Pulmonary Circulation Flashcards
Increase in pulmonary vasculature resistance that leads to right ventricular hypertrophy causing right sided heart failure
Pulmonary hypertension
When the pulmonary arterial pressure rises to a level inappropriate for a given cardiac output
Pulmonary hypertension
Which type of pulmonary hypertension is rare and often has a fatal outcome?
Primary idiopathic pulmonary hypertension
What defective gene causes primary idiopathic pulmonary hypertension?
BMPR2 gene: Normally inhibits pulmonary vessel smooth muscle growth and vasoconstriction
Who is primarily affected by primary idiopathic pulmonary hypertension? When is the mean age of dx?
80% middle-aged or young women
50y.o
What is the most common cause of secondary pulmonary hypertension?
COPD
Other than COPD, what can cause secondary pulmonary hypertension?
Sleep apnea, PE, cardiac, metabolic, systemic disease
What are the 4 types of pulmonary hypertension?
I. Pulmonary artery hypertension
II. Pulmonary hypertension associated with left heart disease
III. Pulmonary HTN due to hypoxemic lung dz
IV: Chronic thromboembolic
What is the most important and potent stimulus of pulmonary arterial vasoconstriction?
Hypoxia
Followed by acidosis and veno-occlusive conditions
Sxs: dyspnea, chest pain, weakness, fatigue, cyanosis, syncope, edema
Pulmonary hypertension
Accentuated increase in S2 (fixed or paradoxically split S2)
Signs of R-sided heart failure
Increased JVP
Peripheral edema
Ascites
Systolic ejection click
Pulmonary regurgitation
RV heave
Pulmonary hypertension physical exam findings
What should you see on a CXR of someone with pulmonary hypertension?
Enlarged pulm. arteries
Insterstitial/alveolar edema
Signs of heart failure
What would you expect to see on a ECG of someone with pulmonary hypertension?
Cor pulmonale**
Right ventricular hypertrophy, RAE, Reactive airway disease, Right bundle branch block
R—>L shunt
What is the definitive diagnosis of pulmonary hypertension?
Rights sided catheterization
With right sided catheterization, what results are used to diagnose pulmonary hypertension?
Pulmonary arterial pressure >25mmHg at rest
or >35mmHg at exercise
What results from a CBC would support a diagnosis of pulmonary hypertension?
Polycythemia with increased hematocrit
What are the two principle management treatments for pulmonary hypertension?
Vasodilators
Oxygen therapy/anticoagulation
What is the first line treatment for primary pulmonary hypertension
Calcium channel blockers (if sensitive)
If pulmonary HTN is not sensitive to CCB, what is the next step in treatment?
Prostacyclines
If pulmonary HTN is not sensitive to prostacyclines, what is the next step in treatment?
Endothelial receptor antagonists
What is usually needed for pulmonary hypertension?
Heart lung transplant
Right heart failure resulting form primary lung disease or pulmonary hypertension. Increased pressures and work result in hypertrophy and eventual failure of the right ventricle.
Cor Pulmonale
Venous congestion
Peripheral edema
SOB
Productive cough that becomes worse during periods of heart failure
Cor pulmonale
Plethora (redness), cyanosis, and warm moist skin result from ______ ______ and desaturation of arterial blood that accompanies chronic lung disease in cor pulmonale
Compensatory polycythemia
With cor pulmonale, drowsiness and altered mental status result due the retention of?
CO2
What does the management of cor pulmonale focus on?
Treatment of lung disease and heart failure
Chronic lung disease causes hypoxemia, which can result in pulmonary hypertension and polycythemia. What can you use to combat the hypoxemia that leads to these disorders with cor pulmonale?
Low-flow oxygen
An alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system.
Cor pulmonale
_________ _________ is the common link between lung dysfunction and the heart in cor pulmonale.
Pulmonary hypertension
What two diseases most often result in ACUTE cor pulmonale?
ARDS and PE
Which disease most commonly results in cor pulmonale?
COPD
What are other important disorders to consider before diagnosing someone with cor pulmonale?
Disorders that cause right sided ventricular failure other than cor pulmonale (right ventricular infarction, congestive heart failure, R side failure due to genetic diseases)
Ventricular septal defect
What is the main principle in obtaining lab work to diagnose cor pulmonale?
To define the underlying cause as well as evaluate possible complications
Why should you get an H+H when looking to diagnose cor pulmonale?
To check for polycythemia (can increase pulmonary arterial pressure bc of increased viscosity)
Why would you want to get an ANA when looking to diagnose cor pulmonale?
To check for scleroderma and other collagen vascular diseases
What is typically used for treatment for chronic cor pulmonale?
Diuretics
Calcium channel blockers
What would you expect to see on CXR in a patient with cor pulmonale?
RV and proximal pulmonary artery enlargement with distal arterial attenuation (reduction of density)
What is the best way to diagnose cor pulmonale?
Echocardiography: Evalues LV and RV function; echocardiography can assess RV systolic pressure but is often technically limited by the lung disorder
