Chapter 40: Pulmonary Arterial Hypertension

Question 1

What is pulmonary arterial hypertension?

Answer 1

Pulmonary arterial hypertension is defined as having a pulmonary pressure greater than 25 mmHg for a continuous amount of time. It usually ranges between 8-20 mmHg.

Question 2

What are the different types of pulmonary arterial hypertension?

Answer 2

According to the world health organization, there are 5 different categories for pulmonary arterial hypertension. When it caused due to another disease such as heart disease, it is known as secondary. If there is no known cause of it, it is called primary or idiopathic. Medications can also be the cause of it.

Question 3

What are the 5 groups of pulmonary arterial hypertension?

Answer 3

1. Primary causes
2. Pulmonary Venous hypertension
3. Chronic diseases (Athma, COPD)
4. Chronic pulmonary thromboembolic hypertension
5. Other, unknown

Question 4

What are key drugs that cause pulmonary arterial hypertension?

Answer 4

1. Cocaine
2. SSRI’s during pregnancy
3. Weight loss drugs (Phentermine)
4. Methamphetamine, Amphetamine

Question 5

What is the pathophysiology of pulmonary arterial hypertension?

Answer 5

There is an imbalance between vasodilators/vasoconstrictors and cell creation/apoptosis. There is an increase in the amount of vasoconstrictors (Endothelin-1, Thromboxane A2) and a decrease in the amount of vasodilators (Prostacyclins). There is also increase in many cells that attach to the arterial walls and eventually damage them and cause scar tissue. This then impedes blood flow to the right ventricle of the heart. This hurts the heart. Heart failure is actually the number one cause of death in pulmonary arterial hypertension patients.

Question 6

What are symptoms of pulmonary arterial hypertension?

Answer 6

Fatigue
Dyspnea
Chest pain

Question 7

Is there a cure for pulmonary arterial hypertension?

Answer 7

No, there is not. All we can do is prevent the progression of the disease. Our knowledge and research of it has increased immensely in the past years. A heart or lung transplant may be a possible option for young patients.

Question 8

What are the non-pharmacologic options to treat Pulmonary Arterial Hypertension?

Answer 8

1. Restrict daily sodium intake to <2 g/day
2. Avoid using NSAIDS (These cause sodium and fluid retention)
3. Avoiding high altitudes
4. Using oxygen therapy/equipment
5. Obtaining influenza and pneumococcal injections