Pulmonary HTN Flashcards
What are the components of the pulmonary artery and right ventricle?
- Wall of the pulmonary artery and branches are only 1/3 thickness of aorta
- Can handle a HUGE amount of blood flow (on the way to the alveoli)
- Blood flow variable and dependent on cardiac output
*5-25 liters
What is the ideal or healthy pressure of the pulmonary vasculature
- Low-pressure, low resistance due to large cross sectional area
What is the pressure of the pulmonary artery and mean pulmonary artery
- Pulmonary artery pressure
*systolic = 15-30mmHg (PASP) - Mean pulmonary artery pressure
*9-18mmHG (MPAP)
What is the Right ventricular and Right atrial pressure
R ventricular
*systolic = 15-30mmHG
*diastolic = 2-8mmHG
R atrial (CVP)
*2-6mmHG
What happens to the pressure in pulmonary HTN
- Increased pulmonary artery pressure
*resistance is affected
*will be a complex disease state
What will the systolic pulmonary artery pressure (PASP) and Mean pulmonary artery pressure (MPAP) be in pulmonary HTN
PASP
*greater than 25-30mmHg
MPAP
*greater than 18-20mmHG
**as pulmonary vasculature resistance increases so does MPAP
What are the steps leading to Cor pulmonale (right sided HF)
- Increased pulmonary vasculature resistance
- Increased MPAP
- Right ventricular hypertrophy
- Cor pulmonale
In the steps leading to cor pulmonale what happens to the cardiac output
- The cardiac output will begin to compromise and decrease
*from increased afterload and decreased contractibility
*tachycarida is an initial compensatory response
What eventually leads to right HF
- Increased afterload compromises right ventricular function and eventually results in right HF
What is group 1 classification of pulmonary HTN
Pulmonary arterial hypertension (PAH) diseases that localize directly on the pulmonary arteries
*idiopathic
*inheritable
*drug and toxin induced
*connective tissue disease, HIV infection
What is group 2 of pulmonary HTN classifications
Pulmonary venous HTN due to left heart disease
*LV systolic dysfunction
*LV diastolic dysfunction
*valvular disease
What is group 3 of pulmonary HTN classifications
Pulmonary HTN due to lung disease and / or hypoxemia
*COPD
*interstitial lung disease
*sleep-disordered breathing
What is group 4 of pulmonary HTN classifications
Pulm HTN due to pulmonary obstruction
*thromboembolism
What is group 5 of pulmonary HTN classifications
Pulm HTN with unclear or multi factorial mechanisms
*hematologic disorders
*systemic disorders
How to determine clinical severity based on symptoms and functional status (I and II)
I
*symptoms free-when physical active or resting
II
*no symptoms at rest, but normal activities such as climbing the stairs, grocery shopping or making bed, some discomfort and SOB
How to determine clinical severity based on symptoms and functional status (III and IV)
III
*resting may be symptom-free but normal chores around the house are greatly limited due to SOB
IV
*symptoms at rest and serve symptoms with an activity
What are the risk factors for PH
- OSA
- Lung disease (obstructive and restrictive)
- Obesity
- Gender
*idiopathic and heritable MC in females - Pregnancy
*women already diagnosed with PH have a much higher risk of mortality - Drugs and toxins (methamphetamines)
What happens when COPD is causing PH
- Hypoxia pulmonary vasoconstriction will redirect blood flow AWAY from the poorly ventilated areas in attempt to match up the ventilation / perfusion ratio and optimize oxygenation of blood
What can hypoxia pulmonary vasoconstriction lead to?
- Vascular remodeling and sustained vasoconstriction
*thickening of the media and peripheral extension of muscle into pulmonary vessels that are normally devoid of muscle
What are the sign of symptoms of pulmonary HTN
- Exertional dyspnea and fatigue
- Syncope
- Hemoptysis
Why is the diagnosis of pulmonary HTN delayed
- Because symptoms are attributed incorrectly
*age, deconditioning, or a coexisting or alternate medical condition
What will you find during the PE?
- Narrow splitting of second heart sound w/loud pulmonary component, R-sided third heart sound, systolic ejection click, tricuspid regurgitation murmur
- Hepatomegaly, ascities
- Lower extremity edema
- Cyanosis
What will be on the PE (more advanced disease)
- Dyspnea at rest
- Chest pain, pressure
- Dizziness
- Weakness or fatigue
- Cyanosis
- Chronic cough
- Palpitations, tachycardia, abdominal pain
- Exertional syncope (severe)
What lab studies should you conduct
- BNP (brain natriuretic peptide)
*secreted by the ventricles in response to excessive stretching of the cardiomycytes - Thyroid function
- Liver function
- Kidney function
- Electrolytes
*labs may be WNL, depending on cause of Pulm HTN
