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Patho 1 (PATH 254) > Mod 9 Hypertension > Flashcards

Mod 9 Hypertension Flashcards

1
Q

Pulmonary hypertension [PH] is defined as?

A

An increase in mean pulmonary artery pressure [mPAP] > 25mmHg

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2
Q

Normal mPAP?

A

10-20

assessed via right heart catheter

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3
Q

What happens when pulmonary pressures increase?

A

Right ventricular afterload increases

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4
Q

What does a increase in hypertrophic of the right ventricle mean?

A

More pressure = increase in size of tissue/space

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5
Q

Where do signs and symptoms usually present for pulmonary hypertension?

A

Right sided heart failure, so usually don’t present until the disease is advance

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6
Q

2 classifications of pulmonary hypertension?

A

Pre-capillary and post-capillary pulmonary hypertension

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7
Q

Pre-capillary pulmonary hypertension can be defined as?

A

PAWP < 15 mmHG

Elevation in pulmonary vascular resistance (PVR)

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8
Q

What does elevation in pulmonary vascular resistance (PVR) entail?

A
  • Pulmonary arterial hypertension (PAH)
  • Pulmonary hypertension due to lung diseases and/or hypoxemia
  • Chronic thrombo-embolic pulmonary hypertension
  • Pulmonary hypertension with unclear or multifactorial mechanisms
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9
Q

Post-capillary pulmonary hypertension is defined as?

A

PAWP > 15 mmHg

  • NOt associated w/increased PVR
  • due to left heart failure
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10
Q

How many groups are there for pulmonary hypertension?

A

5

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11
Q

Define traits of Group 1 hypertension :

pulmonary arterial hypertension (PAH)

A
  • Precapillary pulmonary hypertension
  • Due idiopathic, heritable, or drug induced PAH
  • will see pulmonary arterial remodeling
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12
Q

Define traits of Group 2 hypertension : Post capillary hypertension [PAH]

A

Post Capillary, most common

  • will see pulmonary arterial remodeling
  • Due to left heart disease (secondary to MI or other heart tissue damage)
  • may have preserved or reduced LVEF

Specifics:
- mPAP > 20 mmHg w/left sided valve disease (or systolic/diastolic function)
- valvular heart disease (bicuspid valve)
- congenital/acquired cardiovascular conditions leading to post cap. hypertension

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13
Q

Define traits of Group 3 hypertension: [PAH]

A

Precapiliary pulmonary hypertension

  • Will see pulmonary arterial remodeling
  • Most common (second to group 2), PH due to lung disease or hypoxia
  • Developmental lung disease
  • Seen in obstructive/restrictive lung diseases: ARDS, COPD, Pulmonary fibrosis etc.
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14
Q

**edit and add slide info for the five groups slide 5-9

A
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15
Q

Hypertrophy is associated with what?
- how does it differ from hyperplasia?

A

The growth of muscle vs. growth of new muscle

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16
Q

Mortality of pulmonary artery hypertension is associated w/what?

A
  • increasing age
  • impaired right ventricular function
  • poor functional capacity (MET score)
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17
Q

Signs and symptoms of pulmonary hypertension

A

not usually seen until advanced disease

Dyspnea
Dizziness, confusion, light-headedness
Fatigue
Non productive cough
Hemoptysis
Syncope
Chest pain
Peripheral edema
Tachycardia

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18
Q

GOLD standard of pulmonary hypertension?

A

Echocardiogram

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19
Q

Treatment plans for Group 1

A

** Calcium channel blockers** (nifedipine)

  • **prostanoids **
  • endothelia receptor antagonists
  • phophdiesterase inhibitors
  • lung or heart plants
20
Q

Treatment plans for Group 2?

A

Goal: Improve heart function

Treating underlying condition
- lifestyle change
- meds (inotrope, diuretics)

21
Q

Treatment plans for Group 3

A

Long term oxygen therapy (LTOT)

22
Q

Treatment plans for Group 4

A

Blood thinning medications

potential surgery

Goal is to reduce or slow progression of PH

23
Q

Treatment plans for Group 5

A

Treatment directed at the cause of PH

  • Goal is to reduce or slow progression of PH
24
Q

Role of nitric oxide [NO] in treatment of hypertension?

A

Vasodilation

  • 20 ppm
  • short acting, topical

** (neonates) **

25
Q

Role of Florian (epoprostenol) in treatment of hypertension?

