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Resp DRX > 03c: Pulm HT > Flashcards

03c: Pulm HT Flashcards

1
Q

Which pressure is measured to define Pulm HT?

A

Pulm artery P (over 25 mmHg at rest)

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2
Q

Group 1 PAH, aka (X), includes which causes of PAH?

A

X = pulm arterial HT

  1. Idiopathic (sporadic or heritable) PAH
  2. PAH due to disease that targets small pulm arterioles
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3
Q

Group 2 PH includes which causes of Pulm HT?

A

“Pulm venous HT”

PH due to:

  1. LV dysfunction
  2. L side valve disease
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4
Q

Group 3 PH includes which causes of Pulm HT?

A

Pulm HT associated with disorders of respiratory system or hypoxemia

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5
Q

Group 4 PH includes which causes of Pulm HT?

A

Pulm HT caused by chronic thromboembolic disease

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6
Q

Group 5 PH includes which causes of Pulm HT?

A

Pulm HT from misc causes

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7
Q

T/F: PAH (pulm arterial hypertension) is used exclusively for Group 1 classification.

A

True

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8
Q

COPD patient presents with Pulm HT. The PH would fall into which group?

A

3

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9
Q

Sarcoidosis patient presents with Pulm HT. The PH would fall into which group?

A

5 (sarcoid granulomas likely serve to extrinsically compress vasculature)

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10
Q

List some of the many causes of PAH.

A
  1. Idiopathic or Heritable
  2. CVD
  3. HIV or drug-induced
  4. Portal HT
  5. Shunts
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11
Q

List some of the many causes of PH.

A
  1. COPD
  2. Obstructive sleep apnea
  3. PE
  4. Chronic thromboembolitic disease
  5. L heart disease
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12
Q

Patient with abnormal BMPR2 (bone morphogenetic protein receptor type II) is at high risk for:

A

PAH (heritable)

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13
Q

Patient comes in for yearly physical and confides in you that she takes anorexigens (appetite suppressants). You must warn her that she’s at risk for:

A

Pulmonary arterial HT

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14
Q

(PH/PAH) occurs in about (X) fraction of HIV patients.

A

PAH;

X = 1/200

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15
Q

T/F: Cocaine/amphetamine use increases risk of developing PAH by 3 fold.

A

True

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16
Q

(PH/PAH) in diabetic patient commonly due to (X), which puts them in Group (1/2/3/4/5).

A

PH;
X = LV dysfunction
2

17
Q

Endothelial dysfunction that leads to PH includes (increase/decrease) NO, prostacyclin, thromboxane, and endothelin-1 production.

A

Decrease: NO, prostacyclin
Increase: thromboxane, endothelin-1

18
Q

List the possible etiologies/causes for PAH

A
  1. Vasomediator imbalance
  2. Ion channel defect (impaired K channel)
  3. Inflammation
  4. Dysregulated angiogenesis
19
Q

Most patients with early PH present with (X) symptom(s). What is the rationale behind this?

A

Dyspnea on exertion, lethargy and fatigue;

Inability to increase CO

20
Q

As PHT progresses, (R/L) heart failure develops and which additional symptoms would patient present with?

A

RV;

  1. Exertional chest pain and syncope
  2. Peripheral edema
21
Q

HIV Patient presents with exertional dyspnea, cough and lethargy. You hear splitting of the (first/second) heart sound and are immediately worried he has (X).

A

Second;

X = Pulmonary hypertension

22
Q

Aside from BMPR2, genetic abnormalities in which proteins can predispose one to (X) disease?

A

X = PAH

  1. Activin receptor-like kinase I
  2. Serotonin receptors and transporters
23
Q

What would CXR look like in PHT? List the things you would look for.

A

Normal mainly

  1. Pulm a (may be enlarged)
  2. RV/RA (may be enlarged)
24
Q

List the things you’d look for on Echo when suspecting PHT. Star the MAIN finding you’re interested in.

A
  1. RA/RV size/thickness
  2. Mean Pulm a pressure*
  3. LV, EF%
25
Q

(X) test for PHT has high false positive rate (30-40%) and MUST be confirmed with (Y) test.

A 
X = Cardiac echo
Y = R heart cath
26
Q

Which PFT abnormalities are caused by PHT?

A

Decreased DLCO

27
Q

Prognosis of PH is worse in (younger/older) patient population.

A

Worse if age under 14 OR over 65

28
Q

Patient presents with symptoms of PHT. You would order a V/Q scan to evaluate him for (X) disease. Depending on the result, what additional test would you order?

A

X = chronic thromboembolic disease

Normal: no additional tests needed (accurately excludes this disease)
Abnormal: MUST confirm/define with pulmonary angiography

29
Q

List some blood tests performed in diagnostic evaluation of PHT.

A
  1. HIV serology
  2. Liver function tests (for portal HT)
  3. Titers for CVDs (Antinuclear Ab, RF, Antineutrophil cytoplasmic Ab)
30
Q

(X) test is absolutely essential for confirming diagnosis of PH.

A

X = R heart cath

31
Q

Your 36 y.o. patient has PHT. What is the first crucial piece of therapeutic advice you give her?

A

DO NOT GET PREGNANT!!!

32
Q

List medical therapy/advice (not including drugs) for PHT.

A
  1. Supplemental O2
  2. Aerobic activity (as tolerated)
  3. Avoid altitude
33
Q

List the three classes of agents that have been approved for treatment of PAH.

A
  1. Prostacyclins
  2. Endothelin receptor antagonists
  3. PDE inhibitors (increase NO)

Resp DRX (9 decks)

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