pulmonary htn Flashcards
PH or PAH?
More common
PH
PH or PAH?
progressive disease involving endothelial dysfunction -> elevated pulmonary arterial pressure and pulmonary vascular resistance
PAH duh
normal pulmonary arterial wedge pressure
4-12 mmHg
T or F: PAH is more common in men than women
false, more common in women
PAH leads to (left/right) ventricular failure
right
4 things with endothelial dysfunction in the slides:
-decrease in nitric oxide synthase
- decrease in prostacyclin production
- increase in thromboxane production
- increase in endothelin 1 production
Which class is defined by the following:
- symptom-free when physically active or resting
a. Class I
b. Class II
c. Class III
d. Class IV
a. Class I
Which class is defined by the following:
- slight limitation of physical activity-ordinary activity may cause symptoms
- comfortable at rest
a. Class I
b. Class II
c. Class III
d. Class IV
b. Class II
Which class is defined by the following:
- marked limitation in physical activity-less than ordinary activity causes symptoms
- comfortable at rest
a. Class I
b. Class II
c. Class III
d. Class IV
c. Class III
Which class is defined by the following:
- significant symptoms with activity
- symptoms at rest
a. Class I
b. Class II
c. Class III
d. Class IV
Class IV
first line therapy for pulmonary htn
CCBs
2nd line therapy for pulmonary htn
direct pulmonary vasodilator (inhaled nitric oxide)
3rd line treatment for pulmonary htn
PDE-5 inhibitors
4th line treatment for pulmonary htn
Endothelin receptor antagonists (ERAs)
5th line treatment for pulmonary htn
Prostacyclin (oral, inhaled, parenteral)
6th and last line for pulmonary htn
soluble guanylate cyclase (sGC) stimulator (riociguat)
consider CCBs in _______ responders ______ right-sided failure or other contraindications to CCBs; do not use without positive ____
positive, without, AVT
What are the 3 recommended CCBs in pulmonary htn?
long-acting nifedipine 120-240 mg daily
long acting diltiazem 240-720 mg daily
amlodipine 20 mg daily
which CCB should be avoided due to negative inotropic effects
verapamil
T or F: Pressure is higher on left side of the heart
truee
what artery are we focused on for PAH
pulmonary artery lol
a mean pulmonary artery pressure (mPAP) greater than what is elevated
> 20 mmHg
what WHO group is PAH
WHO Group 1
what is the gold standard for diagnosis of pulmonary htn
right heart catheterization
