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Small Animal Medicine > Cardio - Pulmonary Hypertension > Flashcards

Cardio - Pulmonary Hypertension Flashcards

1
Q

What is the normal PA pressure?

A

25 mmHg (systole)

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2
Q

What is considered PHT?

A

>30 mmHg (systole)

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3
Q

What is mild PHT?

A

30-50 mmHg

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4
Q

What is moderate PHT?

A

50-75 mmHg

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5
Q

What is severe PHT?

A

>75 mmHg

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6
Q

The lungs are _____ pressure, _____ resistance, _____ capacitance.

A

low, low, high

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7
Q

Which side of the heart is at a lower pressure than the other?

A

R side is much lower pressure than the L

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8
Q

What are the 4 causes of PHT?

A
  1. Idiopathic/primary
  2. L-sided heart disease (MVDz, DCM)
  3. Chronic pulmonary disease (bronchitis, pulm fibrosis)
  4. Pulmonary thromboembolic disease
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9
Q

What causes idiopathic/primary PHT?

A

Retention of fetal PVR

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10
Q

What does L-sided heart disease lead to in terms of PHT?

A

pulm venous hypertension

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11
Q

What does chronic pulmonary disease lead to in terms of PHT?

A

Hypoxemia and vasoconstriction

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12
Q

What are some pulmonary thromboembolic diseases?

A

HWD, PLN, PLE, Cushings

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13
Q

What side of the heart has precapillary PHT?

A

R side

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14
Q

What side of the heart has post-capillary PHT?

A

Left

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15
Q

What is pre-capillary PHT?

A

Disease before the blood reaches the capillaries

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16
Q

What is post-capillary PHT?

A

High pressure after the capillaries that backed up across the capillary bed

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17
Q

All PHT causes are ____-capillary EXCEPT _____.

A

pre, L-sided heart disease

18
Q

What happens to the pulmonary arteries/arterioles in PHT?

A

Medial hypertrophy of tunica media, intimal proliferation and fibrosis, plexiform lesions

19
Q

What happens to the heart in PHT?

A

High RV afterload –> RV hypertrophy/dilation –> MPA enlargement –> tricuspid regurg –> pulmonic regurg –> IVS flattening/small LV

20
Q

PHT occurs due to too much _____.

A

afterload

21
Q

What are the CS associated with PHT?

A

Syncope, dyspnea, exercise intolerance cough (from underlying lung disease)

22
Q

PHT is often misdiagnosed as _____ secondary to _____.

A

L-CHF, MVDz

23
Q

How can PHT be differentiated from L-CHF secondary to MVDz?

A

PHT primarily presents with syncope and exercise intolerance (MVDz is dyspnea and cough)

There is none or a SOFT murmur, R > L (LOUD murmur in MVDz)

Sinus arrhythmia or bradycardia (tachycardia in MVDz)

RV enlargement (vs. LA), pulm artery distention (vs. pulm veins)

24
Q

What are some lateral radiographic findings that can point to PHT?

A

Lack of LA enlargement, apex of heart not touching sternum (due to RV enlargement pushing it up), enlargement of cranial lobar pulm artery

25
Q

What are some VD radiographic findings that can point to PHT?

A

Bulge on MPA, generalized interstitial pattern (can be due to heartworm pneumonitis)

26
Q

Doppler echo measures _____ of blood flow.

A

velocity

27
Q

Velocity of blood flow is determined by _____ _____.

A

pressure gradient

28
Q

What is the modifed bernoulli equation?

A

PG = 4v2

29
Q

We can estimate PA pressure using velocity of what two things?

A

Tricuspid regurg (systolic) or pulmonic regurg (diastolic)

30
Q

How is PHT estimated echocardiographically?

A

High velocity of tricuspid regurg –> high RV systolic P –> high PA systolic P

31
Q

What test is used to determine if PHT is due to L-sided heart disease?

A

Echo

32
Q

What test is used to determine if PHT is due to chronic bronchopulmonary disease?

A

TXR, fluoroscopy, bronchoscopy, airway sampling, thoracic CT

33
Q

What test is used to determine if PHT is due to pulmonary thromboembolic disease?

A

D-dimers, thoracic CT angiography, screen for PLE/PLN, screen for Cushing’s

34
Q

What test is used to determine if PHT is due to HWD?

A

HW antigen test

35
Q

What meds are indicated for PHT when there is also R-CHF?

A

Furosemide, Pimobendan, Enalapril/benazepril

36
Q

What meds are indicated for PHT when that is the only problem?

A

Sildenafil

37
Q

What treatments are considered if PHT is due to L-sided heart disease?

A

Enalapril, Pimobendan, Furosemide, Spironolactone (likely stage C)

38
Q

What treatments are considered if PHT is due to chronic bronchopulmonary disease?

A

Bronchodilators (theophylline), cough suppressants (hydrocodone), abx (doxycycline), steroids (pred)

39
Q

What treatments are considered if PHT is due to pulmonary thromboembolic disease?

A

Clopidogral, Aspirin, tx of PLE/PLN, Cushing’s

40
Q

What treatments are considered if PHT is due to HWD?

A

HW preventative, doxycycline, melarsomine protocol

41
Q

Generally, prognosis for PHT is _____ unless _____.

A

guarded, cause is reversible

Small Animal Medicine (100 decks)

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