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Block 4 > FPC: pulmonary hypertension > Flashcards

FPC: pulmonary hypertension Flashcards

1
Q

What is the mean pulmonary artery pressure in pulmonary hypertension?

A

Greater than 20 at rest

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2
Q

What are some causes of pulmonary hypertension?

A

Left heart disease, lung disease, clots, pulmonary arterial remodeling

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3
Q

What is pulmonary capillary wedge pressure?

A

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

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4
Q

How do we calculate pulmonary vascular resistance?

A

(mPAP – PCWP)/CO

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5
Q

Precapillary PH refers to issue with the ___, while post-capillary PH refers to issue with the ___?

A

Pulmonary artery; pulmonary vein

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6
Q

What drives mortality in pulmonary hypertension?

A
  1. Worsening pulmonary vascular load (increasing PVR)
  2. right ventricular inability to adapt
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7
Q

What drives pulmonary hypertension type 1?

A

Pulmonary arterial hypertension; rare but deadly

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8
Q

What drives pulmonary hypertension type 2?

A

Left heart disease

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9
Q

What drives pulmonary hypertension type 3?

A

Lung disease or hypoxia

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10
Q

What drives pulmonary hypertension type 4?

A

Pulmonary artery obstruction

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11
Q

What drives pulmonary hypertension type 5?

A

Unclear or multifactorial mechanisms

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12
Q

Which pulmonary hypertension types are precapillary?

A

1 and 4

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13
Q

Which pulmonary hypertension types are in the pulmonary capillaries?

A

3

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14
Q

Which pulmonary hypertension types are postcapillary?

A

2

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15
Q

Most cases of pulmonary hypertension are from…

A

Left heart disease

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16
Q

What drug is known for causing pulmonary hypertension?

A

Methamphetamines

17
Q

Issues with the left atrium are seen on echo. Is it more likely to be pre or postcapillary pulmonary hypertension?

A

Postcapillary

18
Q

What are the quantitative values in precapillary pulmonary hypertension?

A

PCWP less than 15, PVR >2 woods units. Groups 1, 3, and 4 have this.

19
Q

What are quantitative values in postcapillary pulmonary hypertension?

A

PCWP > 15, PVR <2 woods units

20
Q

What quantitative values are seen in combined pre and postcapillary pulmonary hypertension?

A

PCWP >15, PVR > 2 woods units

21
Q

What quantitative values are seen with high cardiac output?

A

PCWP <15, PVR <2 woods units

22
Q

What are some symptoms of pulmonary hypertension?

A

Dyspnea, fatigue, syncope, chest pain, palpitation, edema

23
Q

Why does syncope happen in pulmonary hypertension?

A

If the right heart becomes really big, it starts squishing on the left heart and prevents adequate pumping of blood to the brain

24
Q

What can be seen on neck exam for pulmonary hypertension?

A

Elevated JVP and distended neck veins

25
Q

What can be seen on cardiac exam for pulmonary hypertension?

A

Parasternal heave, accentuated P2, tricuspid regurgitation, right ventricle S4

26
Q

What can be seen on abdominal exam for pulmonary hypertension?

A

Abdominal distention, hepatomegaly, pulsatile liver, ascites

27
Q

What will be seen when examining extremities in pulmonary hypertension?

A

Cyanosis and edema

28
Q

What is the gold standard for diagnoses of pulmonary hypertension?

A

Right heart catheterization

29
Q

What is a main focus of treatment for pulmonary arterial hypertension?

A

Managing RV failure via minimizing preload, improving contractility, managing arrhythmia

30
Q

What is the best element to target when dealing with RV failure and managing pulmonary arterial hypertension treatment?

A

Using vasodilators to reduce PVR

31
Q

How can we alter the rate of pulmonary vascular remodeling?

A

Reducing inflammation, reducing hypoxia, and treating LV dysfunction

32
Q

What can we do to improve PVR in pulmonary arterial hypertension?

A

Pulmonary arterial vasodilators

33
Q

What is the roadmap for therapeutic decision making in pulmonary arterial hypertension?

A
  1. Confirm diagnosis
  2. Determine baseline RISK score
  3. Select medications
  4. Evaluate response
  5. Add-on therapy as applicable
34
Q

How do we treat type 4 pulmonary hypertension?

A

Surgery to remove clots and anticoagulation medications. Difficult process.

35
Q

What can we do to manage groups 2, 3, and 5 pulmonary hypertension?

A

Diuretics, supplemental oxygen, nocturnal ventilation, pulmonary rehab

Block 4 (28 decks)

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