pulmonary HTN Flashcards
PA systolic pressure of ____ is PH
over 25
you should suspect PH in pt with ____ and ___
increasing dyspnea & a known cause
2 complications of PH
cor pulmonale and Right HF
prognosis of PH
if untreated, 2.8 yrs after diagnosis
4 sx of severe PH
- exertional chest pain
- exertional syncope
- peripheral edema
- anorexia
and known disease
4 exam findings of PH
- Narrowed 2nd heart sounds
- JV pulse
- RV failure
- Cor pulmonale
1st step in work-up, used to screen for PH
echo
what’s next if echo is positive vs negative?
- +, do definitive test
- -, r/o other causes of dyspnea or still do definitive test
definitive diagnostic study for PH
right heart catheterization
3 things R heart cath. can tell you
- severity
- if its R or L sided heart dz
- congenital or L to R shunt
run through 4 functional classes of PH
- PH only
- PH w/ slight limitations
- PH w/ markedly limited physical activity
- PH and can’t do anything w/o sx
if someone has PH and exertional sx, what class are they?
2
if someone has PH with mild resting sx and undue sx w/ any exertion, what class are they?
3
if someone has PH w/ RH failure & increased dyspnea at rest, what class are they?
4
for what functional classes do you consider advanced therapy
class 2-4
5 primary tx for PH
- diuretics
- O2
- anticoag- d/t increased risk for thrombosis from RAE
- exercise
- flu & pneumo vaccine
palliative measure to shunt left PA blood to descending aorta
Transcatheter potts shunt
final option for treating PH if all else fails
heart transplant
which medication works well in vasoreactive pts, causing PA vasodilation
CCB– diltiazem, amlodipine
1st line in severe dz; inhibits platelet activation & effective vasodilator; improves survival & exercise capacity
Prostanoids– Epoprostenol & Treprostinil
- improved pulmonary hemodynamics and exercise capacity
- MOA: smooth muscle relaxation & PA vasodilation
- when used with prostanoids, shows improved outcome
Sildenafil (PDE5)
what two meds improve exercise capacity
prostanoids
sildenafil
