Pulmonary and Systemic Hypertension

Question 1

what are the clinical signs of pulmonary hypertension?

Answer 1

dyspnea
fatigue
syncope

Question 2

is the right ventricle more adapted to increased volume or increased pressure?

Answer 2

increased volume more than increased pressure

Question 3

what does right ventricle dilation lead to?

Answer 3

tricuspid regurgitation

Question 4

what are the common causes of pre-capillary, pulmonary arterial hypertension?

Answer 4

idiopathic
congenital heart disease (with left to right shunt)
heartworm infection

Question 5

what is affected by pulmonary arterial hypertension?

Answer 5

pulmonary arterial system alone

Question 6

what is the general cause of pulmonary arterial hypertension (pre-capillary)?

Answer 6

disorders that cause the arterial system to remodel and imbalance between vasodilation and vasoconstriction (endothelial dysfunction)

Question 7

what is endothelial dysfunction?

Answer 7

imbalance between vasodilators and vasoconstrictors produced by endothelial cells

Question 8

why is poiseuille’s equation important?

Answer 8

change in radius of a vessel causes a giant change in pressure
radius is to fourth power

Question 9

what makes up pulmonary arterial remodeling?

Answer 9

intimal hyperplasia
medial hypertrophy
adventitial proliferation

Question 10

what is pulmonary hypertension from with left-sided heart failure (post-capillary)?

Answer 10

pressure in left atrium passively transmitted backwards to pulmonary veins, capillaries, and even arteries

Question 11

what are some causes of pulmonary thromboembolism in dogs and cats?

Answer 11

neoplasia
metabolic disease
trauma
surgery
renal disease

Question 12

what are some endothelin-receptor antagonists?

Answer 12

bosentan
ambrisentan
macitentan

Question 13

what does phosphodiesterase 5 do?

Answer 13

breaks down cGMP (important in vasodilation)

Question 14

how can we deliver nitric oxide to the patient?

Answer 14

nitroprusside
nitroglycerine paste

Question 15

what are some phosphodiesterase 5 inhibitors?

Answer 15

sildenafil
tadalafil
vardenafil

Question 16

what are the neural controls of vasodilation and vasoconstriction?

Answer 16

sympathetic and parasympathetic systems

Question 17

what does right ventricle dilation lead to?

Answer 17

tricuspid regurgitation

Question 18

what is group 2 of pulmonary hypertension?

Answer 18

post-capillary, pulmonary venous hypertension secondary to left-sided heart disease

Question 19

what are some causes of chronic thromboembolism that lead to pulmonary hypertension (group 4)?

Answer 19

heartworm infection
pulmonary thromboembolism
neoplasia

Question 20

what happens with arterial remodeling?

Answer 20

pilmonary arteriolar remodeling: intima, media, adventitia
thrombus formation
inflammation
plexiform lesions
imbalance between vasodilation and vasoconstriction

Question 21

what are plexiform lesions?

Answer 21

capillary-like vascular channels within lumen of small muscular arteries

Question 22

what are some lung diseases in dogs that can lead to pulmonary hypertension?

Answer 22

interstitial fibrosis
sleep apnea
chronic hypoxia

Question 23

what do endothelin-receptor antagonists do?

Answer 23

block endothelin receptor: prevent vasoconstriction

Question 24

what are the types of systemic hypertension?

Answer 24

situational
secondary (most common)
idiopathic

Question 25

what humoral regulators vasodilate?

Answer 25

nitric oxide histamine prostacyclin

Question 26

what does hydralazine do?

Answer 26

inhibits calcium release in smooth muscle cells: decreases systemic hypertension

Question 27

what can be used to inhibit RAAS to decrease systemic hypertension?

Answer 27

ACE inhibitor or angiotensin receptor blocker: enalapril, benazepril, losartan

Question 28

what are some things that cause pulmonary hypertension through lung disease or hypoxia (group 3)?

Answer 28

interstitial lung disease chronic exposure to high altitude

Question 29

what in heartworm leads to pulmonary arterial hypertension?

Answer 29

endarteritis villous proliferation

Question 30

why is it a problem that pulmonary arteries experience high blood flow in left-to-right shunting?

Answer 30

proliferative changes in arteries increase in pulmonary vascular resistance

Question 31

can pulmonary hypertension secondary to left-sided heart failure lead to pulmonary arterial remodeling?

Answer 31

yes

Question 32

how can direct destruction of the vascular bed from lung disease happen?

Answer 32

stress from hyperinflation inflammation

Question 33

how does lung disease cause pulmonary hypertension?

Answer 33

chronic hypoxia: increased vascular resistance direct destruction of vascular bed from lung disease pulmonary artery remodeling endothelial dysfunction

Question 34

how can we treat pulmonary hypertension?

Answer 34

fix underlying cause if possible try to dilate pulmonary vessels

Question 35

what are some humoral regulators that vasoconstrict?

Answer 35

catecholamines endothelin ADH/vasopressin renin-angiotensin-aldosterone system