Pulmonary Hypertension

Question 1

Define pulmonary hypertension (PHTN)

Answer 1

Elevated pressures in the arterials in the lungs as a result of RV failure (back up of pressures)

Question 2

What is the mPAP of PHTN

Answer 2

> 25mmHg

Question 3

Compare PHTN and PAH

Answer 3

PHTN is secondary to RV failure and PAH is brought on by structural changes in small pulmonary arteries

Question 4

What PHTN category is from post capillary stress?

Answer 4

Category 2- PHTN due to LT heart disease

Question 5

What PHTN categories are from pre capillary causes?

Answer 5

PAH, PHTN due to lung disease, PHTN due to clot in lung, PHTN due to blood and other disorders

Question 6

What are the signs and symptoms of PHTN?

Answer 6

Symptoms: SOB, coughing, wheezing, hemoptysis

Question 7

What are the signs of RT CHF?

Answer 7

Jugular vein congestion, peripheral edema, ascites, hepato-splenomegaly

Question 8

What type of murmur is heard on auscultation with PHTN?

Answer 8

P2 holosystolic (TR)

Question 9

What are normal RT heart pressures

Answer 9

RA & IVC 0-4mmHg
RV <25/<10
PA <25/<10

Question 10

What is the most common cause for increased RT sided pressures?

Answer 10

Left sided heart failure

Question 11

What are the 3 pulmonary causes of increased RT side pressures?

Answer 11

Parenchymal, vascular disease, cor pulmonale

Question 12

What is cor pulmonale

Answer 12

Right sided heart failure SECONDARY to lung condition

Question 13

Compare acute and chronic cor pulmonale

Answer 13

No RVH in acute as it is sudden,

Chronic there is RVH, RV dilation, RA enlargement due to prolonged pressure overload.

Question 14

What is Eisenmenger’s syndrome

Answer 14

Shunt reversal, from RT to LT

Question 15

What are the 3 causes of PHTN

Answer 15

LT sided causes, shunting, embolus

Question 16

What is the RVSP equation?

Answer 16

SPAP=RVSP

RVSP=RAP + (4Vtr^2)

Question 17

What RVSP would indicate PHTN

Answer 17

> 35mmHg

Question 18

What should the TR peak velocity be less than?

Answer 18

<2.8m/s

Question 19

mPAP = 79 - (0.45 x PAT)

Answer 19

Yes

Question 20

How will the RT sided heart appear on ultrasound?

Answer 20

Enlarged RV, hypokinetic RV, septal shifting, enlarged RA, TR, dilated PA, PR, dilated IVC/SVC, RV apical dominance, RV > LV

Question 21

what is a normal TAPSE?

Answer 21

> /= 1.7cm

Question 22

How to differentiate between and RV pressure overload vs and RV volume overload?

Answer 22

RVPO= “D” sign, does not change throughout the cycle ****
RVVO= “D” sign in diastole only

Question 23

Is mitral stenosis considered a pre or post capillary cause of PHTN?

Answer 23

Post-capillary

Question 24

In severe PHTN from a post capillary cause, what happens to RV systolic function?

Answer 24

It decreases

TAPSE and S’ decrease

Question 25

How would you calculate RVSP when given a systolic BP and a VSD peak velocity?

Answer 25

4(Peak Vel)^2 = a BP

Sys BP - Dias BP

Question 26

A PR jet has an early diastolic peak velocity of 3.75 m/s. The IVC is 2.6cm and non collapsing. Is there PHTN and how bad is it?

Answer 26

Severe