Pulmonary Hypertension Flashcards
What is pulmonary hypertension?
It is defined as an increased blood pressure within the pulmonary arteries, specifically a mean arterial pressure greater than 25mmHg at rest
What is the pathophysiological result of pulmonary hypertension?
This increased pressure in the pulmonary arteries results in an increased strain on the right side of the heart and a back pressure of blood into the systemic venous system
What are the two classifications of pulmonary hypertension?
Primary Pulmonary Hypertension
Secondary Pulmonary Hypertension
What is primary pulmonary hypertension?
It is defined as pulmonary hypertension which is not related to an underlying cause
What is secondary pulmonary hypertension?
It is defined as pulmonary hypertension due to an underlying condition
What is the subclassifications of secondary pulmonary hypertension based on?
The specific underlying aetiology
What is group one secondary pulmonary hypertension?
Pulmonary hypertension related to connective tissue disease
What connective tissue disease is associated with pulmonary hypertension?
SLE
What is group two secondary pulmonary hypertension?
Pulmonary hypertension related to left heart disease
What is group three secondary pulmonary hypertension?
Pulmonary hypertension related to chronic lung disease
What three chronic lung diseases are associated with pulmonary hypertension?
COPD
Interstitial lung disease
Obstructive sleep apnoea
What is group four secondary pulmonary hypertension?
Pulmonary vascular disease
What pulmonary vascular disease is associated with pulmonary hypertension?
Pulmonary embolism
What is group five secondary pulmonary hypertension?
Pulmonary hypertension related to miscellaneous conditions
What three miscellaneous conditions are associated with pulmonary hypertension?
Sarcoidosis
Glycogen storage disorder
Haematological disorders
What ten clinical features are associated with pulmonary hypertension?
Dyspnoea
Syncope
Chest Pain
Peripheral Oedema
Tachycardia
Loud Pulmonary Component of S2
Third Heart Sound
Parasternal Heave
Increased JVP
Hepatomegaly
What is the main presenting clinical feature of pulmonary hypertension?
Dyspnoea
What are the clinical features of pulmonary hypertension related to?
The gradually worsening right ventricular function
What four investigations are used to diagnose pulmonary hypertension?
ECG Scan
Chest X-Ray (CXR)
Echocardiogram Scan
Right Heart Catheterisation
What is the first line investigation used to diagnose pulmonary hypertension? Why? However, what is important to remember?
ECG scan
It is a quick bedside investigation that can be conducted
It doesn’t provide a definitive diagnosis of pulmonary hypertension. In addition, normal results don’t exclude a diagnosis
In general, how does pulmonary hypertension present on an ECG scan?
There are features of right ventricular strain
What are the four signs of pulmonary hypertension on ECG scans?
Peaked R Waves in V1 – V3
Peaked S Waves in V4 – V6
Right Axis Deviation
Right Bundle Branch Block
What do peaked R and S waves indicate on an ECG scan?
Right ventricular hypertrophy
What are the two signs of pulmonary hypertension on CXR?
Dilated Pulmonary Arteries
Right Ventricular Hypertrophy
What investigation is used to provide a definitive diagnosis of pulmonary hypertension?
ECHO scan
How are ECHO scans used to diagnose pulmonary hypertension?
They allow an estimated pulmonary arterial pressure to be obtained
What other investigation is used to provide a definitive diagnosis of pulmonary hypertension?
Right heart catheterisation
How is right heart catheterisation conducted?
It involves the insertion of a catheter into the pulmonary artery
How are right heart catheterisations used to diagnose pulmonary hypertension?
They allow an estimated pulmonary arterial pressure to be obtained
In what four ways do we manage primary pulmonary hypertension?
IV Prostanoids
Endothelin Receptor Antagonists
Phosphodiesterase Inhibitors
Cardiopulmonary Transplant
Name a prostanoid used to manage primary pulmonary hypertension
Epoprostenol
Name two endothelia receptor antagonists used to manage primary pulmonary hypertension
Bosentan
Macitentan
Name a phosphodiesterase inhibitor used to manage primary pulmonary hypertension
Sildenafil
How is secondary pulmonary hypertension managed?
We treat the underlying cause
