Pulmonary HTN & Cor Pulmonale Flashcards
Define pulm HTN (PAH)
- increased pulm a. pressure –> RV hypertrophy –> R side heart failure
What does the right ventricle best respond to?
- volume changes/expansion
Define Group 1 PAH
- increased pulm a. pressure with normal capillary wedge pressure
Define Group 2 PAH
- increased pulm a. pressure & pulm capillary wedge pressure
What is also seen in Group 2 PAH?
- left sided atrial or ventricular heart disease
- left sided valvular disease
Define Group 3 PAH?
- chronic hypoxia with mild increase of pulm a. pressure
Define Group 4 PAH?
- elevated pulm a. pressure with documented pulm a. obstruction for > 3mo
Define Group 5 PAH?
- elevated pulm a. pressure in association with systemic disease & unclear mechanism
What are the symptoms of PAH?
- dyspnea w/ exertion
- chest pain
- fatigue
- lethargy
- weakness
- syncope
What labs should be drawn for PAH and what does it show?
- CBC: polycythemia 2ndary to chronic hypoxia
What diagnostic studies should be ordered for PAH?
- CXR
- EKG
- Echo
What will a CXR show in PAH?
- enlarged pulmonary a.
What will an EKG show in PAH?
- RVH
- right atrial hypertrophy
- RV strain
What will an Echo show in PAH?
- ejection fraction
What is the 1 definitive diagnostic test for PAH?
- right heart cath
What is the treatment for Group 1 PAH?
- Ca+2 channel blockers
- endothelial receptor antagonists
- phosphodiesterase-5 inhibitors
- prostacyclines
- lung transplant
What is included in the group of prostacyclines used to treat Group 1 PAH?
- iloprost
- epopprostenol
- preprostinil
What is the treatment for Group 2-5 PAH?
- tx underlying dz
What is the f/u for PAH?
- q 3mo w/ labs prior to appt
Define cor pulmonale
- alteration in the structure & function of the RV caused by a primary disorder of the pulmonary system
What causes cor pulmonale?
- MC: PAH
What are the symptoms of chronic cor pulmonale related to?
- underlying dz
What are the S&S of cor pulmonale?
- dyspnea
- chronic productive cough
- wheezing
- fatigue/weakness
- orthopnea & PND
- LE edema
What is seen on PE in cor pulmonale?
- increased JVP
- V wave in JVP
- tachypnea
- RV palpable heave
- decreased ejection fraction
- hepatomegaly
- LE edema
- cyanosis & clubbing
What is the gold standard for diagnosing cor pulmonale?
- right heart cath
What are the other diagnostic tests for cor pulmonale?
- echo intitial test
- CXR
- PFTs
- spirometry & lung volumes
- ABG
- CT
- V/Q scan
What will be drawn for labs and what will be seen in cor pulmonale?
- CBC: polycythemia d/t hypoxia
- SaO2 less than or equal to 85%
What will be seen on PFTs in cor pulmonale?
- frequently abnormal
- MC: impaired diffusion capacity
- restrictive ventilatory defect
What is the treatment for cor pulmonale?
- tx underlying dz
- improve O2 & RV function by increasing RV contractility & decreasing pulmonary vasoconstriction
How is cor pulmonale managed?
- salt restriction
- smoking cessation
- vasodilators
- pt educations
What are complications of cor pulmonale?
- syncope
- hypoxia
- pedal edema
- passive hepatic congestion
- death
