Pulmonary hypertension

Question 1

What is pulmonary hypertension?

Answer 1

Consistently increased pulmonary arterial pressure of over 20 mmHg under rest

Question 2

What is the aetiology of pulmonary hypertension?

Answer 2

• PRIMARY: idiopathic
• SECONDARY: left heart disease, COPD, PE, increased pulmonary flow (from septal defects and patent ductus arteriosus), connective tissue diseases (SLE, systemic sclerosis), drugs such as amiodarone

Question 3

What is the epidemiology of primary pulmonary hypertension: Age? Gender?

Answer 3

Young females.

Question 4

What are the signs and symptoms of pulmonary hypertension? (x5)

Answer 4

• Dyspnoea (on exertion) and fatigue
• Chest pain
• Syncope
• RIGHT VENTRCIULAR HYPERTROPHY: Left parasternal heave and raised JVP
• AUSCULTATION: Loud pulmonary component of S2, S3/4 may also be heard. An early diastolic murmur caused by pulmonary regurgitation

Question 5

What are the investigations for pulmonary hypertension? (x7)

Answer 5

• CXR: cardiomegaly, prominent main pulmonary arteries which taper rapidly, signs of cause such as COPD
• ECG: right ventricular hypertrophy, right atrial enlargement, limb leads may show low voltage in COPD
• ECHOCARDIOGRAPHY: right ventricular hypertrophy or dilation
• LUNG FUNCTION TESTS: assess for chronic lung disease
• VQ SCAN: assess for PE
• CARDIAC CATHETERISATION: assess severity with right heart pressures
• CT/LUNG BIOPSY: structural lung changes may be aetiology