Pulmonary Hypertension

Question 1

What is a pulmonary hypertension?

Answer 1

Elevated blood pressure in pulmonary artery
Pulmonary artery pressure > 25mmHg
Can be primary or secondary to a condition.

Question 2

What are the causes of pulmonary hypertension

Answer 2

Idiopathic (1)
Secondary to left heart disease (2)
Secondary to chronic respiratoyr disease (3)
Chronic thromboembolic PH (4)
Miscellaneous (5): sarcoidosis, cogenital heart disease (left right shunt)

Question 3

What are the symptoms of pulmonary hypertension?

Answer 3

Exertional breathlessness
Chest tightness
Exertional syncope (blackout) and presyncope (dizziness)
Haemoptysis

Question 4

What are the signs of pulmonary hypertension?

Answer 4

Elevated Jugular venous pressure
Right ventricular heave 
Loud pulmonary second heart sound 
Hepatomegaly 
Ankle oedema

Question 5

What investigations are carried out for pulmonary hypertension?

Answer 5

ECG
Lung function test
Chest x-ray
Echocardiography (ultrasound of heart)
V/Q scandal
Right heart catherisation

Question 6

What is right heart catheristion?

Answer 6

Passing a catheter into the right side of the heart into the pulmonary artery which allows direct measure of pulmonary artery pressure. Measurement of wedge pressure. Measurement of cardiac output

Question 7

How is pulmonary hypertension treated?

Answer 7

Treat underlying condition 
Oxygen 
Anticoagulation
Diuretics 
Lung or heart transplant
Thromboendarterectomy

Question 8

What is a pulmonary embolism?

Answer 8

Thrombus forms in the venous system, usually in the deep veins of the legs and embolisms the pulmonary artery. It can be fatal.

Question 9

What are the risk factors for venous thromboembolism?

Answer 9

Recent major trauma
Recent surgery
Cancer
Cardiopulmonary disease
Pregnancy
Inherited theombophilia

Question 10

What are the presenting symptoms of pulmonary embolism?

Answer 10

Pleuritic chest pain, cough and haemoptysis (spontaneous pulmonary embolismm)
Isolated acute dysponea (bilateral small pulmonary embolism)
Syncope or cardiac arrest (massive pulmonary embolism)

Question 11

What are the signs of pulmonary embolism?

Answer 11

Pyrexia, pleural rub, stony dullness to percussion at base
Tachycardia, tachypnoea, hypoxia
Tachycardia, hypotension, tachypnoea, hypoxia

Question 12

What investigations are carried out for pulmonary embolism?

Answer 12

Full blood count
Chest X-Ray
V/Q scan
Blood gases

Question 13

What is the treatment for pulmonary embolism?

Answer 13

Oxygen
Low molecular weight heparin
Direct oral anticoagulant (rivaroxaban, apixaban)
Thrombolysis - lysine blood clot and restoring circulation.

Question 14

What is the prognosis of pulmonary embolism?

Answer 14

• Massive PE can be fatal
• Minor PE treated with anticoagulation has a very good prognosis

-Mortality at 30 days varies from 0 to 25%

Question 15

Describe the diagnosis of PE?

Answer 15

• Over diagnosed as it is often suspected when it isn’t there
• Underdiagnosed as true diagnosis of PE is often missed

Question 16

Why are you at increased risk of developing a venous thromboembolism id you have recently had surgery or a major trauma?

Answer 16

Your clotting system will be active and therefore you are more likely to develop clots. You are also less likely to be active and so the blood supply to the legs slows.

Question 17

When would symptoms of pulmonary embolism include pleuritic chest pain, cough and haemoptysis?

Answer 17

• A small clot lodging in a small peripheral artery
• The part of the lung becomes infarcted and as a result haemoptysis

-The surface of the lung becomes inflamed and rubs across the chest wall

Question 18

When would symptoms of pulmonary embolism include syncope or cardiac arrest?

Answer 18

• Large blood clot blocks the main pulmonary artery

- Reduction in cardiac output from heart reduces blood flow to the brain

Question 19

What pre-test probability tests are there?

Answer 19

Wells score

Revised geneva score

Question 20

What is included in the wells score?

Answer 20

Symptoms and signs of VTE, previous VTE and risk factors

Question 21

What is included in the revised geneva score?

Answer 21

Based on risk factors, symptoms and signs

Question 22

What do you need to pay extra attention to in the echocardiogram?

Answer 22

Right ventricle

Question 23

What is the D-dimer test?

Answer 23

Blood test of the product of clotting cascade of the blood

Question 24

What test is used in the prognosis of PE?

Answer 24

PESI score

Question 25

What is the PESI score based on?

Answer 25

Age, sex, comorbidity and physiological parameters

Question 26

How long is a patient usually treated for PE?

Answer 26

• Usually for 3 months

- If patient is at risk of reoccurrence then they might be put on lifelong anticoagulants

Question 27

What happens if pulmonary hypertension is left untreated?

Answer 27

It is a rapidly progressive condition that leads to premature death

Question 28

What is the epidemiology of secondary pulmonary hypertension?

Answer 28

• It is more common than primary

- Tends to occur in an older age group

Question 29

What are the specific treatments for pulmonary hypertension?

Answer 29

• Calcium channel antagonist
• Prostacyclin
• Endothelin receptor antagonists
• Phosphodiester inhibitors