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Clin Med2: Pulmonology > cor pulmonale and pulmonary HTN - eric > Flashcards

cor pulmonale and pulmonary HTN - eric Flashcards

1
Q

What is right sided heart failure due to chronic pulmonary disease

A

cor pulmonale

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2
Q

what does cor pulmonale result in

A

increase right sided end diastolic pressure and right atrial enlargement

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3
Q

what is acute cor pulmonale usually caused by

A

pulmonary embolism

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4
Q

what is chronic cor puolmonale usually caused by

A

COPD

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5
Q

what are the effects of cor pulmonale

A

peripheral edema
hepatic portal system congestion- ascites
spleen engorges
increased RBC to optimize oxygenation (plethora)

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6
Q

what is pulmonary hypertension

A

increased pulmonary artery pressure - cor pulmonale

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7
Q

what is primary Pulmonary HTN

A

rare: idiopathic and self perpetuating

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8
Q

what is secondary pulmonary HTN

A

more common: lung or BV disease

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9
Q

what is the pathophysiology of pulmonary HTN

A

hypertrophic muscularis-intimal fibrosis
distal pulmonary arteries are thin-walled causing dilation
smooth muscle hypertrophy occur and there is porliferation of vessel intima

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10
Q

what are the symptoms of pulmoary HTN

A

SOB with exertion
Syncope with exertion
sometimes (chest pain, cough, fatigue)

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11
Q

what is seen on PE with pulmonary HTN

A

SOB, chest pain, weakness, fatigue, peripheral edema, JVD, hepato/splenomegaly, splitting of S2, tricuspid regurgitation

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12
Q

what secondary causes need to be considered with pulmonary HTN

A

HIV screen
CT disorders
BNP elevation in HF
AST/ALT for liver dysfunction
CT scan of throax
PFTs can identiy obstructive vs restrictive patterns

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13
Q

what is the gold standard for diagnosis of pulmonary HTN

A

right sided cardiac catheterization

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14
Q

what are diagnostic tests for Pulmonary HTN

A

Cardiac cath
echo
EKG
CXR

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15
Q

what is primary pulmonary HTN

A

rare and fatal
defect of BMPR2 gene - normallly inhibits muscle growth in bronchioles
contraction of blood vessels

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16
Q

what are the causes of primary pulmonary HTN

A

genetic, HIV, Pulm HTN infancy, portal HTN, fenfluramine

17
Q

what is secondary pulmonary HTN

A

caused by destruction of pulmonary artery tree
COPD, OSA, PE, HTN -> L heart disease

18
Q

what are the treatments for pulmonary HTN

A

anticoagulation
phosphodiesterase inhibitors
CCB
prostacyclins
endothelial antagonists
oxygenation
transplantation

19
Q

when in anticoagulation used for pulmonary HTN

A

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

20
Q

when is sildenafil (revatio, viagra) used for pulmonary HTN

A

PDE 5 inhibitors - stops degradation of cGMP
decreases calcium levels -> decreased vasoconstriction
increased release of Nitric Oxide to relax smooth muscle

21
Q

when are CCB used for pulmonary HTN

A

works be decreasing pulmonary artery vasoconstriction
pulmonary vasculature decreases resistance and allow for easier blood flor

amlodipine, diltiazem, nifedipine

22
Q

what are prostacyclins

A

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

23
Q

what are the endothelial antagnoists

A

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

24
Q

why is the use of oxygen benefiticial for pulmonary HTN

A

used to increase O2 concenration in alveoli
decreases shunting due to poor O2 concentration
utilized by people with progressively worsening pulmonary HTN

25
Q

what is the only true treatment for pulmonary HTN

A

double lung transplantation
reserved for cases where medication is no longer effective
occasionally heart transplantation is required as well

Clin Med2: Pulmonology (13 decks)

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