Pulmonary hypertension

Question 1

Define pulmonary hypertension

Answer 1

An increase in mean pulmonary arterial pressure which can be caused by or associated w/ a wide variety of other conditions

Question 2

Aetiology of pulmonary hypertension

5

Answer 2

Idiopathic
Problems w/ smaller branches of pulmonary arteries
Left ventricular failure
Lung disease (e.g. COPD, interstitial lung disease)
Thromboses/emboli in lungs

Question 3

Epidemiology of pulmonary hypertension

2

Answer 3

Idiopathic pulmonary hypertension is RARE

More common in severe respiratory & cardiac disease

Question 4

Presenting symptoms of pulmonary hypertension

5

Answer 4

Progressive breathlessness
Weakness/tiredness
Exertional dizziness & syncope
LATE STAGE - oedema & ascites
Angina & tachyarrhythmia

Question 5

Signs of pulmonary hypertension on physical examination

7

Answer 5

Right ventricular heave
Loud pulmonary 2nd heart sounds 
Murmur - pulmonary regurgitation 
Tricuspid regurgitation 
Raised JVP
Peripheral oedema 
Ascites

Question 6

Investigations for pulmonary hypertension

7

Answer 6

CXR - exclude other lung disease
ECG - right ventricular hypertrophy & strain
Pulmonary function tests
LFTs - liver damage —> portal hypertension
Lung biopsy - interstitial lung disease
Echocardiography - assess right ventricular function
Right heart catheterisation - directly measure pulmonary pressure & confirm diagnosis