Pulmonary HTN Flashcards
What is the heart disease secondary to lung disease known as?
Cor pulmonale
Leads to R ventricular failure
What lung diseases can lead to Cor Pulmonale?
Vascular in nature (PE)
Parenchymal (Chronic bronchitis or Pulm Fibrosis)
Hypoventilatory (Pickwickian)
What do many COPD’ers also die secondarily of?
Cor Pulmonale
What is the consequence of untreated pulmonary hypertension in PTs >50y/o age
Cor Pulmonale
Mean pulmonary arterial pressure must be greater than what value to Dx a PT with pulmonary HTN?
> 20mmHg
What is Group 1 Pulm HTN?
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
What is Group 2 Pulm HTN?
Pulm VENOUS HTN
Left Heart Dz
What is Group 3 Pulm HTN?
Hypoxemic Chronic lung Dz
COPD, ILD, High altitude
What is Group 4 Pulm HTN?
Chronic Thrombotic or Embolic Dz
PEs are the MC of sudden-onset Pulm HTN and R vent failure
What is Group 5 Pulm HTN?
Idiopathic Pulmonary HTN
Sarcoidosis Hematologic Disorder (myeloproliferative) Metabolic Disorder (Glycogen storage Dz)
MC complain of Severe Pulm HTN is….
Other S/Sx include:
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
One of the most notable Physical Exam findings of Pulm HTN would be auscultating what?
ACCENTUATED P2!!!!!
Late signs of R vent failure include:
JVD
Hepatomegaly
Ascites and/or Peripheral edema
Large V wave on EKG
What Diagnostic tests could be utilized to Dx Pulm HTN?
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)
What findings on an EKG would lead you to suspect a Pulm HTN?
RVH (lead 1) –> RAD
Peaked P wave (lead 2)
RBBB
RV strain pattern
How would you Tx a PT w/ pulm HTN?
Tx R heart failure (diuretics) O2 supplement Surg. thrombotic emboli Warfarin Heart/Lung transplant
Pulm HTN is characterized by elevated Mean Pulmonary Pressure greater than what? How is it obtained?
> 20 mmHg
R heart catheterization
What is the most common cause of sudden onset pulmonary HTN?
Pulmonary Emboli
What is a PT’s primary symptoms with pulm HTN?
Early:
Dyspnea on exertion
Lethargy and Fatigue
Late: R vent failure Exertional chest Px Syncope Edema
Diagnostic evaluation of a PT with potential Pulm HTN should begin with what study?
2D ECHO w/ doppler flow!
Advanced therapy is reserved for which Pulm HTN Group?
Pulm HTN Group 1 (Pulm Artery HTN)
