Pulmonary HTN

Question 1

What are the 5 types of PH?

Answer 1

1 - arterial hypertension 
2 - left sided failure
3 - chronic lung conditons / hypoxia 
4 - CTEPH
5 - unknown

Question 2

What are the causes of type 1 PH?

Answer 2

Autoimmune
Drugs
Genetic

Question 3

What is the mPAP for pre-capillary PH?
What is the PAWP?
PVR?

Answer 3

MPAP >20
PAWP <15
PVR >3 WU

Question 4

What types of PH have pre-capillary PH?

Answer 4

1, 3, 4 + 5

Question 5

What types of PH have post-capillary PH?

Answer 5

2 & 5

Question 6

What are the mPAP, PAWP and PVR for post-capillary PH?

Answer 6

MPAP >20mmHg
PAWP >15mmHg
PVR <3 woods units

Question 7

Symptoms of PH

Answer 7

Dyspneoa and fatigue 
RV failure 
- exertional chest pain
- exertional syncope 
- weight gain [oedema]
- anorexia, abdominal pain

Question 8

What is Ortner’s syndrome?

Answer 8

Hoarseness caused by compression of the left recurrent laryngeal nerve by a dilated main pulmonary artery.
Unilateral vocal cord paralysis

Question 9

What are some PH signs?

Answer 9

1. Increased intensity of the pulmonic component of 2nd heart sound —> leads to splitting of 2nd heart sound
2. Raised JVP
3. Holosystolic murmur in TR —> severe diastolic Pulmonary regurgitation
4. Hepatomegaly
5. Ascites, peripheral oedema, effusions

Question 10

CXR findings in PH?

Answer 10

Enlarged central pulmonary arteries “oligemic lung fields”
RV enlargement “diminished retrosternal space”
RA dilation “prominent right heart border”
Pleural effusions

Question 11

CT findings for PH?

Answer 11

Main pulmonary artery/ascending aorta diameter ratio >1

Question 12

ECG findings for PH?

Answer 12

Right axis deviation
R/S wave ratio >1 on V1
Incomplete or complete RBBB
Increased P wave amplitude lead II “p pulmonale”

Question 13

Drugs that can cause PH?

Answer 13

Appetite suppressants
Cocaine
Rapeseed oil
Nicotine

Question 14

What is the most valuable measurement on Echo for PH?

What two measurements give you clear diagnosis?

Answer 14

Tricuspid valve regurgitation

TVR >3.4m/s plus ePASP >50mmHg

Question 15

What are features of PH on echo?

Answer 15

TRV >3.4m/s
Estimated PASP >35mmHg young >40mmHg old
Increased RV size and wall thickness
(Left-sided heart disease i.e. MS)

Question 16

What will an echo show if there is RV pressure overload?

Answer 16

Systolic flattending of interventricular septum 
RV dilation and hypokinesis 
RA dilation
Tricuspid regurg 
PA diameter >25mm

Question 17

What are 4 reasons to perform right heart catheterisation?

Answer 17

Confirm PH
Assess contribution of left heart disease
Assess for congential disease
Baseline assessment + vasoreactive testing