Pulmonary Hypertension

Question 1

What is pulmonary hypertension?

Answer 1

Pulmonary arterial blood pressure >25 mmHg

Question 2

What are the main causes of pulmonary hypertension?

Answer 2

Left heart disease, lung disease/ hypoxia, thromboembolic hypertension, chronic thromboembolic hypertension

Question 3

What are the three main mechanisms for pulmonary hypertension?

Answer 3

Increase in left atrial pressure, increase in pulmonary blood flow, increase in pulmonary vascular resistance

Question 4

What can increase left atrial pressure?

Answer 4

• Mitral valve stenosis/ regurgitation
• Increased left ventricle pressure
• Loss of LA compliance

Question 5

What can cause an increase in pulmonary blood flow?

Answer 5

• Congenital heart disease, -Left to right shunts

- Mix up in pulmonary and systemic circulation

Question 6

What can cause an increase in pulmonary vascular resistance?

Answer 6

• Vasoconstriction caused by hypoxia
• Obliterative (capillary bed is broken up and blood can’t flow easily (emphysema)
• Obstructive (COPD)

Question 7

What is the treatment for pulmonary hypertension?

Answer 7

-Treat underlying cause

Question 8

What are some risk factors for pulmonary hypertension?

Answer 8

• Family history
• Women
• Overweight/ obesity
• Blood clotting disorder
• Exposure to asbestos
• Congenital heart disease
• Living at high altitude
• Cocaine/ meth
• Serotonin uptake re-inhibitors

Question 9

What are the symptoms for pulmonary hypertension? (Think smoker)

Answer 9

• Dyspnoea on exertion
• Fatigue
• Syncope
• Angina
• Hemophysis (coughing blood)
• Raynauds phenomenon (fingers, toes feel cold)

Question 10

What are the NYHA classifications?

Answer 10

Class 1 - Without limitation of PA
Class 2 - Slight limitation during PA, no symptoms at rest
Class 3 - Marked limitation of PA, some symptoms at rest
Class 4 - Inability to do PA, symptoms at rest

Question 11

What are some effects on exercise in pulmonary hypertension?

Answer 11

• Reduced stroke volume
• Reduced VO2peak
• Reduced ventilatory threshold
• Increase VE/VCO slope (dead space)
• Reduced peripheral oxygen uptake
• Desaturation during exercise

Question 12

What are some recommendations for exercise testing?

Answer 12

6MWT, patients who score above 450m can undergo a CPET

Question 13

What are some test terminations for pulmonary hypertension?

Answer 13

Light-headedness, chest pain, severe dyspnoea, pale appearance

Question 14

What are some recommendations for exercising?

Answer 14

• Follow recommendations on the other extreme conditions

- No guidelines for PH specifically

Question 15

What are some complications to consider during exercise?

Answer 15

• Hypoxia
• Supraventricular tachycardia
• Hypotension
• Right bundle branch block
• Presyncope