Pulmonary hypertension

Question 1

What are the causes of pulmonary hypertension?

Answer 1

1. Primary arterial hypertension
   - HIV associated
   - Idiopathic/inherited
   - Veno-occlusive disease
2. PH secondary to left heart disease
   - Systolic dysfunction
   - Diastolic dysfunction
   - valvular disease
3. PH secondary to lung disease
   - COPD
   - ILD
   - OSA
4. CTEPH
5. Multifactorial/unclear aetiology
   - Sarcoid
   - Myeloproliferative disorders

Question 2

What is pulmonary hypertension?

Answer 2

Mean pulmonary artery pressure of >25mmHg

Question 3

How would you manage a patient with acute pulmonary hypertension?

Answer 3

Resuscitate in ABCDE approach.
Treat underlying cause.

1. Treat underlying cause
2. Optimise RV preload
   - Cautious fluids
   - Diuretics/RRT
3. Reduce RV afterload
   - Avoid: hypoxia, hypercapnia, atelectasis
   - Low ventilatory pressures, low PEEP
   - Pulmonary artery dilatation: Inhaled nitric oxide, Sildenafil (Prostacyclin)
4. Improve RV contractility
   - inotropes
   - Vaso over NA
5. Liase with specialist centres:
   - Pulmonary hypertension
   - ECMO