9. Pulmonary Hypertension Flashcards
Pulmonary hypertension (PH) is included on the test blueprint. However, you are more likely to get questions that cover ___
status asthmaticus, PE, pneumonia, and ARDS than questions that over PH. Keep that in mind.
PH is defined as a ___
mean pulmonary artery pressure that is greater than 25 mmHg at rest and a PAOP that is less than 16 mmHg at rest with secondary right heart failure.
The normal mean pulmonary artery pressure is
~20 mmHg. Since the RV normally pumps into a low-pressure system, the wall of the RV is thin compared to that of the LV. Pulmonary hypertension results in cor pulmonate and right ventricular failure.
5 groups of PH, as defined by the World Health Organization (WHO)
Group 1 - Pulmonary arterial hypertension (PAH); sporadic and hereditary due to localized small pulmonary muscular arterioles (i.e., collagen vascular diseases, drug/toxin induced)
Group 2 - Pulmonary hypertension (PH) due to left heart disease, such as LVF or valvular (mitral, aortic) disease
Group 3 - PH due to lung diseases or hypoxemia
Group 4 - PH due to chronic thromboembolic problems
Group 5 - PH that has unclear factors or is multifactorial (e.g. sarcoidosis)
Signs and Symptoms of PH
-Exertional dyspnea, lethargy, and fatigue due to an inability to increase cardiac output with activity.
-Progression to RV failure, chest pain, syncope with exertion, and peripheral edema
-Passive hepatic congestion may cause anorexia and ABD pain
-Ortner’s syndrome - cough, hemoptysis, and hoarseness
-Systolic ejection murmur, increased intensity of pulmonic component of S2 heart sound, diastolic pulmonic regurgitation murmur, right-sided murmurs, and gallops are augmented with inspiration.
-RV hypertrophy, elevated JVD, hepatomegaly, ascites, and pleural effusion
Treatment of pulmonary hypertension
-Treat the underlying cause as able
-Each “group” has specific trmts based on the cause.
-All regimens should consider diuretics, oxygen, anticoagulants, digoxin, and exercise training.
-Use dilators, which include calcium channel blockers or phosphodiesterase-5 inhibitors, eg sildenafil (viagra), tadalafil (Cialis), or treprostinil (Remodulin)
-For pts who are refractory to all medical interventions: lung transplantation (bilateral or heart-lung transplant) or possible atrial septostomy (right to left shunt)
