Pulmonary Hypertension

Question 1

what is pulmonary hypertension

Answer 1

increase in mean pulmonary arterial pressure (normally around 15mmHg)

Question 2

causes of pulmonary hypertension

Answer 2

Parenchymal lung disease: COPD, Chronic Asthma, Interstitial lung disease, bronchiectasis, cystic fibrosis

Pulmonary vascular disease: Idiopathic pulmonary hypertension, pulmonary vasculitis, pulmonary embolism, portal hypertension

Hypoventilation: Sleep apnea, kyphosis/scoliosis, neuromuscular conditions (e.g. myasthenia gravis)

Left Heart Disease: Mitral stenosis, mitral regurgitation, left ventricular failure

Question 3

how may pulmonary hypertension present (clinical features)

Answer 3

shortness of breath, fatigue, syncope

Question 4

signs of pulmonary hypertension on examination

Answer 4

raised JVP, parasternal heave, loud P2, S3 sound present, pansystolic murmur (tricuspid murmur) and end-diastolic murmur (pulmonary regurgitation)

Question 5

what murmurs will be present in pulmonary hypertension

Answer 5

pansystolic murmur (tricuspid regurgitation)

end-diastolic murmur (pulmonary regurgitation)

Question 6

what investigations will be done for pulmonary hypertension

Answer 6

ECG; P pulmonale, right ventricular hypertrophy, right axis deviation

echocardiogram

right heart catheterisation (gold standard)- increased pulmonary artery pressure

Question 7

management

Answer 7

Treat underlying condition

Reduction of pulmonary vascular resistance: Long term oxygen therapy, Nifedipine, Sildenafil, Prostacycline analogues, Bosentan (endothelin receptor antagonist)

Manage heart failure

Heart-lung transplant for selected cases