Pulmonary HTN

Question 1

What is pulmonary hypertension?

Answer 1

Increase in mean pulmonary arterial pressure

Question 2

List 5 causes of pulmonary hypertension

Answer 2

Idiopathic
Problems with smaller branches of pulmonary arteries
LV failure
Lung disease (e.g. COPD, interstitial lung disease)
Thromboses/ Emboli in lungs

Question 3

List 4 risk factors for pulmonary hypertension

Answer 3

FH
Female
Appetite suppressants (e.g. aminorex)
BMPR2 mutations

Question 4

Describe the epidemiology of pulmonary hypertension

Answer 4

Idiopathic pulmonary HTN is RARE

More common in severe respiratory + cardiac disease

Question 5

List 5 symptoms of pulmonary hypertension

Answer 5

Progressive breathlessness  
Weakness/ fatigue
Exertional dizziness + syncope   
Angina 
Tachyarrhythmia

Question 6

List 7 signs of pulmonary hypertension

Answer 6

RV heave  
Loud pulmonary 2nd HS
Pulmonary regurgitation (graham-steel murmur)  
Tricuspid regurgitation  
Raised JVP  
Peripheral oedema  
Ascites

Question 7

What is Cor pulmonale?

Answer 7

Right HF caused by chronic pulmonary arterial HTN

Question 8

Describe an ECG in pulmonary hypertension

Answer 8

Right ventricular hypertrophy + strain
Tall R wave + small S wave in lead V1
Small R wave + large S wave in lead V5/6
RAD

Question 9

What tests may you use to exclude other/ identify causes of pulmonary hypertension ?

Answer 9

CXR: exclude other lung diseases 
Pulmonary function tests (mild reductions in lung volume or normal)  
LFTs: liver damage --> portal HTN
Lung biopsy: interstitial lung disease  
Echo: assess left ventricular function

Question 10

Why perform right heart catheterisation in pulmonary hypertension?

Answer 10

directly measure pulmonary pressure + confirm the dx

Question 11

Describe bloods taken in pulmonary hypertension

Answer 11

BNP elevated  
FBC: baseline + ?haemoglinopathy  
LFTs: ?liver disease or portal HTN
TFTs ?cause
HIV serology: ?cause