Pulmonary Hypertension Flashcards
What is a pulmonary hypertension?
Elevated blood pressure in pulmonary artery
Pulmonary artery pressure > 25mmHg
Can be primary or secondary to a condition.
What are the causes of pulmonary hypertension
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)
What are the symptoms of pulmonary hypertension?
Exertional breathlessness
Chest tightness
Exertional syncope (blackout) and presyncope (dizziness)
Haemoptysis
What are the signs of pulmonary hypertension?
Elevated Jugular venous pressure Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
What investigations are carried out for pulmonary hypertension?
ECG Lung function test Chest x-ray Echocardiography (ultrasound of heart) V/Q scandal Right heart catherisation
What is right heart catheristion?
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
How is pulmonary hypertension treated?
Treat underlying condition Oxygen Anticoagulation Diuretics Lung or heart transplant Thromboendarterectomy
What is a pulmonary embolism?
Thrombus forms in the venous system, usually in the deep veins of the legs and embolisms the pulmonary artery. It can be fatal.
What are the risk factors for venous thromboembolism?
Recent major trauma Recent surgery Cancer Cardiopulmonary disease Pregnancy Inherited theombophilia
What are the presenting symptoms of pulmonary embolism?
Pleuritic chest pain, cough and haemoptysis (spontaneous pulmonary embolismm)
Isolated acute dysponea (bilateral small pulmonary embolism)
Syncope or cardiac arrest (massive pulmonary embolism)
What are the signs of pulmonary embolism?
Pyrexia, pleural rub, stony dullness to percussion at base
Tachycardia, tachypnoea, hypoxia
Tachycardia, hypotension, tachypnoea, hypoxia
What investigations are carried out for pulmonary embolism?
Full blood count
Chest X-Ray
V/Q scan
Blood gases
What is the treatment for pulmonary embolism?
Oxygen
Low molecular weight heparin
Direct oral anticoagulant (rivaroxaban, apixaban)
Thrombolysis - lysine blood clot and restoring circulation.
What is the prognosis of pulmonary embolism?
- Massive PE can be fatal
- Minor PE treated with anticoagulation has a very good prognosis
-Mortality at 30 days varies from 0 to 25%
Describe the diagnosis of PE?
- Over diagnosed as it is often suspected when it isn’t there
- Underdiagnosed as true diagnosis of PE is often missed
Why are you at increased risk of developing a venous thromboembolism id you have recently had surgery or a major trauma?
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.
When would symptoms of pulmonary embolism include pleuritic chest pain, cough and haemoptysis?
- 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
When would symptoms of pulmonary embolism include syncope or cardiac arrest?
- Large blood clot blocks the main pulmonary artery
- Reduction in cardiac output from heart reduces blood flow to the brain
What pre-test probability tests are there?
Wells score
Revised geneva score
What is included in the wells score?
Symptoms and signs of VTE, previous VTE and risk factors
What is included in the revised geneva score?
Based on risk factors, symptoms and signs
What do you need to pay extra attention to in the echocardiogram?
Right ventricle
What is the D-dimer test?
Blood test of the product of clotting cascade of the blood
What test is used in the prognosis of PE?
PESI score
What is the PESI score based on?
Age, sex, comorbidity and physiological parameters
How long is a patient usually treated for PE?
- Usually for 3 months
- If patient is at risk of reoccurrence then they might be put on lifelong anticoagulants
What happens if pulmonary hypertension is left untreated?
It is a rapidly progressive condition that leads to premature death
What is the epidemiology of secondary pulmonary hypertension?
- It is more common than primary
- Tends to occur in an older age group
What are the specific treatments for pulmonary hypertension?
- Calcium channel antagonist
- Prostacyclin
- Endothelin receptor antagonists
- Phosphodiester inhibitors
