B4-067 Pulmonary Vascular Disease Flashcards
mean pulmonary artery pressure > 20mm Hg by right heart cath
pulmonary hypertension
- mean pulmonary arterial pressure > 20 mm Hg
- PCWP less than 15 mmHg
- PVR greater than 3 wood units
pulmonary arterial hypertension
3 prostaglandin pathways
- endothelin
- NO pathway
- prostacyclin
- activity through cAMP
- vasodilator
- inhibits proliferation of vascular smooth muscle
- decreases platelet aggregation
prostacyclin
PGI2
in PAH, prostacyclin synthase is […]
decreased
in PAH, endothelin is […]
increased
- arterial vasoconstrictor
- increases sympathetic activity
- increases systemic vascular resistance
endothelin
- vasodilator
- inhibits smooth muscle hypertrophy
NO
in PAH, NO is
decreased
- decreased NO and prostacylin
- increased endothelin 1
lead to vascular injury via
2
- smooth muscle hypertrophy
- vasocontriction
early intimal proliferation
PAH eventually causes right ventricular overload, leading to
RV failure
cause of death
symptoms of right sided heart failure
- hepatosplenomegaly
- JVD
- ascites
- weight gain
- peripheral edema
oral therapies for NO pathway
3
- sildenafil
- tadalafil
- riociguat
inhibit PDE-5
oral therapies for endothelin pathway
3
- bosentan
- ambrisentan
- macitentan
endothelin receptor antagonists
oral therapies for prostacylin pathway
2
- treprostinil
- selexipag
inhaled therapy
1
other one she said no longer used
treprostinil
prostacylin pathway
infusion therapies
2
- epoprostenol
- treprostinil
prostacyclin pathway
- pressure related phenomenon
- LV problems, left sided valve problems, pulmonary vein obstruction
cardiogenic pulmonary edema
- leaky capillaries
- ARDS, HAPE, Opiate OD, etc
non cardiogenic pulmonary edema
causes of PAH
7
- idiopathic
- drugs
- connective tissue disease
- HIV
- portal hypertension
- CHD
- schistosomiasis
the biggest factor in RV adaptation is
time
- related to increased left side pressures
- may be exacerbated by volume overload
cardiogenic edema
what is used to make the definitive diagnosis of pulmonary artery hypertension?
right heart cath
most common cause of PH in the world
schistosomiasis
most common cause of PH in US
heart disease
most common cause of death in patients with PAH
progressive RV failure and collapse
lung transplantation in PAH is reserved for those
failing maximal medical therapy
treatment for severe PAH at urgent risk of HF
- parenteral prostacyclin
- diurectics
- oxygen
- mean pulmonary pressure >20 mmHg
- wedge pressure <15 mm Hg
- pulmonary vascular resistance greater than 3 wood units
PAH group 1
what 3 pathways are implicated in the development of PAH
- nitric oxide
- prostacyclin
- endothelin
- abdominal distention
- hepatomegaly
- lower extremity edema
indicate..
right sided heart failure
bilateral rales would indicate
pulmonary edema/left sided HF
what measures correspond to risk assessment in PAH?
2
- decreased CO
- syncope
