Pulmonary Circulation Flashcards

1
Q

Increase in pulmonary vasculature resistance that leads to right ventricular hypertrophy causing right sided heart failure

A

Pulmonary hypertension

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2
Q

When the pulmonary arterial pressure rises to a level inappropriate for a given cardiac output

A

Pulmonary hypertension

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3
Q

Which type of pulmonary hypertension is rare and often has a fatal outcome?

A

Primary idiopathic pulmonary hypertension

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4
Q

What defective gene causes primary idiopathic pulmonary hypertension?

A

BMPR2 gene: Normally inhibits pulmonary vessel smooth muscle growth and vasoconstriction

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5
Q

Who is primarily affected by primary idiopathic pulmonary hypertension? When is the mean age of dx?

A

80% middle-aged or young women

50y.o

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6
Q

What is the most common cause of secondary pulmonary hypertension?

A

COPD

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7
Q

Other than COPD, what can cause secondary pulmonary hypertension?

A

Sleep apnea, PE, cardiac, metabolic, systemic disease

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8
Q

What are the 4 types of pulmonary hypertension?

A

I. Pulmonary artery hypertension
II. Pulmonary hypertension associated with left heart disease
III. Pulmonary HTN due to hypoxemic lung dz
IV: Chronic thromboembolic

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9
Q

What is the most important and potent stimulus of pulmonary arterial vasoconstriction?

A

Hypoxia

Followed by acidosis and veno-occlusive conditions

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10
Q

Sxs: dyspnea, chest pain, weakness, fatigue, cyanosis, syncope, edema

A

Pulmonary hypertension

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11
Q

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

A

Pulmonary hypertension physical exam findings

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12
Q

What should you see on a CXR of someone with pulmonary hypertension?

A

Enlarged pulm. arteries
Insterstitial/alveolar edema
Signs of heart failure

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13
Q

What would you expect to see on a ECG of someone with pulmonary hypertension?

A

Cor pulmonale**
Right ventricular hypertrophy, RAE, Reactive airway disease, Right bundle branch block
R—>L shunt

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14
Q

What is the definitive diagnosis of pulmonary hypertension?

A

Rights sided catheterization

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15
Q

With right sided catheterization, what results are used to diagnose pulmonary hypertension?

A

Pulmonary arterial pressure >25mmHg at rest

or >35mmHg at exercise

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16
Q

What results from a CBC would support a diagnosis of pulmonary hypertension?

A

Polycythemia with increased hematocrit

17
Q

What are the two principle management treatments for pulmonary hypertension?

A

Vasodilators

Oxygen therapy/anticoagulation

18
Q

What is the first line treatment for primary pulmonary hypertension

A

Calcium channel blockers (if sensitive)

19
Q

If pulmonary HTN is not sensitive to CCB, what is the next step in treatment?

A

Prostacyclines

20
Q

If pulmonary HTN is not sensitive to prostacyclines, what is the next step in treatment?

A

Endothelial receptor antagonists

21
Q

What is usually needed for pulmonary hypertension?

A

Heart lung transplant

22
Q

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.

A

Cor Pulmonale

23
Q

Venous congestion
Peripheral edema
SOB
Productive cough that becomes worse during periods of heart failure

A

Cor pulmonale

24
Q

Plethora (redness), cyanosis, and warm moist skin result from ______ ______ and desaturation of arterial blood that accompanies chronic lung disease in cor pulmonale

A

Compensatory polycythemia

25
With cor pulmonale, drowsiness and altered mental status result due the retention of?
CO2
26
What does the management of cor pulmonale focus on?
Treatment of lung disease and heart failure
27
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
28
An alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system.
Cor pulmonale
29
_________ _________ is the common link between lung dysfunction and the heart in cor pulmonale.
Pulmonary hypertension
30
What two diseases most often result in ACUTE cor pulmonale?
ARDS and PE
31
Which disease *most commonly* results in cor pulmonale?
COPD
32
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**
33
What is the main principle in obtaining lab work to diagnose cor pulmonale?
To define the underlying cause as well as evaluate possible complications
34
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)
35
Why would you want to get an ANA when looking to diagnose cor pulmonale?
To check for scleroderma and other collagen vascular diseases
36
What is typically used for treatment for chronic cor pulmonale?
Diuretics | Calcium channel blockers
37
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)
38
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