A

Another Vasodilator

  • Typically w/adult population
  • Much less expensive than NO
26
Q

Pulmonary edema is characterized by what 2 aspects?

A

An accumulation of extra calculate fluid in the lungs

  1. Increase in pulmonary capillary hydrostatic presssure secondary to left sided heart disease [cardiogenic pulmonary edema]
  2. Increased membrane permeability [noncardiogenic pulmonary edema]
27
Q

Is CHF left or right sided heart failure

A

Left sided (can lead to right side as well)

28
Q

Cardiogenic Pulmonary Edema

A

Describes the rate of filtration of fluid
(there is a formula)

  • Ensure that intestinal fluid does not acclimate into a edema?
29
Q

What is hydrostatic pressure in a vessel?

A

pressure against the vasculature walls

30
Q

What are oncotic pressures in the capillary

A

Pressures that that pull proteins back within the vessels

31
Q

What happens as hydrostatic pressures increase?

A

Excess filtrate seeks and fills the peri-bronchovascular interstitial spaces

  • accommodates 300-400 mls of fluid
32
Q

What happens when interstitial spaces are full/brimming?

A

Fluid begins to fluid the alveolar spaces

33
Q

Common causes of Cardiogenic pulmonary edema

A
  1. Heart failure
  2. MI
  3. Cardiomyopathy (impaired ability to pump blood)
  4. Valve leak
  5. Arrhythmias (lead to blood build up)
34
Q

Noncardiogenic pulmonary edema results from what?

A

Injury to the lungs sufficient to increase endothelial permeability and cause extravasating of protein rich fluid into the interstitial and alveolar spaces

(leaking fluid out of capillary)

35
Q

interstitial vs alveolar edema?

edit slide 8

A
36
Q

Common causes of noncardiogenic pulmonary edema

A
  1. Severe ARDS
  2. Toxins or injury/trauma
  3. Reperfusion injury
37
Q

What would you expect to see for a Pulmonary edema CxR?

Bat wings CxR
A

“bat wings”
- Bilateral fluffy opacities
- Dilated pulmonary arteries
- left ventricular hypertrophy (cardiomegaly)
- Kerley A and B lines
- pleural effusion

38
Q

what does “bat-wing” shadow reflect about portions of the lungs?

A

Infiltrates in the central (peri-hilar) portions of the lungs

39
Q

Add info on Kerley A + B lines (edema slide 14)

A
40
Q

Pulmonary Edema CxR:

What does pleural effusion and cardiomeagly reflect on a CxR?

A

Severe heart failure

41
Q

Treatments for Pulmonary edema?

A
  • Reduce preload
  • Reduce afterload
  • Oxygen therapy (low and high flow)
  • CPAP and NIV (NIV for vent. failure)
  • Intubate and ventilate
42
Q

What Tx could you apply to reduce preload?

add info on diuretics from slide 16 to another slide

A
  1. Diuretics
    - loop diuretics
    - Thiazides
    - Spironolactone
  2. Vasodilation via nitroglycerin
43
Q

Group 4 PAH

A

Pre capillary

Due to:
- artery obstructions, after treating a pulmonary emboli

  • Increase in resistance to flow in pulmonary tree
  • Congenital stenosis (pulmonary artery blockages)
44
Q

Group 5 PAH

A

Mix of pre and post capillary

  • unknown factors, can be hematological disorders, systemic and metabolic disorders, chronic renal failure etc.
45
Q

Pathogenesis of PAH (aka development of disease)

A

Fibrotic changes: pulmonary artery remodeling

  • vascular proliferation (increase in blood vessels)
  • hypertrophy (important role in PH development)

TLDR: things that can generally cause or include
Inflammation, vasoconstriction, thrombosis

46
Q

What does hypertrophy of the vessels do?
- how does it have a role in pulmonary hypertension [PH]?

A

Preface:
- In PH, pulmonary arteries become stiff and narrow = increase resistance to blood flow in the RV of heart to lungs

What happens:

  • Pulmonary arteries have to work harder to pump blood through narrowed vessels = increase in size
  • when pulmonary arteries increase in size, it narrows the arteries causing more resistance to blood
47
Q

General Treatments for PAH?

  • aka non-specific to any group?
A

Nitric oxides (neonates)
- results in vasodilation
- short acting + topical

Flolan (Epoprostenol)
- For adults
- less expensive than NO, P. vasodilator

Patho 1 (PATH 254) (17 decks)

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