FPC: pulmonary hypertension Flashcards
What is the mean pulmonary artery pressure in pulmonary hypertension?
Greater than 20 at rest
What are some causes of pulmonary hypertension?
Left heart disease, lung disease, clots, pulmonary arterial remodeling
What is pulmonary capillary wedge pressure?
A catheter wedges into a distal pulmonary artery and measures pressures from the left heart; a high PCWP with PH indicates left heart issues, where a low PCWP with PH may indicate lung tissue problems
How do we calculate pulmonary vascular resistance?
(mPAP – PCWP)/CO
Precapillary PH refers to issue with the ___, while post-capillary PH refers to issue with the ___?
Pulmonary artery; pulmonary vein
What drives mortality in pulmonary hypertension?
- Worsening pulmonary vascular load (increasing PVR)
- right ventricular inability to adapt
What drives pulmonary hypertension type 1?
Pulmonary arterial hypertension; rare but deadly
What drives pulmonary hypertension type 2?
Left heart disease
What drives pulmonary hypertension type 3?
Lung disease or hypoxia
What drives pulmonary hypertension type 4?
Pulmonary artery obstruction
What drives pulmonary hypertension type 5?
Unclear or multifactorial mechanisms
Which pulmonary hypertension types are precapillary?
1 and 4
Which pulmonary hypertension types are in the pulmonary capillaries?
3
Which pulmonary hypertension types are postcapillary?
2
Most cases of pulmonary hypertension are from…
Left heart disease
What drug is known for causing pulmonary hypertension?
Methamphetamines
Issues with the left atrium are seen on echo. Is it more likely to be pre or postcapillary pulmonary hypertension?
Postcapillary
What are the quantitative values in precapillary pulmonary hypertension?
PCWP less than 15, PVR >2 woods units. Groups 1, 3, and 4 have this.
What are quantitative values in postcapillary pulmonary hypertension?
PCWP > 15, PVR <2 woods units
What quantitative values are seen in combined pre and postcapillary pulmonary hypertension?
PCWP >15, PVR > 2 woods units
What quantitative values are seen with high cardiac output?
PCWP <15, PVR <2 woods units
What are some symptoms of pulmonary hypertension?
Dyspnea, fatigue, syncope, chest pain, palpitation, edema
Why does syncope happen in pulmonary hypertension?
If the right heart becomes really big, it starts squishing on the left heart and prevents adequate pumping of blood to the brain
What can be seen on neck exam for pulmonary hypertension?
Elevated JVP and distended neck veins
What can be seen on cardiac exam for pulmonary hypertension?
Parasternal heave, accentuated P2, tricuspid regurgitation, right ventricle S4
What can be seen on abdominal exam for pulmonary hypertension?
Abdominal distention, hepatomegaly, pulsatile liver, ascites
What will be seen when examining extremities in pulmonary hypertension?
Cyanosis and edema
What is the gold standard for diagnoses of pulmonary hypertension?
Right heart catheterization
What is a main focus of treatment for pulmonary arterial hypertension?
Managing RV failure via minimizing preload, improving contractility, managing arrhythmia
What is the best element to target when dealing with RV failure and managing pulmonary arterial hypertension treatment?
Using vasodilators to reduce PVR
How can we alter the rate of pulmonary vascular remodeling?
Reducing inflammation, reducing hypoxia, and treating LV dysfunction
What can we do to improve PVR in pulmonary arterial hypertension?
Pulmonary arterial vasodilators
What is the roadmap for therapeutic decision making in pulmonary arterial hypertension?
- Confirm diagnosis
- Determine baseline RISK score
- Select medications
- Evaluate response
- Add-on therapy as applicable
How do we treat type 4 pulmonary hypertension?
Surgery to remove clots and anticoagulation medications. Difficult process.
What can we do to manage groups 2, 3, and 5 pulmonary hypertension?
Diuretics, supplemental oxygen, nocturnal ventilation, pulmonary rehab
