Pulmonary HTN

Question 1

definition of pul HTN

Answer 1

A consistently increased pulmonary arterial pressure (>20 mmHg) under resting conditions.

Question 2

aetiology of pul HTN

Answer 2

primary - idiopathic

secondary

• Left heart disease (mitral valve disease, left ventricular failure, left atrial myxoma/thrombosis
• COPD
• recurrent PE
• increased pul blood flow - ASD, VSD, patent ductius arteriosus
• connective tissue disease - SLE, systemic sclerosis
• drugs - amiodarone

Question 3

epidemiology of pul HTN

Answer 3

young females

Question 4

sx of pul HTN

Answer 4

dyspnoea on exertion

chest pain

syncope

tiredness

symptoms of underlying cause eg chronic cough

Question 5

signs of pul HTN

Answer 5

JVP raised - prominent a wave

palpation - L parasternal heave (R ventricular hypertrophy)

auscultation

• Loud pulmonary component of S2(S3/S4may be heard),
• an early diastolic murmur (Graham–Steell murmur) caused by pulmonary regurgitation may be present, iftricuspid regurgitation develops (large cv wave and pansystolic murmur).

signs of underlying condition

signs of RHF if severe

Question 6

Ix for Pul HTN

Answer 6

CXR

ECG

echo = visulaise RV hypertrophy or dilation and possible underlying cause

LFT - assess for chronic lung disease

V/Q - assess PE

cardiac catheterisation

high res CT thorax -image pul arteries and diagnoses lung disease

lung biopsy - assesses structural lung changes

Question 7

CXR for pul HTN

Answer 7

cardiomegaly - RV enlargement, RA dilation

prominent main pulmonary arteries (which taper rapidly),

signs of the cause (e.g. COPD, calcified mitral valves).

Question 8

ECG for pul HTN

Answer 8

R ventricular hypertrophy - RAD, prominent R wave in V1, T inversion in V1,V2

RA enlargement - peaked P wave in II, called ‘P pulmonale’

limb leads exhibit low voltage (R<5 mm) in COPD.

Question 9

cardiac catheterisation for pul htn

Answer 9

assess severity

R heart pressures and response to vasodilators