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Echo 2 > C13: Pulmonary hypertension > Flashcards

C13: Pulmonary hypertension Flashcards

1
Q

define PHT

A

characterized by evaluated pulmonary arterial pressure secondary to RV failure

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2
Q

can both pulmonary disease and disease of the RV muscle cause PHT

A

yes

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3
Q

w/ PHT, what changes are seen to systolic and diastolic function of the RV

A

reduced FAC, TAPSE and S prime

diastolic usually abnormal

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4
Q

2 categories of causes of PHT

describe them

A

pre-capillary:
before the lungs….
-congenital heart disease - shunts
-respiratory diseases - PE, PPS

post-capillary:
after the lungs...
-MV disease, AV disease
-myoxoma
-cor triartiatum
-PV compression
-myocardial disease
-systemic HTN
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5
Q

are most causes of PHT pre or post capillary causes

A

post

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6
Q

PHT values for:
PCWP
SPAP
MPAP

A

PCWP - > 18mmHg ( > 15 mmHg is abnormal)

SPAP = RVSP if no obstruction - >35 mmHg (30-35 is borderline)

MPAP - >/= 25 mmHg

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7
Q

respiratory symptoms for PHT

A

SOB
cough
wheezing
hemoptysis - press is so high, blood is getting into the air passageways
intercostal retraction - increased muscle mass due to difficulty breathing

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8
Q

associated cardiac symptoms w/ PHT

A 
palpitations/arrhythmias
chest pain
SOB
orthopnea
syncope

signs of RHF

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9
Q

norm mean pressure in the RA and IVC

A

0-4 mmHg

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10
Q

norm pressure in the RV and PA

A

< 25 / < 10 (systolic and diastolic)

same for both

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11
Q

is TV pg the same as 4(v)^2

A

yes

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12
Q

cardiac causes of RHF

A 
LHF
pulmonary valve stenosis
RV infarction
massive TR
congenital malformations
shunts
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13
Q

when the R heart fails, what always happens to the pulmonary pressures

A

they always go up

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14
Q

2 pulmonary/lung causes of elevated R heart pressures

A

parenchymal

vascular

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15
Q

parenchymal, pulmonary causes of elevated R heart pressures

A

COPD
interstitial lung disease
adult respiratory distress syndrome
chronic lun infection

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16
Q

vascular, pulmonary causes of elevated R heart pressures

A

PE

primary pulmonary HTN

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17
Q

describe the pathophysiology of cor pulmonale

A

progressively increasing chronic pressure overload of the RV as it ejects into the high resistance vascular bed

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18
Q

how does cor pulmonale initially affect the RV?

how does it progress

A

initially: RVH…

…then RV dilation and TR from annular dilation…. then RV failure

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19
Q

common cause of PE

A

DVT that became an emboli

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20
Q

what is a saddle emboli

A

clot that lodges @ the bifurcation of the PA

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21
Q

in patients w/ a shunt (ASD/VSD/PFO) who have developed P HTN, what can happen to the direction of the shunt

What is it called when thIs happens?

A

it can be reversed (going from right to left) due to very high pulmonary pressures… or could be biphasic depending on which press is higher

Eisenmengers syndrome

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22
Q

how does chronic volume overload of the RV affect the lungs

A

permanent lung damage which raises pulmonary pressures and RVSP

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23
Q

anything that causes pressure or volume overload of the RV will also cause what

A

RVH and RV and TV annular dilation (TR)

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24
Q

chronic evaluation of the RT heart pressure often lea to what 3 things

A

dilated coronary sinus
reopening of a PFO (acquired PFO)
dilated main PA

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25
Q

how does the reopening of a PFO due to high Rt heart pressures occur

A

the atria are stretched so the foramen oval is no longer covered

26
Q

post capillary causes of P HTN usually involve what type of dysfunction of the LV

A

systolic, diastolic dysfunction or L heart valvular disease

27
Q

R heart US features w/ P HTN

IVC/SVC?
PA?

