Pulmonary hypertension Flashcards
Pulmonary hypertension
Increased resistance and pressure of blood in the pulmonary arteries
Causes strain on right side of the heart and back pressure of blood into the systemic venous system
Group 1 causes
Primary pulmonary hypertension or connective tissue diseases such as SLE
Group 2 causes
Left heart failure usually due to MI or systemic HTN
Group3 causes
Chronic lung disease such as COPD
Group 4 causes
Pulmonary vascular disease such as PE
Group 5 causes
Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders
Signs and symptoms
SOB is main presenting symptom
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema
ECG changes
Right ventricular hypertrophy seen as larger R waves on right sided chest leads (V1-3) and S waves on left sided chest leads (V4-6)
Right axis deviation
RBBB
CXR changes
Dilated pulmonary arteries
Right ventricular hypertrophy
Other investigations
Raised NT-proBNP indicates right ventricular failure
Echo used to estimate pulmonary artery pressure
Prognosis
30-40% 5-year survival from diagnosis
Can increase to 60-70% where specific treatment possible
Primary pulmonary HTN treatment
IV prostanoids
Endothelin receptor antagonists
Phosphodiesterase-5 inhibitors
Secondary pulmonary HTN management
Treat the underlying cause
