CCS Pulmonary Hypertension 2020

Question 1

5 systemic causes of PAH?

Answer 1

• CTD
• HIV
• Schistosomiasis
• Portal Hypertension
• CHD

Question 2

What two tests should patients with scleroderma have annually>

Answer 2

• Echocardiogram

- Lung diffusing capacity

Question 3

Review the high risk criteria for PAH?

Answer 3

Question 4

What % of patients with PAH have vasoreactivity?

Answer 4

10-15%

Question 5

Review the PAH directed therapies

Answer 5

Question 6

When to follow up after initiation of Pulmonary Hypertension treatment?

Answer 6

3 months after, then 6-12 months thereafter if they achieve low risk status

Question 7

What monotherapy can be given to patients with CTEPH if turned town for Pulmonary Endarterectomy?

Answer 7

Riociguat

Question 8

Supportive Echo findings of PH? (6)

Answer 8

TRV > 2.8 m/s (For diagnosis)

Supporting:

• RA dilation
• RV dilation
• RV hypertrophy
• RV dysfunction
• Septal Flattening
• IVC dilated and non compressible
• Pericardial Effusion

Question 9

How to decide on initial therapies for PAH patients?

Answer 9

Low risk: Oral monotherapy

Intermediate risk: Combination oral therapy

High Risk: Combination therapy including IV Epoprostenol

Question 10

When after PE should patients be assessed for CTEPH?

Answer 10

3 months post PE with persistent symptoms

Question 11

What should all CTEPH patients be assessed for? And what if turned down?

Answer 11

Pulmonary Endarcterectomy

Assess for Pulmonary Balloon Angioplasty if turned down and start on Riociguat monotherapy

Question 12

What are the three classification of etiologies for Class 5 Pulmonary Hypertension?

Answer 12

• Hematologic Malignancies/Disorders
• Complex Congenital Disease
• Systemic and metabolic disorders

Question 13

What is the formula for diastolic pressure gradient, and what is the relevance?

Answer 13

Diastolic Pressure Gradient = PADP - PCWP

If it is 7mmhg then there is pre capillary component, if 7mmhg or less then is post capillary