A 
RV and RA dilated
decreased systolic function
IVS and IAS bowing to the LV
TR/ TV annular dilation
PA dilated w/ PR
IVC and SVC dilated
28
Q

why might a patient w/ P HTN have tachycardia

A

to compensate for low output

29
Q

L heart US features w/ P HTN

A 
LV and LA dilated
decreased systolic function
LVH or cardiomyopathy
MR/ MV abnormalities
Av sclerosis
LV, IAS, IVS aneurysmal
30
Q

how can the LV often appear w/ P HTN

A

can appear compressed b/c the RV can become severely enlarged

31
Q

how will the motion of the IVS often appear the P HTN

A

paradoxical, will move towards the RV during systole instead of the LV

will also appear flattened in PSAX and created the “D” bounce

32
Q

size of the RV free wall with P HTN

in which view do we measure

A

> 5 mm

subcostal 4CH b/c we are using axial res

33
Q

in how many view must you see and ASD/PFO to diagnose it

A

2 views

34
Q

which pathology of the pericardium often goes with pulmonary disease

A

pericardial disease

35
Q

what causes RV pressure overload (RVPO)

when would the “D” sign be seen during the cardiac cycle w/ press overload

A
  • longstanding regurg
  • primary pulmonary disease

both systole and diastole

36
Q

can RVPO and RVVO coexist

A

yes

37
Q

over time, what does RVVO lead to

A

RVPO

38
Q

what causes RV volume overload (RVVO)

when would the “D” sign be seen during the cardiac cycle w/ press overload

A

any etiology that causes increased volume… e.g.

  • severe TR
  • left to right shunt like an ASD

only in diastole

39
Q

norm measurements for RVOT distal and prox MPA

A

RVOT distal PV: <33mm

prox MPA: < 27mm

40
Q

does the RV contract well with high afterload

A

no… TAPSE, S prime and FAC will be reduced, RV cant handle high afterload

41
Q

how do you get the SPAP (systolic pulmonary artery pressures) aka RVSP

A

using TR max velocity + RAP
OR
using VSD peak velocity

42
Q

how do you get the MPAP

A

MPAP = 4v^2 + RAP
using PR early diastolic velocity of the CW tracing (PSAX preferred for better alignment)

OR

MPAP = 80 - (0.5 x PAT)
using PW

43
Q

how do you get the PA-EDP

A

PA-EDP = 4v^2 + RAP

using the PR end-diastolic velocity of the CW tracing (PSAX preferred for better alignment)

44
Q

is the RVSP valid w/ severe TR

A

no

45
Q

w/ a VSD, do we still use the TR jet to estimate the RVSP

A

no, use the VSP jet, it will be more accurate

46
Q

how to calculate RVSP w/ VSD jet

A

take the blood pressure minus the press gradient from the VSD jet (4v^2) to get the RVSP

RVSP = SBP - 4(peak velocity of VSD)^2

47
Q

what does the velocity of the VSD jet reflect

A

the press gradient b/w the Lv and RV during systole

48
Q

what should sweep speed be set to for TR jet for RVSP

A

100 cm/s

49
Q

in which views do we assess the TR jet velocity

A

RVIT
PSAX
A4CH (on and off axis)
Sub4CH

50
Q

which view is best to asses an eccentric TR jet

A

Sub4CH… especially if jet is medially directed

51
Q

how can you make the measurement of the IVC more accurate

A

get perpendicular to the IVC

52
Q

normal PAEDP

A

4-12 mmHg

53
Q

how does increased PA pressure affect PAT

A

it will shorten… press in the RV has to rise above that of the PV in order for the PV to open, when it finally does, its open for a shorter amount of time and the RV hard hardly push any blood into the PA due to resistance…. making the PAT short

54
Q

how should sweep speed be set to measure PAT

A

100 cm/s or more, b/c we’re measuring a short period of time

55
Q

when should you use PR jet velocities to assess the mPAP and RV-EDP

A

whenever RVSP is suspected to be elevated

56
Q

value for mild SPAP/RVSP elevation

severe

A

mild 35-40 mmHg

severe > 70 mmHg

57
Q

normal RVOT AT / PAT

A

> /= 120

58
Q

value for mild PAT

severe

A

mild 80-110 ms

severe < 60 ms

59
Q

value for mild mPAP elevation

severe

A

mild 30-40 mmHg

severe > 50 mmHg

60
Q

normal mPAP

A

< 25 mmHg

Echo 2 (15 decks)

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