FPC: pulmonary hypertension

Question 1

What is the mean pulmonary artery pressure in pulmonary hypertension?

Answer 1

Greater than 20 at rest

Question 2

What are some causes of pulmonary hypertension?

Answer 2

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

Question 3

What is pulmonary capillary wedge pressure?

Answer 3

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

Question 4

How do we calculate pulmonary vascular resistance?

Answer 4

(mPAP – PCWP)/CO

Question 5

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

Answer 5

Pulmonary artery; pulmonary vein

Question 6

What drives mortality in pulmonary hypertension?

Answer 6

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

Question 7

What drives pulmonary hypertension type 1?

Answer 7

Pulmonary arterial hypertension; rare but deadly

Question 8

What drives pulmonary hypertension type 2?

Answer 8

Left heart disease

Question 9

What drives pulmonary hypertension type 3?

Answer 9

Lung disease or hypoxia

Question 10

What drives pulmonary hypertension type 4?

Answer 10

Pulmonary artery obstruction

Question 11

What drives pulmonary hypertension type 5?

Answer 11

Unclear or multifactorial mechanisms

Question 12

Which pulmonary hypertension types are precapillary?

Answer 12

1 and 4

Question 13

Which pulmonary hypertension types are in the pulmonary capillaries?

Answer 13

3

Question 14

Which pulmonary hypertension types are postcapillary?

Answer 14

2

Question 15

Most cases of pulmonary hypertension are from…

Answer 15

Left heart disease

Question 16

What drug is known for causing pulmonary hypertension?

Answer 16

Methamphetamines

Question 17

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

Answer 17

Postcapillary

Question 18

What are the quantitative values in precapillary pulmonary hypertension?

Answer 18

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

Question 19

What are quantitative values in postcapillary pulmonary hypertension?

Answer 19

PCWP > 15, PVR <2 woods units

Question 20

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

Answer 20

PCWP >15, PVR > 2 woods units

Question 21

What quantitative values are seen with high cardiac output?

Answer 21

PCWP <15, PVR <2 woods units

Question 22

What are some symptoms of pulmonary hypertension?

Answer 22

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

Question 23

Why does syncope happen in pulmonary hypertension?

Answer 23

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

Question 24

What can be seen on neck exam for pulmonary hypertension?

Answer 24

Elevated JVP and distended neck veins

Question 25

What can be seen on cardiac exam for pulmonary hypertension?

Answer 25

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

Question 26

What can be seen on abdominal exam for pulmonary hypertension?

Answer 26

Abdominal distention, hepatomegaly, pulsatile liver, ascites

Question 27

What will be seen when examining extremities in pulmonary hypertension?

Answer 27

Cyanosis and edema

Question 28

What is the gold standard for diagnoses of pulmonary hypertension?

Answer 28

Right heart catheterization

Question 29

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

Answer 29

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

Question 30

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

Answer 30

Using vasodilators to reduce PVR

Question 31

How can we alter the rate of pulmonary vascular remodeling?

Answer 31

Reducing inflammation, reducing hypoxia, and treating LV dysfunction

Question 32

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

Answer 32

Pulmonary arterial vasodilators

Question 33

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

Answer 33

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

Question 34

How do we treat type 4 pulmonary hypertension?

Answer 34

Surgery to remove clots and anticoagulation medications. Difficult process.

Question 35

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

Answer 35

Diuretics, supplemental oxygen, nocturnal ventilation, pulmonary rehab