis in a setting of close monitoring)—Liver monitoring of all patients is essential prior to initiation of treatment and monthly thereafter.

High potential for major birth defects—Pregnancy must be excluded and prevented through the use of reliable forms of birth control; monthly pregnancy tests should be obtained.

Contraindicated for use with cyclosporine A and glyburide.

Please see full prescribing information including BOXED WARNING.

Review the therapeutic pathways in PAH

1. Nauser TD, Stites SW. Diagnosis and treatment of pulmonary hypertension. Am Fam Physician. 2001;63:1789-1798.
2. McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension. J Am Coll Cardiol. 2009;53:1573-1619.