What treatment is available for primary pulmonary hypertension ? • Diuretics are useful in reducing excessive preload in patients with right heart failure, particularly when hepatic congestion and ascites are present. • Oral anticoagulants: warfarin is the anticoagulant of choice, in doses adjusted to achieve an INR of approximately 2.0. Anticoagulants nearly double the 3-year survival rate (Circulation 1984; 70: 580-7). * Calcium channel blockers: nifedipine, diltiazem. Patients who respond to calcium channel blockers have a 5-year survival rate of 95% (N Engl J Med 1992; 327: 76-81). • Intravenous epoprostenol (formerly prostacyclin or prostaglandin I2), which is a potent short-acting vasodilator and inhibitor of platelet aggregation that is produced by the vascular endothelium (N Engl J Med 1996; 334: 296-301; N Engl J Med 1998; 338: 273-7). • Atrial septostomy: the creation of a right-to-left shunt by blade-balloon atrial septostomy has been reported to improve forward output and
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