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Clinical Medicine > Pulmonary HTN > Flashcards

Pulmonary HTN Flashcards

1
Q

What are the components of the pulmonary artery and right ventricle?

A
  1. Wall of the pulmonary artery and branches are only 1/3 thickness of aorta
  2. Can handle a HUGE amount of blood flow (on the way to the alveoli)
  3. Blood flow variable and dependent on cardiac output
    *5-25 liters
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2
Q

What is the ideal or healthy pressure of the pulmonary vasculature

A
  1. Low-pressure, low resistance due to large cross sectional area
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3
Q

What is the pressure of the pulmonary artery and mean pulmonary artery

A
  1. Pulmonary artery pressure
    *systolic = 15-30mmHg (PASP)
  2. Mean pulmonary artery pressure
    *9-18mmHG (MPAP)
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4
Q

What is the Right ventricular and Right atrial pressure

A

R ventricular
*systolic = 15-30mmHG
*diastolic = 2-8mmHG
R atrial (CVP)
*2-6mmHG

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5
Q

What happens to the pressure in pulmonary HTN

A
  1. Increased pulmonary artery pressure
    *resistance is affected
    *will be a complex disease state
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6
Q

What will the systolic pulmonary artery pressure (PASP) and Mean pulmonary artery pressure (MPAP) be in pulmonary HTN

A

PASP
*greater than 25-30mmHg
MPAP
*greater than 18-20mmHG

**as pulmonary vasculature resistance increases so does MPAP

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7
Q

What are the steps leading to Cor pulmonale (right sided HF)

A
  1. Increased pulmonary vasculature resistance
  2. Increased MPAP
  3. Right ventricular hypertrophy
  4. Cor pulmonale
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8
Q

In the steps leading to cor pulmonale what happens to the cardiac output

A
  1. The cardiac output will begin to compromise and decrease
    *from increased afterload and decreased contractibility
    *tachycarida is an initial compensatory response
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9
Q

What eventually leads to right HF

A
  1. Increased afterload compromises right ventricular function and eventually results in right HF
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10
Q

What is group 1 classification of pulmonary HTN

A

Pulmonary arterial hypertension (PAH) diseases that localize directly on the pulmonary arteries
*idiopathic
*inheritable
*drug and toxin induced
*connective tissue disease, HIV infection

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11
Q

What is group 2 of pulmonary HTN classifications

A

Pulmonary venous HTN due to left heart disease
*LV systolic dysfunction
*LV diastolic dysfunction
*valvular disease

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12
Q

What is group 3 of pulmonary HTN classifications

A

Pulmonary HTN due to lung disease and / or hypoxemia
*COPD
*interstitial lung disease
*sleep-disordered breathing

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13
Q

What is group 4 of pulmonary HTN classifications

A

Pulm HTN due to pulmonary obstruction
*thromboembolism

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14
Q

What is group 5 of pulmonary HTN classifications

A

Pulm HTN with unclear or multi factorial mechanisms
*hematologic disorders
*systemic disorders

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15
Q

How to determine clinical severity based on symptoms and functional status (I and II)

A

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

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16
Q

How to determine clinical severity based on symptoms and functional status (III and IV)

A

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

17
Q

What are the risk factors for PH

A
  1. OSA
  2. Lung disease (obstructive and restrictive)
  3. Obesity
  4. Gender
    *idiopathic and heritable MC in females
  5. Pregnancy
    *women already diagnosed with PH have a much higher risk of mortality
  6. Drugs and toxins (methamphetamines)
18
Q

What happens when COPD is causing PH

A
  1. 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
19
Q

What can hypoxia pulmonary vasoconstriction lead to?

A
  1. Vascular remodeling and sustained vasoconstriction
    *thickening of the media and peripheral extension of muscle into pulmonary vessels that are normally devoid of muscle
20
Q

What are the sign of symptoms of pulmonary HTN

A
  1. Exertional dyspnea and fatigue
  2. Syncope
  3. Hemoptysis
21
Q

Why is the diagnosis of pulmonary HTN delayed

A
  1. Because symptoms are attributed incorrectly
    *age, deconditioning, or a coexisting or alternate medical condition
22
Q

What will you find during the PE?

A
  1. Narrow splitting of second heart sound w/loud pulmonary component, R-sided third heart sound, systolic ejection click, tricuspid regurgitation murmur
  2. Hepatomegaly, ascities
  3. Lower extremity edema
  4. Cyanosis
23
Q

What will be on the PE (more advanced disease)

A
  1. Dyspnea at rest
  2. Chest pain, pressure
  3. Dizziness
  4. Weakness or fatigue
  5. Cyanosis
  6. Chronic cough
  7. Palpitations, tachycardia, abdominal pain
  8. Exertional syncope (severe)
24
Q

What lab studies should you conduct

A
  1. BNP (brain natriuretic peptide)
    *secreted by the ventricles in response to excessive stretching of the cardiomycytes
  2. Thyroid function
  3. Liver function
  4. Kidney function
  5. Electrolytes
    *labs may be WNL, depending on cause of Pulm HTN
25
Q

What diagnostic tests could you conduct

A
  1. PFT
  2. CXR
  3. EKG
  4. Exercise testing
26
Q

What will be on the CXR?

A
  1. Enlargement of pulmonary, hilar vessels
  2. Attenuation (pruning) of the peripheral pulmonary arterial tree
  3. Advanced disease
    *enlargement of the right atrium and ventricles
27
Q

What will be on the EKG

A
  1. Right ventricular strain of hypertrophy
    *right axis deviation, R BBB
  2. Right atrial enlargement
    *peaked P waves in inferior and right-sided leads
28
Q

What imaging studies could you do?

A
  1. Echocardiogram w/Doppler flow
    *right ventricular dilatation or dysfunction
    *elevated right systolic ventricular pressure
  2. CT of chest
  3. V/Q scan
  4. Cardiac MRI
29
Q

What is the gold standard for confirming Pulm HTN?

A
  1. Right heart catherteization
    *can quantify / obtain pressures
30
Q

What is the reason to conduct a left heart catheterization?

A

LV dysfunction or valvular disease

31
Q

What is the primary action for treatment

A
  1. Identify, identify cause, and aim therapy at cause
32
Q

What is the treatment for group 1 of Pulm HTN

A

Pulmonary vasodilators
*endothelin receptor antagonists
*phosphodiesterase inhibitors
*prostacyclin/prostacyclin analogue

33
Q

What are some other treatment options

A
  1. Calcium channel blockers
  2. Digoxin
  3. Diuretics
  4. Anticoagulants (Warfarin, for group 4)
34
Q

What is atrial septostomy (right to left shunt)? (Potential tx)

A

Want to divert blood flow to bypass the pulmonary vascular bed and enter the systemic circulation which will elevate systemic blood flow and maintaining tissue perfusion

35
Q

What is the benefit of right to left shunt

A
  1. Decreased pressure of the pulmonary vasculature bed, but
  2. Less oxygenated blood in circulation
    *not curative, only for symptoms
36
Q

What is the prognosis

A

Can improve with therapy (group 1)
1. Poor prognosis
*Age >50
*Cor Pulmonale, RV dysfunction
*male gender
*functional class III or IV

Clinical Medicine (164 decks)

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