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Echo 2 > Module 11 : Pulmonary Hypertension > Flashcards

Module 11 : Pulmonary Hypertension Flashcards

1
Q

what is pulmonary hypertension characterized by

A
  • elevated pulmonary arterial pressures secondary to RV failure
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2
Q

how are the categories of pulmonary hypertension characterized

A
  • based on which area of the circulatory system they affect which increased the pulmonary pressure
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3
Q

what is pulmonary HTN

A
  • increased pressure in the pulmonary vasculature
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4
Q

what is pulmonary HTN defined as

A
  • PCWP > 15mmHg
  • SPAP = RVSP if no RVOT obstruction 30-35
  • MPAP >/= 35mmHg
  • PVR >/= 3 wood units
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5
Q

what will be the respiratory symptoms of PHTN

A
  • shortness of breath
  • cough
  • wheezing
  • hemoptysis
  • intercostal retraction
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6
Q

what are the 4 signs of right heart failure

A
  • jugular venous congestion
  • peripheral edema
  • ascites
  • hepatosplenomegaly
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7
Q

what are 5 associated cardiac symptoms with PHTN

A
  • palpitations/arrhtymias
  • chest pain
  • shortness of breath on exertion
  • othropnea
  • syncope
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8
Q

what is normal RA and IVC pressure

A

0-4mmHg (average)

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9
Q

what is normal right ventricle systolic and diastolic pressure

A

< 25 / < 10

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10
Q

what is normal pulmonary artery systolic and diastolic pressure

A

< 25 / < 10

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11
Q

how do we calculate RVSP with RAP and TV pg

A

RVSP = RAP + TVpg

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12
Q

what is the RAP

A

RA pressure from IVC diameter

- 3,8,15

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13
Q

what is the TV pg

A
  • tricuspid valve pressure gradient

- reflects the difference in pressure between RA and RV

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14
Q

what RVSP would indicate mild moderate or severe PHTN

A

< 30 mmHg
30-35 mmHg
> 35 mmHg

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15
Q

what is normal TR velocity

A

< 2.8-2.9 m/s

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16
Q

what are the 6 cardiac causes of right sided heart failure

A
  • left sided heart failure is most common
  • pulmonic valve stenosis
  • right ventricular infarction
  • massive TR
  • congenital malformation
  • shunts
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17
Q

what are the 2 categories of pulmonary causes of right heart failure

A
  • parenchymal

- vascular disease

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18
Q

what are the 5 parenchymal causes of elevated right heart pressure

A
  • COPD asthma
  • interstitial lung disease
  • adult respiratory distress syndrome
  • chronic lung infection
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19
Q

what are the 2 vascular causes of right heart pressure increase

A
  • pulmonary embolism

- primary pulmonary hypertension

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20
Q

how does left sided heart failure increase right heart pressure

A
  • retrograde increased load/pressure

+ LV>LA>PLM VASC>RV>RA>IVC

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21
Q

why does cor pulmonale occur

A
  • increased resistance in the pulmonary circulation
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22
Q

what is the pathophysiology of cor pulmonale

A
  • progressively increasing chronic pressure overload of the right ventricle as it ejects into the high resistance vascular bed
    + if slow and gradual will first lead ti RV hypertrophy
    + if fast then RV dilation will happen first
    + then RV failure occurs
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23
Q

what is an acute pulmonary embolism most often caused by

A
  • deep vein thrombosis
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24
Q

how is PE and DVT treated

A
  • PE = treat DVT or lung resection

- DVT = IVC filter

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25
Q

what is eisenmengers syndrome

A
  • shunt reversal in patients with significant shunt that have developed PHTN from the shunt
  • shunt goes right to left
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26
Q

what 3 things does chronic elevation of RT heart pressures lead to

A
  • dilated coronary sinus
  • reopening of PFO
  • dilated main PA
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27
Q

what are the 2 different categories of PHTN

A
  • precapillary

- post capillary

28
Q

what is the role of echo with PTHN

A
  • identify cause of PHTN

+ precapillary post capillary

29
Q

what are the 3 most common post capillary causes of PHTN

A
  • LV systolic function
  • LV diastolic function
  • left heart valvular disease
30
Q

