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Pulmonology 2 > Pulmonary HTN and Cor Pulmonale > Flashcards

Pulmonary HTN and Cor Pulmonale Flashcards

1
Q

Pulmonary HTN def

A

elevated pressures in the pulmonary vasculature system

  • arterial from right ventricle
  • venous side coming back into the atrium
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2
Q

Cor Pulmonale def

A

elevated pressures in pulmonary vascular system leading to enlargement of the right side of the heart, usually the right ventricle

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3
Q

Right atrium pressure

A

5 mmHg

nickel

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4
Q

Left atrium pressure

A

10 mmHG

dime

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5
Q

Right ventricle pressure

A

25 mmHG quarter

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6
Q

left ventricle pressure

A

124 mmHG $1.25

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7
Q

what is normal pulmonary artery pressure

A

20/10

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8
Q

what is normal resting pulmonary artery pressure

A

around 15 mmHg

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9
Q

What pressure defines pulmonary hypertension

A

pulmonary artery pressure of =>25 mmHg

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10
Q

List of things that cause pulmonary hypertension

A
  1. Pulmonary arterial HTN (primary and secondary)
  2. Pulmonary venous HTN due to left sided heart disease
  3. Pulmonary hypertension associated with disorders of respiratory system
  4. Chronic thrombotic and/or embolic disease
  5. Disorders affecting pulmonary vasculature
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11
Q

Primary arterial PH

A
  • sporatic
  • familial
  • pathophys is in small pulmonary arteries and arterioles
  • increased contraction and decreased relaxation which elevates pressure
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12
Q

secondary arterial PH

A
  • collagen vascular disease (RA, lupus, etc.)
  • congenital: pulmonary left to right shunts, overload right side of heart
  • portal HTN - back pressure to right side of heart
  • HIV
  • drugs/toxins
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13
Q

Pulmonary venous HTN

A

left sided heart disease

  • ventricular heart disease
  • valvular heart disease
  • pulmonary veno-occlusive disease
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14
Q

what is pulmonary veno-occlusive disease?

A

veins returning to LA are clotted

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15
Q

PH associated with disorders of the respiratory system

A
  • COPD
  • Interstitial lung dz
  • sleep disordered breathing
  • alveolar hypoventilation disorders (central sleep disorder due to brain problem)
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16
Q

PH due to chronic thrombotic and embolic dz

A
  • thromboembolic obstruction of proximal pulmonary arteries (chronic emboli)
  • obstruction of distal pulmonary arteries (PE or sickle cell dz)
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17
Q

PH due to disorders affecting pulmonary vasculature

A
  • sarcoidosis (fibrosis interferes with circulation, similar to COPD)
  • scleroderma (collagen vascular dz)
18
Q

Two classifications of pathophysiology

A
  1. pre-capillary - problem is in pulmonary artery or arteriole
  2. passive - pressure is on left side of the pulmonary capillary, pulmonary venous side or “back pressure” usually due to left sided heart disease
19
Q

Mild clinical manifestations

A

fate and vague chest discomfort

20
Q

severe clinical manifestations

A

wide range

  • dyspnea (most common)
  • SOB
  • syncope
  • atypical chest pain
21
Q

true or false, PH is the most common cause of dyspnea when pt has PH

A

FALSE

  • would never jump to PAH if pt has dyspnea, would suspect many other things first
22
Q

PE findings with mild PH

A

no discernable physical findings

23
Q

what are two major heart sounds heard on every healthy heart

A

S1 and S2

24
Q

What is S1

A

closer of the AV valves

25
Q

What is S2

A

A2 and P2 which are aortic and pulmonary valves

26
Q

Which closes first, A2 or P2? Why?

A

A2
- pressure on the left side > right side so aortic pressure is higher which causes the aortic valve to close slightly faster than the pulmonic valve

27
Q

Which heart sound is louder when listen at the base of the hearT? why?

A

S2, because you’re physically closer to the aortic and pulmonary valves

28
Q

What happens on inspiration to heart sounds?

A

separation between A2 and P2

29
Q

Why is there separation between A2 and P2 on inspiration

A

when inspire, pressure in chest drops, causes blood to flow faster and longer into the lungs
- Increase in blood volume across pulmonary valve causes it to close slower

30
Q

what are two abnormal heart sounds

A

S3 and S4

31
Q

What are S3 & S4

A

soccer analogy:

  • sound of blood falling from atria to ventricles and “bouncing” bc ventricles are stiff and don’t give to cushion falling blood.
  • S3 early diastole
  • S4 late diastole
32
Q

what are common high frequency sounds

A

S1
S2
murmurs

*listen with diaphragm

33
Q

What are common low frequency sounds

A

gallops

*use bell

34
Q

which type of valve insufficiency is common

A

tricuspid insufficiency

35
Q

What are PE sx of PH

A
  1. increased intensity of P2
  2. murmurs of pulmonary and tricuspid insufficiency
  3. increased JVD
36
Q

Why is S2 louder in PH

A

loudness is determined by amt of blood coursing back towards right ventricle after ventricular contraction and how sudden the motion is arrested when the valve closes.

37
Q

why does PH have splitting of A2 and P2

A
  • takes longer to get blood into pulmonary circulation, takes longer for pulmonary valve to close.
  • “fixed splitting”
  • split on inspiration AND expiration
38
Q

where should S2 be loudest?

A

base

higher on chest

39
Q

5 dx tests

A 
Not useful:
- Hx and PE
- CXR
- EKG
More useful
- echo-cardiogram
Diagnostic
- Right heart cath
40
Q

Treatment of PH

A

pulmonologist or cardiologist :)

Except PE which is treated by generalist

Pulmonology 2 (17 decks)

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