Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVPR > CVPR Week 6: Pulmonary Hypertension > Flashcards

CVPR Week 6: Pulmonary Hypertension Flashcards

1
Q

Objectives

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Question 1

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why aren’t the incorrect answers correct?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition of pulmonary hypertension

A

pHTN refers to the presence of abnormally high pulmonary vascular pressure

Normal mPAP: 8 - 20 mmHg at rest

pHTN is defined as mPAP > 20 mmHg at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical classifications of pHTN

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hemodynamic classification of pHTN

A

Pre-capillary pHTN

or

Post-capillary pHTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What pressure is defined as PH?

A

MPAP > 20 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Groups of PH

A
  • Pulmonary arterial hypertension (PAH)
  • PH due to left heart disease
  • PH due to lung disease and/or hypoxia
  • PH due to pulmonary artery obstructions
  • PH with unclear multifactorial mechanisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PAH AKA

A

Pulmonary Arterial hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pulmonary Arterial Hypertension cause

A

45% idiopathic (Idiopathic PAH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PAH is associated with?

5 listed

A
  • connective tissue disease
  • HIV infection
  • Portal hypertension
  • Congenital heart disease
  • Schistomiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PPHN AKA

A

Persistent pulmonary hypertension of the newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PVOD/PCH

A

PAH with overt features or venous/capillaries involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PAH long-term responders to Ca channel blockers

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PH due to left heart disease

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PH due to lung disease and/or hypoxia

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PH due to pulmonary artery obstructions

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PH with unclear multifactorial mechanisms

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hemodynamic classification of PH

A

is it precapillary or postcapillary or is there a little bit of both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Features of Post-capillary PH

4 listed

A

↑ PVP (pulmonary venous pressure)

↑ LAP (Left atrial pressure)

↑ LVEDP (Left ventricular end-diastolic pressure)

However vascular resistance on the arterial side remains normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Some common causes of Post-capillary PH

9 listed

A

Myocardial diseases such as

  • Dilated CMP-ischemic/non-ischemic
  • Hypertrophic CMP
  • Restrictive/infiltrative CMP
  • Obesity-related CMP
  • Pericardial disease

Aortic valve disease

Mitral valve disease

Mass can compress pulmonary vein

etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pre-capillary PH

A

PCWP <15 mmHg

PVR >= woods units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Question 2

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

WHO Group 1 PH

A

Pulmonary Arterial Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PAH Definition

A

is a syndrome resulting from restricted blood flow in the pulmonary arterial circulation resulting in increased pulmonary vascular resistance which causes right ventricular strain and ultimately failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Hemodynamic definition of PAH

A
  • mPAP > 20 mmHg
  • PCWP <= 15 mmHg
  • PVR >= 3 woods units
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prevalence of PAH

A

PAH affects 15 to ~60 people per 1 million inhabitants in countries where studies have been conducted

1000 new cases are diagnosed in the United States every year

PAH incidence is more commonly diagnosed in

  • Women (70% - 80% of cases)
  • Older patients (50-65 years of age)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PAH is most common in

A

Older female patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PAH Pathogenesis

A

Aberrant pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pathophysiologic changes in PAH

A

Pulmonary vascular remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Prevalence of PAH in connective tissue diseases

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drugs and toxins definitely associated with PAH

7 listed

A
  • Aminorex
  • Fenfluramine
  • Dexfenfluramine
  • Toxic rapeseed oil
  • Benfluorex
  • Dasatinib
  • Methamphetamines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Possible drugs and toxins associated with PAH

10 listed

A
  • Cocaine
  • Phenylpropanolamine
  • St. John’s Wort
  • Interferon-alpha and beta
  • Amphetamines
  • Alkylating agents
  • Direct acting antiviral agents against hepititis
  • Bosutinib
  • Leflunomide
34
Q

Question 3

A
35
Q

Most common presenting symptoms

A
36
Q

Most examination in PAH

A
37
Q

The role of ECG in the diagnosis of PAH

A
38
Q

Pulmonary exam findings in PAH

6 listed

A
  • Accentuated pulmonary component of S2 (audible at apex in over 90%)
  • Early systolic click
  • Midsystolic ejection murmur
  • Left parasternal lift
  • Right ventricular S4
  • Increased jugular a wave
39
Q

PAH Detection and diagnosis

A
40
Q

PAH Detection and diagnosis

A
41
Q

WHO Functional classification of PAH

4 listed

A
42
Q

WHO Class I PAH

A
  • No limitation of usual physical activity
  • Ordinary physical activity does not increase dyspnea, fatigue, chest pain or pre-syncope
43
Q

WHO Class II PAH

A
  • Slight limitation of physical activity
  • No discomfort at rest
  • normal physical activity causes increased dyspnea, fatigue, chest pain or presyncope
44
Q

WHO Class III PAH

A
  • Marked limitation of physical activity
  • No discomfort at rest
  • less than ordinary activity causes increased dyspnea, fatigue, chest pain or pre-syncope
45
Q

