Pulmonary HTN + Cor Pulmonale

Question 1

Pulmonary HTN

Answer 1

PA pressure >25mmHg

Question 2

Causes of pulmonary HTN

Answer 2

Left Heart Disease:

• Mitral stenosis or regurgitation
• Left ventricular failure

Lung Parenchymal Disease
COPD
Severe asthma
Interstitial lung disease
CF, bronchiectasis

Pulmonary Vascular Disease:

• Pulmonary embolism: acute or chronic
• Portal HTN

Hypoventilation

Thoracic cage abnormality: kyphosis, scoliosis

Question 3

How does lung parenchymal disease cause pulmonary HTN

Answer 3

Chronic hypoxia due to V/Q mismatch → hypoxic vasoconstriction

Question 4

Ix

Answer 4

Respiratory examination 
Basic obs
ECG
Echo - valves 
Right heart catheterisation: gold standard

Question 5

Cor Pulmonale

Answer 5

RHF due to chronic pulmonary HTN

Question 6

Symptoms of cor pulmonale

Answer 6

Dyspnoea
Fatigue
Syncope

Question 7

Signs of cor pulmonale

Answer 7

1. ↑ JVP
2. Left parasternal heave
3. Loud P2 ± S3
4. Murmurs
5. Pulsatile hepatomegaly
6. Fluid: Ascites + Peripheral oedema

Question 8

Ix of Cor pulmonale

Answer 8

Cardio- resp examination 
Basic obs
Bloods: FBC, U+E, LFTs, CRP, ANA, RF
ABG: hypoxia ± hypercapnoea
CXR
ECG
Echo: RVH
Right heart catheterisation

Question 9

Mx of cor pulmonale

Answer 9

Tx underlying condition

• Long term oxygen therapy
• CCB: e.g. nifedipine

Cardiac failure:

• ACEi + β-B
• Diuretics

Question 10

Cor pulmonale pathogenesis

Answer 10

1. Lung disorder causes poor ventilation of alveoli
2. Vasoconstriction of pulmonary arteries to compensate
3. Pulmonary HTN
4. Back flow to right ventricle causes hypertrophy
5. Right ventricular HF

Question 11

Obstructive sleep apnoea

Answer 11

Intermittent closure/collapse of pharyngeal airway →

apnoeic episodes during sleep

Question 12

Risk factors for sleep apnoea

Answer 12

Obesity
Male
Smoker
EtOH
Idiopathic pulmonary fibrosis

Question 13

Mx of sleep apnoea

Answer 13

Wt. loss
Avoid smoking and EtOH
CPAP during sleep