cor pulmonale and pulmonary HTN - eric Flashcards
What is right sided heart failure due to chronic pulmonary disease
cor pulmonale
what does cor pulmonale result in
increase right sided end diastolic pressure and right atrial enlargement
what is acute cor pulmonale usually caused by
pulmonary embolism
what is chronic cor puolmonale usually caused by
COPD
what are the effects of cor pulmonale
peripheral edema
hepatic portal system congestion- ascites
spleen engorges
increased RBC to optimize oxygenation (plethora)
what is pulmonary hypertension
increased pulmonary artery pressure - cor pulmonale
what is primary Pulmonary HTN
rare: idiopathic and self perpetuating
what is secondary pulmonary HTN
more common: lung or BV disease
what is the pathophysiology of pulmonary HTN
hypertrophic muscularis-intimal fibrosis
distal pulmonary arteries are thin-walled causing dilation
smooth muscle hypertrophy occur and there is porliferation of vessel intima
what are the symptoms of pulmoary HTN
SOB with exertion
Syncope with exertion
sometimes (chest pain, cough, fatigue)
what is seen on PE with pulmonary HTN
SOB, chest pain, weakness, fatigue, peripheral edema, JVD, hepato/splenomegaly, splitting of S2, tricuspid regurgitation
what secondary causes need to be considered with pulmonary HTN
HIV screen
CT disorders
BNP elevation in HF
AST/ALT for liver dysfunction
CT scan of throax
PFTs can identiy obstructive vs restrictive patterns
what is the gold standard for diagnosis of pulmonary HTN
right sided cardiac catheterization
what are diagnostic tests for Pulmonary HTN
Cardiac cath
echo
EKG
CXR
what is primary pulmonary HTN
rare and fatal
defect of BMPR2 gene - normallly inhibits muscle growth in bronchioles
contraction of blood vessels
what are the causes of primary pulmonary HTN
genetic, HIV, Pulm HTN infancy, portal HTN, fenfluramine
what is secondary pulmonary HTN
caused by destruction of pulmonary artery tree
COPD, OSA, PE, HTN -> L heart disease
what are the treatments for pulmonary HTN
anticoagulation
phosphodiesterase inhibitors
CCB
prostacyclins
endothelial antagonists
oxygenation
transplantation
when in anticoagulation used for pulmonary HTN
patients with chronic thromboembolism
can be used in patients with sickle cell
less commonly used without evidence of hematologic disease now
Warfain, lovenox, eliquis, xartelto
when is sildenafil (revatio, viagra) used for pulmonary HTN
PDE 5 inhibitors - stops degradation of cGMP
decreases calcium levels -> decreased vasoconstriction
increased release of Nitric Oxide to relax smooth muscle
when are CCB used for pulmonary HTN
works be decreasing pulmonary artery vasoconstriction
pulmonary vasculature decreases resistance and allow for easier blood flor
amlodipine, diltiazem, nifedipine
what are prostacyclins
PGI2i
eproprostenol - inhibits platelet aggregation and increase vasodilation. very short half life (3-5 min) - requires use of ambulatory pump
Trepostinil - new inhaled med for interstitial lung disease
what are the endothelial antagnoists
bosentan and ambrisentan
blocks the vasoconstruction and paracrine effects of the smooth muscle - blocks endothelial-1
new RCT who reduction in hispitalization, morbidity and mortality with the use of endothelial agonists and vasodilators
why is the use of oxygen benefiticial for pulmonary HTN
used to increase O2 concenration in alveoli
decreases shunting due to poor O2 concentration
utilized by people with progressively worsening pulmonary HTN
