Pulmonary hypertension

Question 1

what is pulmonary hypertension?

Answer 1

increased resistance and BP in the pulmonary arteries

this can cause R sided heart strain as it’s trying to push blood into the high pressure lungs. this can therefore cause a back pressure of blood into the venous system

Question 2

what are the causes of pulmonary hypertension?

Answer 2

Group 1 – Primary pulmonary hypertension or connective tissue disease such as systemic lupus erythematous (SLE)

Group 2 – Left heart failure usually due to myocardial infarction or systemic hypertension

Group 3 – Chronic lung disease such as COPD

Group 4 – Pulmonary vascular disease such as pulmonary embolism

Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

Question 3

signs and symptoms of pulmonary hypertension

Answer 3

Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema.

Question 4

investigations for pulmonary hypertension

Answer 4

bedside:
ECG changes
*RVH V1-3, S wave V4-V6
*right axis deviation
*right BBB

bloods:
NT-proBNP (right ventricular failure)

imaging:
CXR - dilated pulmonary arteries RVH

Echo- to estimate pulmonary artery pressure

Question 5

management of pulmonary hypertension

Answer 5

poor prognosis (30-40% 5 year survival)

1’ pulmonary hypertension tx:
IV prostanoids
endothelia receptor antagonist
phosphodiesterase-5-inhibitors (sildenafil)

2’ pulmonary HTN
treat underlying cause (PE/SLE)

supportive of complications- res failure, arrhythmias, HF