Pulmonary HTN DSA

Question 1

Pulmonary HTN is defined as ________

Answer 1

Mean pulmonary arterial pressure of 25mmHg or greater at rest.

Question 2

When PH develops, it can lead to what?

Answer 2

Secondary effects on right-sided heart function and patient symptoms

Question 3

What are the etiologies for group 1-group 5 pulmonary HTN?

Answer 3

• Group 1 (PAH) = idiopathic and CT diseases
• Group 2 = PH secondary to heart (i.e., systolic, diastolic, valvular)
• Group 3 = PH secondary to lungs
• Group 4 = PH seconary to pulmonary emboli
• Group 5 = all others (i.e., hematologic, systemic, metabolic..)

Question 4

80% of PH are due to what?

Answer 4

• 1. Increase left-sided heart filling pressure (group 2)
• 2. Pulmonary disease (group 3)

Question 5

Mangement of idiopathic PAH is different from other causes because treatment is focused on _______.

Answer 5

Vasodilators

Question 6

What are the best predictors of prognosis for pulmonary HTN than pulmonary arterial pressure?

Answer 6

- Right-sided heart function

AND

• Functional status (as determined by 6-minute walk test)

Question 7

What are the most common symptoms of pulmonary HTN?

Answer 7

1. Fatigue

2. Dyspnea

Other: palpitations, chest pain

Question 8

What are signs of advanced PH?

Answer 8

Right ventricular decomposition including:

1. syncope
2. edema
3. ascites
4. hepatomegaly.

Question 9

Which finding on CXR is suggestive of pulmonary HTN?

Answer 9

Pulmonary artery enlargement

Question 10

What is needed to confirm the diagnosis of pulmonary HTN and to assess its cause if therapy is to be considered?

Answer 10

• Right heart catheterization*** and direct measurement of mean pulmonary artery pressure
• Echocardiography w/ estimated mean systolic pulmonary artery pressure of 40 mmHg or greater is highly suggestive

Question 11

Once PH is confirmed, what is the next step?

Answer 11

Eval is directed at determing cause, anatomic involvement and extent of vascular involment.

Question 12

What othe scans can be helpful in selected patients?

Answer 12

1. Imaging of chest to assess parenchymal lung disease
2. VQ scanning to assess thromboembolic dz
3. Serologic studies for CT, liver disease or HIV
4. B-type NP or troponins

Question 13

All patients suspected of having PAH should be considrered for what to confirm diagnosis and guide therapy?

Answer 13

Right heart/pulmonary artery catheterization

Question 14

How do we treat pulmonary HTN?

Answer 14

Treat underlying condtion