Pulm Vascular Disorder: Pulmonary HTN

Question 1

What is pulm HTN? >_____mmHg?

Answer 1

persistant and sustained pulm arterial pressure > 25 mmHg

Question 2

What is the normal pressure pulm circuit?

Answer 2

~15mmHg

Question 3

The pulm circuit is ______ and has low _____ therefore low _______ and minimal increase in pulm pressure if _____ _______ increases

Answer 3

compliant

pressure

resistant

CO

Question 4

Pulm ___________—–> increase ________.

Answer 4

vasconstriction

pressure

Question 5

If no longer compliant, anything that causes ________ will persistently ________ pressure

Answer 5

constriction

increase

Question 6

At nonpeak time, the heart is pumping at ____ and blood is distributed through the circuit with no real _____ in ________

Answer 6

rest

increase

pressure

Question 7

At peak time, the _____ _____ increases and more _____ goes thru the ______ and there’s some ______ in _______

Answer 7

heart rate

blood

arteries

increase, pressure

Question 8

What happens, then there is a break in one or two vessels? In peak time and nonpeak time?

Answer 8

PROBLEM:

pressure in pulm circuit increases

nonpeak time: congestion in vessels

peak time: even more congestion

Question 9

Etiology: _____% is mostly d/t ______ and ______ problems

Answer 9

95%

cardiac and pulm

Question 10

Etiology: What are the 3 categories of cardiac and respiratory prob that leads to pulm HTN?

Answer 10

1. hypoxemia
2. increase pulm blood volume
3. increase pulm venous pressure

Question 11

Etiology: Why does hypoxemia cause pulm HTN?

Answer 11

in systemic hypoxemia, the pulm circuit vasoconstrict b/c if dilated more CO2 are added to the circulation and distributed to the rest of the body worsening hypoxia elsewhere

Question 12

drop in O2—> vessels in pulm circuit _____ —> increase ______

Answer 12

constrict

pressure

Question 13

in systemic hypoxemia in all tissue/organs besides lung there is _________ to increase _______ ______ to all tissues to receive more ______

Answer 13

vasodilation

blood flow

oxygen

Question 14

Etiology: increase in pulm _______ ______ —> more blood —-> increase _______

Answer 14

blood volume

pressure

Question 15

Etiology: Explain how septal defect cause pulm HTN?

Answer 15

in fetal dev, the foramina is an opening that closes during brith, if not closed, there is open communication from L and R ventricles and –> blood goes thru the aorta and pulm arteries —> blood vol increases in pulm circuit—> pulm HTN

Question 16

In fetal life, do they use they lungs? Explain.

Answer 16

In fetal life, there lungs collapse and there is no blood flow in pulm circuit. They draw O2 from maternal blood and passing CO2 in maternal blood

Question 17

Etiology: In pulm HTN, there is an ____ in pulm _______ pressure.

Answer 17

increase

venous

Question 18

Etiology: Explain how mitral valve stenosis contribute to increase pulm venous pressure.

Answer 18

mitral valve is stiff and do not open easily —> blood coming thru from pulm circuit into the L atrium cannot empty fully into L ventricle–> there is residual volume in L atrium —> congestion of blood in venous circuit increase pressure in pulm circuit

Question 19

What is happening in the R ventricle in pulm HTN?

Answer 19

d/t build up of pressure—> R ventricle pump against increase resistance —> build up of pressure and volume –> more congestion and less blood return

Question 20

Manifestations (7) Explain each

Answer 20

1. dyspnea: associated with hypoxia
2. fatigue: d/t inadeq perfusion
3. syncope: d/t inadeq perfusion in brain
4. chest pain on exertion: d/t decrease CO
5. those of RHF: d/t heart pumping against increase resistance in pulm circuit
6. distended pulm arteries: d/t increase pressure/volume in cardiac and pum circuit–> dilation in pulm artery
7. RV hypertrophy: d/t R-sided HF

Question 21

How does decrease CO lead to angina?

Answer 21

CO decreases–> less perfusion in pulm circuit –> form of angina

Question 22

How does RHF result from pulm HTN?

Answer 22

the heart is persistently pumping against increase resistance in pulm circuit d/t increase pressure –> RHF

Question 23

Why is there hypertrophy in RV?

Answer 23

RHF–> R ventricle pumps against increase resistance –> increase size in muscle cells — RV hypertrophy

Question 24

Treatment of pulm HTN (3)

Answer 24

1. address underlying cause
2. Ca channel blockers
3. prostacyclin

Question 25

How does CCB tx pulm HTN?

Answer 25

calcium is required for muscle contraction–> if Ca channels are blocked muscles cannot contract—> muscle relaxes relieving pressure

Question 26

What are prostacyclin and how does it tx pulm HTN? When is it used?

Answer 26

A form of prostaglandins 12 and is used as a potent vasodilators to relieve pressure

When pt is non responsive to CCB