Pulmonary HTN

Question 1

What is the heart disease secondary to lung disease known as?

Answer 1

Cor pulmonale

Leads to R ventricular failure

Question 2

What lung diseases can lead to Cor Pulmonale?

Answer 2

Vascular in nature (PE)
Parenchymal (Chronic bronchitis or Pulm Fibrosis)
Hypoventilatory (Pickwickian)

Question 3

What do many COPD’ers also die secondarily of?

Answer 3

Cor Pulmonale

Question 4

What is the consequence of untreated pulmonary hypertension in PTs >50y/o age

Answer 4

Cor Pulmonale

Question 5

Mean pulmonary arterial pressure must be greater than what value to Dx a PT with pulmonary HTN?

Answer 5

> 20mmHg

Question 6

What is Group 1 Pulm HTN?

Answer 6

Idiopathic Pulm ARTERIAL HTN
HIV, Collagen Vasc. Dz, Congenital L to R shunts

R vent heart failure
FPAH mutation
Females > Males

Nitric Oxide Deficiency
Prostacyclin Deficiency
XS endothelin

Question 7

What is Group 2 Pulm HTN?

Answer 7

Pulm VENOUS HTN

Left Heart Dz

Question 8

What is Group 3 Pulm HTN?

Answer 8

Hypoxemic Chronic lung Dz

COPD, ILD, High altitude

Question 9

What is Group 4 Pulm HTN?

Answer 9

Chronic Thrombotic or Embolic Dz

PEs are the MC of sudden-onset Pulm HTN and R vent failure

Question 10

What is Group 5 Pulm HTN?

Answer 10

Idiopathic Pulmonary HTN

Sarcoidosis
Hematologic Disorder (myeloproliferative)
Metabolic Disorder (Glycogen storage Dz)

Question 11

MC complain of Severe Pulm HTN is….

Other S/Sx include:

Answer 11

Dyspnea on exertion (otherwise pretty asymptomatic in early stages)

Other S/Sx:  
Palpitations
FATIGUE and LETHARGY
Syncope w/ exertion
Hemoptysis
Cough
Hoarseness (laryngeal compression) from  dilated pulm artery

Question 12

One of the most notable Physical Exam findings of Pulm HTN would be auscultating what?

Answer 12

ACCENTUATED P2!!!!!

Question 13

Late signs of R vent failure include:

Answer 13

JVD
Hepatomegaly
Ascites and/or Peripheral edema
Large V wave on EKG

Question 14

What Diagnostic tests could be utilized to Dx Pulm HTN?

Answer 14

CXR and PFTs
CT or V/Q scan if cant handle contrast
EKG
2D ECHO w/ DOPPLER FLOW
Sleep Study
Cardiac Cath (R heart cath to monitor Pulm artery pressure)

Question 15

What findings on an EKG would lead you to suspect a Pulm HTN?

Answer 15

RVH (lead 1) –> RAD
Peaked P wave (lead 2)
RBBB
RV strain pattern

Question 16

How would you Tx a PT w/ pulm HTN?

Answer 16

Tx R heart failure (diuretics)
O2 supplement
Surg. thrombotic emboli
Warfarin
Heart/Lung transplant

Question 17

Pulm HTN is characterized by elevated Mean Pulmonary Pressure greater than what? How is it obtained?

Answer 17

> 20 mmHg

R heart catheterization

Question 18

What is the most common cause of sudden onset pulmonary HTN?

Answer 18

Pulmonary Emboli

Question 19

What is a PT’s primary symptoms with pulm HTN?

Answer 19

Early:
Dyspnea on exertion
Lethargy and Fatigue

Late:
R vent failure
Exertional chest Px
Syncope
Edema

Question 20

Diagnostic evaluation of a PT with potential Pulm HTN should begin with what study?

Answer 20

2D ECHO w/ doppler flow!

Question 21

Advanced therapy is reserved for which Pulm HTN Group?

Answer 21

Pulm HTN Group 1 (Pulm Artery HTN)