Pulmonary Arterial Hypertension / Obstructive sleep apnea

Question 1

Pulmonary hypertension = Increase in resting mean pulmonary arterial pressure ≥ __ mmHg, diagnosed by ___

Answer 1

25

right heart catheterization - differentiates arterial vs venous pulm hypertension

Question 2

Most common cause of pulmonary hypertension

Answer 2

PH due to left heart disease

*this is different than pulmonary ARTERIAL hypertension

Question 3

Pathogenesis of PAH includes all of the following EXCEPT:

a. vasoconstriction by increased prostacyclin
b. smooth muscle proliferation
c. thrombosis
d. vasoconstriction by decreased NO
e. vasoconstriction by increased endothelin

Answer 3

a is false - DECREASED prostacyclin causes vasocontriction

Question 4

Evaluation of vasoreactivity during Right heart catheterization has what significance?

Answer 4

better prognosis if pulmonary arteries are reactive. you can use CCBs to treat

Question 5

Group 4 PH is caused by: __

Answer 5

Chronic thromboembolic PH (CTEPH) (aka PE)

Question 6

Group 3 PH is caused by: __

Answer 6

Chronic Lung Disease (ex. COPD, *sleep apnea, chronic high altitude exposure)

Question 7

True/False: Obstructive sleep apnea is associated with hypertension

Answer 7

True.

Question 8

Treatment of choice for Obstructive sleep apnea

Answer 8

Nasal Continuous Positive Airway Pressure
(CPAP)
effective, but long term compliance is not very good (dry nose and throat)

Question 9

What’s the key difference between central and obstructive sleep apnea?

Answer 9

In central, there is a lack of respiratory effort (signal from the brain)

Question 10

Central sleep apnea is seen in 50% of patients with __

Answer 10

CHF

-independent risk factor for death

Question 11

obstructive sleep apnea in kids is caused by (2) and treated how?

Answer 11

1st peak- lymphoid hyperplasia –> tonsillectomy

2nd peak - obesity –> weight loss/ CPAP

Question 12

4 preventative measures for SIDS

Answer 12

1. back to sleep
2. no smoke exposure
3. avoid overheating
4. avoid soft bedding/ no pillow

Question 13

All of the following are predictors of poor survival in idiopathic pulmonary arterial hypertension EXCEPT:

a. syncope
b. signs of left heart failure
c. poor exercise endurance
d. pericardial effusion
e. advanced functional class

Answer 13

b. is false - signs of RIGHT heart failure