Pulmonary hypertension

Question 1

What is pulmonary hypertension?

Answer 1

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

Question 2

Symptoms of pulmonary hypertension

Answer 2

SOB
fatigue
syncope

Question 3

Signs of pulmonary hypertension

Answer 3

raised JVP
parasternal heave
loud P2
presence of S3 sound
pansystolic murmur (tricuspid regurgitation)
end-diastolic murmur (pulmonary regurgitation)

Question 4

Causes of pulmonary hypertension

Answer 4

parenchymal lung disease (COPD, chronic asthma, ILD, bronchiectasis, CF)

pulmonary vascular disease (idiopathic pulmonary hypertension, pulmonary vasculitis, pulmonary embolism, portal hypertension)

hypoventilation (sleep apnoea, kyphosis/scoliosis, neuromuscular conditions, eg. myasthenia gravis)

left heart disease (mitral stenosis, mitral regurgitation, left ventricular failure)

Question 5

Pulmonary hypertension investigations

Answer 5

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

echocardiogram

right heart catheterisation (gold standard) - shows mean pulmonary artery pressure >25 mmHg

Question 6

Management of pulmonary hypertension

Answer 6

treat underlying condition

avoid pregnancy (increases cardiac output, increases strain on right heart)

influenza, COVID-19 and pneumococcal vaccinations

reduction of pulmonary vascular resistance (LTOT, nifedipine, sildenafil, prostacycline analogues, bosentan)

manage heart failure

heart-lung transplant for selected cases

Question 7

What are the 5 clinical classifications of pulmonary hypertension?

Answer 7

1) Pulmonary arterial hypertension (PAH)

2) Left heart disease

3) Lung disease (cor pulmonale)

4) CTEPH (chronic thromboembolic pulmonary hypertension)

5) Unclear/multifactorial

Question 8

What is the most common subtype of pulmonary hypertension?

Answer 8

left heart disease (followed by lung disease)