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Sp: Coexisting I > 5. Pulm HTN > Flashcards

5. Pulm HTN Flashcards

1
Q

the heart is

A

a double pump

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2
Q

pulm HTN is defined as

A

mPAP > 20 mmHg

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3
Q

3 types of pulm HTN

A

precapillary
postcapillary
pre and postcapillary

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4
Q

precapillary HTN

A

pulm artery HTN
CTEPH
lung disease
thromboembolic disease

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5
Q

postcapillary HTN

A

LH disease

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6
Q

what other variable determine pulm HTN

A

pulm arterial wedge pressure
pulm vascular resistance

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7
Q

ways to diagnosis pulm HTN

A

TEE
TTE
Right Heart catheterization

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8
Q

most accurate way to diagnose pulm HTN

A

right heart cath

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9
Q

PCWP in pulm HTN

A

<15mmHg

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10
Q

safest way to diagnose pulm HTN

A

TEE or TTE

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11
Q

PASP: mild pulm HTN

A

36-49 mmHg

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12
Q

PASP: mod

A

50-59 mmHg

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13
Q

PASP: severe

A

> 60 mmHg

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14
Q

mPAP

A

> 20 mmHg

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15
Q

PAWP

A

> 15 mmHg

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16
Q

PVR

A

> 3 WU

(240 dynes/s/cm5)

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17
Q

what increase pulm HTN

A

arterial resistance
venous resistance
incr flow
- incr RH CO
- L to R shunt

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18
Q

PVR equation

A

PVR = (mPAP - PWCP)/CO

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19
Q

1 WU

A

80 dynes/s/cm5

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20
Q

5 classifications of PHTN

A

isolated PHTN
PHTN 2/2 LH disease
PHTN 2/2 lung
CTEPH
PHTN unclear etiology

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21
Q

CTEPH

A

chronic thromboembolic PHTN

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22
Q

progressed PHTN results in

A

cardiac remodelling

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23
Q

advanced PHTN characteristics

A

RV hypertrophy
decr CPP
RAD
RA dysrhtmias

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24
Q

PHTN treatment

A

lifestyle changes
prostanoids
endothelin-R antagonist
NO

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25
Q

prostanoids

A

vasodilation
inhibit plt aggregation

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26
Q

prostanoids drugs

A

epoprostenol
iloprost
treprotsinil
beroprost

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27
Q

which prostanoids are given by IV

A

epoprostenol
treporstinil

28
Q

endothelin-R antagoist

A

blocks vasoconstriction
== incr vasodilation

29
Q

Endothelin-R antagonist drugs

A

bosentan
ambristentan
macitentan

30
Q

NO

A

cGMP formation
incr vasodilation

31
Q

PDE5 inhibitor

A

soldenafil
tadalfil

32
Q

what incr PHTN

A

venous embolism
incr CVP
incr airway pressure
HPV
decr lung volumes
incr inflammatory states

33
Q

why does PHTN have high risk of perioperative mortality

A

large blood loss risk
large fluid shifts

34
Q

when should you conduct a diagnoist test for PHTN

A

mod or severe PHTN screening ansers

35
Q

what therapy is beneficial before PHTN surgery

A

CCB therapy

36
Q

when is inhaled NO test positive

A

decr 10 mmHg
w/ baseline > 40mmHg

37
Q

what makes you suspricious of PHTN

A

Sob on exertion
hemoptysis
jugular distension
edema

38
Q

main pathologica issues of PHTN

A

right ventricular hypertrophy
decr R wave amplitude from V1-V4
Right atrial dilation
lg P wave in 2, 3, aVF leads

39
Q

intraoperative manaagement for PHTN

A

mx LH preload:
incr venous flow (fluids)
incr contractility
avoid hypoxia
avoid hypercarbia

40
Q

what things cause incr in pulm vasoconstriciton

A

transient hypotension
high PEEP
high PIP
hypercarbia
hypoxia
IV bubbles
trendelenburg
pneumoperitoneum
single lung ventilation

41
Q

what Ph is deleterious

A

< 7.0

42
Q

what decr inotorpy

A

modern anesthetics

43
Q

what is a negative inotrope

A

acidosis

44
Q

what drug is best for RHF

A

milrinone

45
Q

what drugs should we give for RV inotropy

A

NE
phenylephrine
epi
vasopressing
Dopa
dobutamine
milrinone

46
Q

which inotropes have arrythmia risk

A

dopamine
dobutamine
milrinone

47
Q

which drug has improved PA/RV coupling

A

NE

48
Q

which drug has greater O2 delivery

A

NE

49
Q

which drugs incr PVR

A

NE
phenylephrine
epi
vasopressin

50
Q

which drug has reflex brady

A

phenylephrine

51
Q

which drug increases catecholamine sensitivity

A

vasopressin

52
Q

what should you think when you hear “RV afterload”

A

PVR
(incr workload)

53
Q

how can you reduce RV afterload

A

decr PEE
decr PIP
decr PVR

54
Q

how do you decr PVR

A

avoid hypoxia
avoid hypercarbia
avoid atelectasis

55
Q

myocardial supply/demand

A

incr RV wall tension
incr RV EDV
incr RV work/O2 demand
decr RV CPP
decr RV CO
decr LV preload
decr LV CO
decr hypotension
decr RV CPP
decr RV CO
decr LV preload
decr LV CO and LV BP

56
Q

ultimate ramification

A

cardiac death

57
Q

how do you avoid hypoxia

A

100% FiO2
recruit alveoli

58
Q

how do you avoid acidosis

A

mx MV

59
Q

how do you mx CO

A

sympathomimetics
milrinone
inhaled NO

60
Q

how do you avoid incr intrathoracic pressures

A

avoid laparaoscopu
avoid trendelenberg
avoid mechanical vent

61
Q

what can drop systemic BP during labor

A

pushing incr PVR

62
Q

why is a regional w/sedation dangerous

A

hypoxia and/or hyperarbia

63
Q

why is enuraxial dangerous

A

sympathectomy

64
Q

laparoscopy considerations

A

CO2 induces acidosis
incr PIP
decr CO

65
Q

thoracic surgery consideration

A

one lung ventilation

66
Q

one lung ventilation causes

A

incr RV afterload
hypoxia
hypercarbia

67
Q

one lung ventilation tratment

A

inhaled NO

Sp: Coexisting I (11 decks)

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