Pulmonary hypertension

Question 1

What is pulmonary HTN

Answer 1

increased resistance and pressure of blood in the pulmonary arteries. Increasing the pressure and resistance in the pulmonary arteries causes strain on the right side of the heart trying to pump blood through the lungs

Question 2

Causes of pulmonary hypertension

Answer 2

SLE
LVF 
COPD 
PE
Sarcoidosis

Question 3

Signs and symptoms of pulmonary HTN

Answer 3

SOB
Syncope 
Tachycardia 
Raised JVP 
Hepatomegaly 
Peripheral oedema

Question 4

ECG changes in pulmonary HTN

Answer 4

Right ventricular hypertrophy seen as larger R waves on the right sided chest leads (V1-3) and S waves on the left sided chest leads (V4-6)
Right axis deviation
Right bundle branch block

Question 5

CXR changes in pulmonary HTN

Answer 5

Dilated pulmonary arteries

Right ventricular hypertrophy

Question 6

Other relevant ix in pulmonary HTN

Answer 6

A raised NT-proBNP blood test result indicates right ventricular failure
Echo can be used to estimate pulmonary artery pressure

Question 7

Mx of primary pulmonary HTN

Answer 7

IV prostanoids (e.g. epoprostenol)
Endothelin receptor antagonists (e.g. macitentan)
Phosphodiesterase-5 inhibitors (e.g. sildenafil)

Question 8

Mx of secondary pulmonary HTN

Answer 8

managed by treating the underlying cause such as pulmonary embolism or SLE.

Supportive treatment for complications such as respiratory failure, arrhythmias and heart failure.