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A Case-based Approach to Diagnosing Pulmonary Arterial Hypertension in Primary Care

Pulmonary Disease
Diagnosing and Managing PAH
0.5 AAFP Prescribed Credit(s) 0.5 AANP Contact Hours 0.5 AMA PRA Category 1 Credit(s)
Launch Date:
September 01, 2016
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Primary Care MD/DO; and NPs/PAs and other clinicians managing patients with PAH

Relevant Terms:

Pulmonary arterial hypertension; pulmonary hypertension

Franck Rahaghi, MD, MHS, FCCP

Franck Rahaghi, MD, MHS, FCCP
Director of Advanced Lung Disease Clinic
Director, Pulmonary Hypertension Clinic
Head of Alpha-1 Foundation Clinical Resource Center 
Cleveland Clinic Florida
Weston, FL

Dr. Franck Rahaghi graduated from the University of California San Diego cum laude with a degree in biomedical engineering. He subsequently attended the University of California San Francisco where he obtained his doctorate in medicine. He also attended University of California Berkeley at the same time to obtain a degree in public health and health administration. Dr. Rahaghi completed his internship at the University of Minnesota and in his medical residency at the University of Illinois in Chicago. He completed his pulmonary and critical care fellowship at the Weil-Cornell campus of New York Presbyterian Hospital. He has since been serving as staff attending and clinical researcher at the Cleveland Clinic Florida. He holds the positions of Chair of Quality, Head of the Pulmonary Education department, and Director of the Pulmonary Hypertension Clinic at the Cleveland Clinic in Florida.

Murali Chakinala, MD, FCCP

Murali Chakinala, MD, FCCP
Associate Professor of Medicine 
Washington University School of Medicine
Director, Washington University & Barnes Jewish Hospital Pulmonary Hypertension Care Center
Co-Director, Washington University Hereditary Hemorrhagic Telangiectasia Center of Excellence
St. Louis, MO

Dr. Murali Chakinala received his undergraduate education at Duke University and then received his medical degree at Vanderbilt University School of Medicine.  He completed an Internal Medicine Residency at the University of Texas – Southwestern, and also served as a Chief Resident.  He finished his Pulmonary and Critical Care training at Washington University in 2002 and then joined the faculty.  He is board certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine.  He is an Associate Professor in the Department of Internal Medicine and is director of the Pulmonary Hypertension Clinic and co-director of the Hereditary Hemorrhagic Telangectasia (HHT) Center at Washington University.  He is a member of the Scientific Leadership Council of the Pulmonary Hypertension Association, a member of the Pulmonary Hypertension Care Centers Oversight Committee, and the HHT Foundation International’s Global Research Medical Advisory Board.  His interests include clinical management and clinical research in the areas of pulmonary hypertension, pulmonary arterio-venous malformations, pulmonary thrombo-embolic diseases, and end-stage lung diseases.
1. Explain the pathophysiology of pulmonary arterial hypertension (PAH)
2. Determine when PAH should be suspected and how to determine the specific etiology
3. Define parameters that determine the severity of PAH
4. Review treatments and appropriately refer and follow patients receiving treatment for PAH

Planning Committee
Gregg Sherman, MD
Family Practice
Plantation, FL
Harvey C. Parker, Ph.D., CCMEP
National Association for Continuing Education
Plantation, FL
Joshua Kilbridge, President
Kilbridge Associates
San Francisco, CA
Pulmonary arterial hypertension (PAH) is a subgroup of pulmonary hypertension (PH) - a chronic and progressive condition characterized by abnormally high pressure in the pulmonary vasculature. PAH has previously been considered a rare disease, but evidence suggests a prevalence of about 15-50 cases per million. In the United States, about 1,000 new cases of PAH are diagnosed each year and mortality and hospitalization rates for PH have been increasing.
The pathophysiology of PAH is complex, with abnormalities occurring at the genetic and molecular levels, and involving pulmonary arterial smooth muscle, endothelial cells, and the adventitia. PAH may be associated with disturbances in the balance of endogenous vasoconstrictors and vasodilators (including endothelin, prostacyclin, nitric oxide and cGMP) in response to endothelial dysfunction or injury, and has led to the development of specific therapies targeting the prostacyclin-, nitric oxide- and endothelin-mediated pathways.
Dramatic advances in the treatment of PAH have occurred over the past two decades, but despite these advances, education and training of clinicians has lagged behind advances in the management of PAH. It is important for clinicians to know when additional or more aggressive treatment is needed, and timely referral to a specialty PH center for a more detailed evaluation and/or more aggressive therapy should be carefully considered. Unfortunately, PAH patients are commonly referred too late in the disease process, at a time when hemodynamic abnormalities are at an advanced stage.
This program will help to bridge the knowledge and performance gaps related to identification, and management of PAH.  This educational initiative offers a two-phased curriculum. Phase 1 offered a Self Assessment Program (SAP) allowing learners to assess their knowledge and skills in this area, compare their selections and scores with all other learners to date, and review commentary from the faculty.  The goal of the SAP is to make learners aware of their strengths and weaknesses in this subject area.
This Phase 2 activity utilizes a case-based interactive structure that was developed focusing on results from Phase 1 learner knowledge gaps. 
It is the policy of NACE to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. NACE assesses conflict of interest with its faculty, planners and managers of CME activities. Conflicts of interest that are identified are resolved by reviewing that presenter's content for fair balance and absence of bias, scientific objectivity of studies utilized in this activity, and patient care recommendations.
While NACE endeavors to review faculty content, it remains the obligation of each physician or other healthcare practitioner to determine the applicability or relevance of the information provided from this course in his or her own practice.
Franck Rahaghi, MD, MHS, FCCP serves as a speaker for United Therapeutics, Actelion and Lung Biotech. Dr. Rahaghi also serves as a Consultant for Bayer and Lung Biotech and a Researcher for Gilead and Lung Biotech. 
Murali Chakinala, MD, FCCP serves as a Consultant for Actelion and SteadyMed Therapuetics. Dr. Chakinala also serves as a Consultant/Speaker for Gilead and Bayer.   
Planning Committee
Gregg Sherman, MD, has no real or apparent conflicts of interest to report. 
Harvey Parker, PhD, has no real or apparent conflicts of interest to report. 
Josh Kilbridge has no real or apparent conflicts of interest to report. 
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The National Association for Continuing Education designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number 121222. This program has been approved for 0.5 contact hours of continuing education (which includes 0.25 pharmacology hours).
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  • Physicians who successfully complete the post-test and evaluation will receive CME credit.
  • Nurse Practitioners who successfully complete the post-test and evaluation will receive AANP CE credit.
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iPhone/iPad with iOS 6.1 or above

This activity is sponsored by National Association for Continuing Education.
This educational activity is supported by an independent educational grant from Actelion Pharmaceuticals US, Inc.
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