what are the right side 2D signs of of pulmonary artery hypertension

A
  • enlarged RV (hypoinetic)
  • septal shifting (toward left)
  • RA enlarged
  • TV regurge
  • PA dilated
  • PV regurge
  • IVC dialted
  • SVC dilated
31
Q

what are the 4 doppler right sided assessments of PAH

A
  • TV regurge
  • PV insufficiency
  • IVC collapsible / reflux into hepatic veins
  • arrhythmia on ECG
32
Q

what are the left side 2D signs oF pAH

A
  • LV enlargement
  • LV hypo
  • LV, IAS, IVS aneurysmal
  • CMO
  • LA enlarged
  • MV abnormalities
  • AV sclerosis
  • prosthetic valves
33
Q

what are the 5 left sided sided doppler features of PAH

A
  • MV stenosis regurege
  • AV stenosis or regurge
  • systolic dysfunction
  • diastolic dysfunction
  • arrhythmia
34
Q

what is the etiology of RVPO (RV pressure overload)

A
  • any cause the increases pressure to the right heart
    + long standing regurge
    + primary pulmonary disease
35
Q

what signs is seen with RVPO

A
  • PSAX d sign seen in both systole and diastole
36
Q

what does RVVO eventually become

A
  • RVPO
37
Q

what is the etiology of RVVO

A
  • anything that causes increased volume to the right heart

+ a left to right shunt such as significant ASD

38
Q

what sign is seen with RVVO

A
  • PSAX D sign in only diastole
39
Q

what are the 3 spectra doppler methods of summarizing PAH

A
  • SPAP (RVSP
  • MPAP
  • PAEDP
40
Q

what 2 things does RVSP/SPAP use

A
  • TR max velocity

- RAP

41
Q

what does MPAP use

A
  • using PR early diastolic velocity (PW or CW)
42
Q

what does PAEDP use

A
  • PR end diastolic velocity
43
Q

what should we use to calculate the RVSP if it is present

A
  • the VSD jet
  • more accurate
  • reflects the pressure difference between LV and RV
44
Q

what is the equation for RVSP using VSD

A

-RVSP = SBP - (4 V^2)

45
Q

what 5 technical factors need to be adjusted with RVSP

A
  • peak velocity with CW is angle dependant
  • use color doppler to align
  • sweep speed 100cm/s
  • no feathering
  • do not measure unless peal clearly seen
46
Q

what 4 windows are used to interrogate peak velocity of TR jet

A
  • PLAX RVIT
  • PSAX
  • A4C
  • subcostal window
47
Q

what is the equation for PAEDP

A

PAEDP = 4V ^2 + RAP

48
Q

what velocity is used int he PAEDP equation

A
  • PR CW trace at end diastole
49
Q

what is normal PAEDP

A

< 10-12 mmHg

50
Q

what is the real formula for MPAP

A

MPAP = 79 - (0.45 x PAT)

PAT = pulmonary acceleration time

51
Q

what is the rough estimate formula for MPAP

A

MPAP = 80 - ( 0.5 x PAT)

52
Q

can PR jet velocity be used to asses MPAP and PAEDP

A
  • yes

- should be done whenever RVSP is suspected to be elevated

53
Q

how is the MPAP and PAEDP calculated with PR jet

A
  • PG from early diastolic velocity tells us the MPAP (with RAP)
  • RVEDP is estimated from end diastolic velocity of the PR jet
54
Q

what is normal SPAP (RVSP)

A

18-25 mmHg

55
Q

what is mild elevated SPAP

A

30-40 mmHg

56
Q

what is moderate elevated SPAP

A

40-70mmHg

57
Q

what is severe elevated SPAP

A

> 70 mmHg

58
Q

what is normal RVOT AT

A

> /= 120ms

59
Q

what is mild decreased RVOT AT

A

80-110ms

60
Q

what is moderate decreased RVOT AT

A

60-80 ms

61
Q

what is severe decreased RVOT AT

A

< 60ms

62
Q

what is normal MPAP

A

< 25 mmHg

9-18 average

63
Q

what is mild elevated MPAP

A

30-40mmHg

64
Q

what is moderate elevated MPAP

A

40-50mmHg

65
Q

what is severe elevated MPAP

A

> 50 mmHg

66
Q

what is normal PAEDP

A

4-12 mmHg

Echo 2 (18 decks)

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