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L5W2 PHTN & CP Flashcards

1
Q

Def PHTN?

A

Inc PAP >=25mmHg(rest)/30(exercise) by rt heart cathe/inc SPAP>30

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2
Q

Normal Intracardiac Pressures?

A
  • RA 0-3mmHg
  • RV 25 sys/4 dias mmHg
  • LA 6-10 mmHg
  • LV 120 sys/10 dias mmHg
  • Aorta 120 sys/80 dias
  • PA sys 18-25mmHg(rest)
  • PA dias 10 mmHg
  • Mean pulmonary 12-16mmHg
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3
Q

Severity PHTN? (3)

A

Degree(mPAP)
Mild(25-40)
Moderate(41-55)
Severe(>55)

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4
Q

Causes PHTN?(1ry/2ry)

A 
1ry
-arteriolar, venous, capillary
2ry
A) pul coz
-COPD, pul embo, kyphoscoliosis
B) cardiac coz
-vsd,asd,pda,mitral & aortic valve dis, lt ventri fail
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5
Q

Classification PHTN?(5)

A 
Group 1: Pul art htn(PAH)
Group 2: Phtn(lt heart dis)
Group 3: Phtn(lung dis &/ hypoxia)
Group 4: Chr thromboembolic phtn(CTEPH)
Group 5: Phtn w unclear(Idiopathic/multifactorial etio)
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6
Q

Group 1. Pulmonary Arterial Hypertension (PAH)?(5)

A
  1. Idiopathic PAH
  2. Familial PAH
  3. Drug & toxin induced(Amphetamines, Methamphetamines, Cocaine)
  4. Asso w other sys dis(APAH):
    -CoVD
    -Connective tissue dis
    -Portal htn
    -HIV infection
    -Congenital HD
    -Other(gly storage dis, Gaucher dis, hereditary hemorrhagic telangiectasia)
  5. Asso w sig venous/capillary involve
    -Pul veno-occlusive dis & Pul capillary
    hemangiomatosis
    -Persistent Pul Htn Newborn(PPHN)
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7
Q

Group 2. Pulmonary Arterial Hypertension (PAH) Due to Left Heart Disease?(2)

A
  1. Lt ventricular sys & dias dysfx

2. Valvular HD

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8
Q

Group 3. Pulmonary Hypertension Due to Lung Disease Associated With Hypoxemia?(5)

A
  1. COPD
  2. Interstitial lung dis
  3. Sleep-disorder breathing
  4. Alveolar hypoventilation disorder
  5. Chronic exposure to high altitude
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9
Q

Group 4. Pulmonary Hypertension Due to Chronic Thrombotic and/or Embolic Disease (CTEPH)? (2)

A
  1. Thromboembo obs prox/distal pul art

2. Pul embo(tumor, parasite, foreign material)

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10
Q

Group 5.Miscellaneous?(5)

A
  1. Sarcoidosis
  2. Histiocytosis X
  3. Lymphangioleimyomatosis
  4. Compress pul vessel(adenopathy, tumor, fibrosing mediastinitis)
  5. Metabolic disorders: Glycogen storage diseases
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11
Q

Symptom PHTN?(8)

A
  1. Dyspnea(60%)
  2. Fatigue(19%)
  3. Near syncope/syncope(13%)
  4. Chest pain(7%)
  5. Palpitation(5%)
  6. Leg edema(3%)
  7. Hoarse voice(ortner syn)
  8. Hemoptysis(rare)
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12
Q

Sign PHTN? (5)

A
  1. No signs
  2. Congest Neck vein: Inc JVP
  3. Cyanosis
  4. Precordial examination
    - pul art dilatation
    - rt ventricular hypertrophy
  5. Auscultation:
    - Closely split second sound w accentuated pul component
    - Pul systolic ejection click.
    - Ejection sys murmur/early dias (Graham-Steele) murmur is heard
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13
Q

Inv PHTN?

A
  1. Electrocardiogram
  2. CXR & nCT chest
  3. Echocardiography
  4. Cardiac MRI
  5. Cardiac catheterization
  6. Lung biopsy
  7. Pul fx test
  8. Screen BMPR2 gene mutation
  9. Polysomnography
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14
Q

Complication PHTN?(4)

A
  1. Rt HF
  2. Pul art dissection & rupture, massive hemoptysis, lt main compress syn
  3. Hemoptysis 2ry to bronchial art source, hypoxic vasoconstriction leads to collateralization & proliferation bronchial art
  4. Supraventricular, less commonly ventricular arrhythmias
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15
Q

Goals of Therapy?(4)

A
  1. Alleviate symptoms, improve exercise capacity & quality of life
  2. › Improve cardiopulmonary hemodynamic & prevent rt hf
  3. › Delay clinical worsening
  4. › Reduce morbidity & mortality
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16
Q

PAH Therapy: Life Style Considerations? (6)

A 
1. Abstinence from smoking
›2. Sodium restriction
›3. Avoid high altitude <4k feet above sea lvl
4. Avoid phy exertion
›5. Avoid preg
›6. Influ & pneumococcal vac
17
Q

Ttt?

A
  1. Pulmonary vasodilator
    - ccb, pde5, prostacyclin analog, ltot
  2. Inhaled nitric oxide
  3. Digoxin
  4. Diuretic
  5. Anticoagulant
  6. Phlebotomy
  7. Atrial septostomy
  8. Lung heart transplant
18
Q

Def cp?

A

RV enlarge w/wo failure result from pul dis after exclude lt hf & congenital hd

19
Q

Types of Cor Pulmonale?(3)

A 
1. Acute cor pulmonale
• Acute massive pul embo
• Tension pneumothorax
• Acute massive collapse
2. Subacute cor pulmonale
• Lymphangitis carcinomatosis
• Recurrent minor pul embo
3. Chronic cor pulmonale
• COPD
• IPF
• Kyphoscoliosis
20
Q

Cp CP(rt hf)?(6)

A
  1. Anorexia & discomfort ruq abd (hepatic engorgement)
  2. Tricuspid insuf->Pansystolic murmur
  3. Prominent v wave appear(jugular pulse)
  4. Liver show expansile pulse that sync w heart beat
  5. Pedal edema
  6. Arrhythmias
21
Q

Dx CP? (3)

A
  1. Dx phtn
  2. Exclude lt hf & congenital hd
  3. Dx cause cp
22
Q

Ttt cp?(4)

A
  1. Pul vasodilators(ccb & prostacyclin, Inhaled nitric oxide)
  2. Diuretics.
  3. Oxygen therapy
  4. Anticoagulants

Chest (8 decks)

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