WHO Class IV PAH

A
  • Unable to perform any physical activity
  • possible signs of ventricular failure
  • Dyspnea and/or fatigue may be present at rest and symptoms are increased by almost any physical activity
46
Q

Increased risk of PAH

A
  • Systemic Lupus Erythematosis
  • Mixed connective tissue disease
  • Systemic Sclerosis
  • drugs and toxins
47
Q

Diagnostic gold standard of PAH

A
  • Hemodynamics - RAP, mPAP, PCWP, CO/Cl, PVR
  • Saturations to rile out shunts
  • Angiography - vessel properties CTEPH
  • Vasodilator response
48
Q

PAH Hemodynamic diagnostic tests

5 listed

A
  • RAP
  • mPAP
  • PCWP
  • CO/Cl
  • PVR
49
Q

PAH Saturation diagnostic tests

A

Rule out shunts

50
Q

PAH Angiography diagnostic tests

A
  • Vessel properties
  • CTEPH (Chronic Thromboembolic Pulmonary Hypertension)
51
Q

PAH Vasodilator response

A
52
Q

PAH/CTEPH Fluid/volume control

3 listed

A
  • Diuretics
  • Low sodium diet
  • Daily wgts/I&Os
53
Q

PAH/CTEPH oxygen care

A

hypoxia is a potent pulmonary vasoconstrictor and can elevate PA pressure

54
Q

PAH/CTEPH Anticoagulation treatment

A
  • IPAH/CTEPH patients on anticoagulation
  • consideration in other WHO group 1 patients
55
Q

PAH/CTEPH General care categories and treatment

3 listed

A
56
Q

Question 4

A
57
Q

Therapeutic pathways for PAH

3 listed

A
  • Endothelin pathway
  • Nitric oxide pathway
  • Prostacyclin pathway
58
Q

Groups approved for treating PH

A
  • Group 1 (PAH)
  • Group 4 (CTEPH)
  • The other groups require treatment of the underlying condition causing the elevated pressures
59
Q

Therapeutic options for PAH: Drug classes

3 listed

A
  • Prostanoid/Prostanoid analogs
  • ERAs
  • PDE-5 inhibitors
60
Q

Prostanoids description

A

Prostacyclin (PGl2) member of the eicosanoids family, inhibits platelet activation and effective vasodilator

61
Q

Prostacyclin is usually made where?

A

In healthy endothelial cells

62
Q

Level of prostacyclin in PAH patients

A

They have a deficiency of prostacyclins

63
Q

Prostanoids ROA

A

Sever routes of administration

  • IV/Parenteral
  • SQ
  • Inhaled
  • Oral
64
Q

IV Prostanoids

A

Esoprostenol - Flolan and Veletri

Treprostinil - Remodulin

65
Q

Epoprostenol half life

A

Approximately 2-5 minutes

66
Q

Treprostinil half-life

A

several hours

67
Q

Treprostinil and Remodulin administration rate

A

ng/kg/min

68
Q

Treprostinil and Remodulin dosing changes

A
  • Dosing never changes even if the weight does
  • The weight at start remains the same throughout the duration of therapy
69
Q

Single lumen Hickman Catheter

A
  • Never stop infusion
  • Never draw labs from line
  • Never flush
70
Q

Oral prostacyclins

A
  • Treprostinil (orinetram)
  • Selexipag (Uptravi)
71
Q

Treprostinil (orinetram)

A

Antiplatelet and vasodilatory actions including pulmonary vasodilation

72
Q

Selexipag (Uptravi)

A
  • Most recently approved in Jan 2016
  • Not a substitute for parenteral therapy
  • Prostacyclin analog
73
Q

Endothelin receptor antagonist for PAH because

A

Endothelin-1 (ET-1) levels are increased in PAH and found in the precapillary pulmonary microvasculature which is the site of the increased vascular resistance in PAH

74
Q

Endothelin receptor antagonist for PAH AGENTS

A
  • Bosentan
  • Ambrisentan
  • Macitentan
75
Q

Phosphodiesterase-5 inhibitors for PAH because

A

PDE5 inhibitor - blocks the degradative action of phosphodiesterase type 5 on cyclic GMP in smooth muscle cells resulting in vasodilation of the vessels

76
Q

Phosphodiesterase-5 inhibitors for PAH Agents

A

Sildenafil

Tadalafil

77
Q

Guanylate Cyclase Stimulator for PAH

A
  • Riociguat has a dual mode of action
  • Synergist with endogenous nitric oxide
  • Directly stimulating guanylate cyclase independent of NO availability
  • FDA approved for both use in PAH as well as inoperable or residual CTEPH
78
Q

Ongoing management for PAH patients

A
79
Q

PH Discussion

A

PH is a simple hemodynamic definition but is an umbrella term

80
Q

PH is screened with?

A

Echo

81
Q

PH is diagnosed with

A

RHC (right heart catheterization)

CVPR (93 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions