Fouty- Pulmonary HTN Flashcards
mean pressure for PCWP (LA pressure)
5-15 mmHg
how to measure PA pressure
R heart cath
mean PA pressure > ______mmHg to diagnose pulmonary HTN
20 mmHg
sx’s of this include:
dyspnea on exertion/sob
fainting
chest pain/pressure
swelling of abd and legs
pulmonary HTN
JVD
ascites
edema
(signs of what)
RV failure
presence of loud 2nd heart sound indicates what
extra hard closure of aortic or pulmonic valve closing against higher pressure
increased 2nd heart sound
RV heave
murmurs
(can indicate what)
pulmonary arterial HTN (precapillary)
gold standard for determining if someone has pulmonary HTN
R heart cath
artery that supplies upper lobe of lung
R upper pulmonary artery
artery that supplies middle and lower R lung lobes
R lobar artery
arteries or veins seen here
veins
arteries or veins seen here
arteries
blood pressure=
CO x vascular resistance
mean pulmonary artery pressure=
(CO x PVR)+ LA pressure
3 main causes of increased mean pulmonary artery pressure
- increased CO
- increased PVR
- increased LA pressure
clinically relevant causes of pulmonary HTN
increase in L atrial pressure
increase in pulm. vascular resistance
increase in L atrial pressure (PCWP) is associated with what HTN
post-capillary (pulmonary venous HTN)
increase in pulmonary vascular resistance is associated with what HTN
pre-capillary (pulmonary arterial HTN)
increase in _____ pressure ultimately causes increase in pressure in capillaries and mean pulmonary arterial pressure
LA
mean PAP>20 mmHg and increased PCWP
pulmonary HTN due to pulmonary venous HTN
most common causes of pulmonary HTN due to pulmonary venous HTN
cardiac causes (LA hypertrophy or dilation, mitral stenosis)
hydrostatic pulmonary edema due to aortic stenosis
mean PAP>20 mmHg with a NORMAL PCWP
pulmonary HTN due to pulmonary arterial HTN
primary vascular disorder can cause what pulm. HTN
pulmonary arterial HTN
pleural/pulmonary causes such as emphysema or interstitial lung disease can cause what pulm. HTN
pulmonary arterial HTN
chronic alveola hypoventilation can cause chronic hypoxia leading to remodeling that causes what pulm. HTN
pulmonary arterial HTN
HTN due to what
idiopathic pulmonary arterial HTN (see R and L hilum enlarged)
this person has a VSD, what kind of HTN?
pulmonary arterial HTN
untreated congenital heart defect causing pulmonary arterial HTN later in life
Eisenmenger’s syndrome
person with congenital heart defect that was never resolved; what HTN?
pulmonary arterial HTN
idiopathic
genetic
scleroderma
VSD
(what kind of diseases and what can they cause)
pulmonary vascular disease causing pulmonary arterial HTN
what obstructive pulmonary disease can cause pulmonary arterial HTN
emphysema
pathophys of how emphysema can cause pulmonary arterial HTN
chronic hypoxia (due to decreased surface area of alveoli/capillary and decreased DLCO) which causes vasoconstriction and pulm/ HTN
ALSO destruction of pulmonary vessels
restrictive lung disease that can cause pulmonary arterial HTN
interstitial lung disease
pathophys of how interstitial lung disease can cause pulmonary arterial HTN
chronic hypoxia and destruction of pulmonary vessels
pathophys of scoliosis causing pulmonary arterial HTN
chronic hypoventilation of alveoli and respiratory failure
obesity can cause what HTN and why
pulmonary arterial HTN; due to chronic hypoxia and chronic vasoconstriction of pulmonary circulation
remodeling of vessels due to chronic hypoxia (steps and it can ultimately lead to what)
vasoconstriction
increased vascular resistance
pulmonary HTN
RV failure
pulmonary arterial medial hypertrophy (from severe PAH)
pulmonary arterial intimal thickening
normal; no CO decline
reversible; CO starts to decline
irreversible; PAP and CO decrease and PVR continues to increase
severe pulmonary arterial HTN causes
RV hypertrophy
RV dilatation
RV failure
normal
RV failure
4 main risk factors for pulmonary arterial HTN due to pulmonary vascular disease
genetics
drugs (diet pills)
systemic disease (scleroderma)
infection (schistosomiasis)
drug for PAH that decreases endothelin effects
endothelin receptor antagonists
drugs for PAH that increase impact of NO in pathway
phosphodiesterase inhibitors
drugs for PAH that prevent vasoconstriction by increasing cAMP (decrease in Ca2+)
Prostacyclin derivatives