Pulmonary Hypertension Flashcards

1
Q

What is pulmonary hypertension?

A

Increased resistance and pressure of blood in the pulmonary arteries

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2
Q

What is there an increase of with pulmonary hypertension?

A

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

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3
Q

What can an increase in pulmonary arterial pressure result in?

A

Strain on the right side of the heart

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4
Q

How does increased pulmonary arterial pressure result in right heart strain?

A

Heart trying to pump blood through the lungs

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5
Q

What effect can increased pulmonary arterial pressure have on the venous system?

A

Can cause a back pressure of blood into the systemic venous system

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6
Q

What is the main presenting symptom of pulmonary hypertension?

A

Shortness of breath

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7
Q

What are other possible presenting symptoms of pulmonary hypertension?

A

Syncope
Tachycardia
Raised JVP
Peripheral oedema

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8
Q

What investigations would you carry out in someone with increased pulmonary arterial pressure?

A

ECG (MAIN)
Echocardiogram
Chest x-ray
Right heart catheterisation

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9
Q

What ECG changes would you see in someone presenting with pulmonary hypertension?

A

Right ventricular hypertrophy
Right axis deviation
Right bundle branch block

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10
Q

What changes might you see on a chest x-ray of someone with pulmonary hypertension?

A

Dilated pulmonary arteries
Right ventricular hypertrophy

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11
Q

What would right heart catheterisation show in someone with pulmonary hypertension?

A

Mean pulmonary artery pressure >25mmHg

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12
Q

What can the causes of pulmonary hypertension be divided into?

A

5 groups

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13
Q

What is group 1 pulmonary hypertension?

A

Primary pulmonary hypertension or
Connective tissue disease- SLE

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14
Q

What is group 2 pulmonary hypertension?

A

Left heart failure usually due to myocardial infarction or systemic hypertension

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15
Q

What is group 3 pulmonary hypertension?

A

Chronic lung disease- COPD

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16
Q

What is group 4 pulmonary hypertension?

A

Pulmonary vascular disease- pulmonary embolism

17
Q

What is group 5 pulmonary hypertension?

A

Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

18
Q

How can primary pulmonary hypertension be treated?

A

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

19
Q

How can secondary pulmonary hypertension be managed?

A

Treat the underlying cause such as pulmonary embolism or SLE.

20
Q

How can pulmonary vascular resistance be reduced?

A

Long term oxygen therapy, Nifedipine, Sildenafil, Prostacycline analogues, Bosentan (endothelin receptor antagonist)