Pulmonary hypertension Flashcards
Physiology of pulmonary hypertension?
increased resistance and pressure of blood in the pulmonary arteries
Increasing the pressure and resistance in the pulmonary arteries causes strain on the right side of the heart trying to pump blood through the lungs
Causes a back pressure of blood into the systemic venous system
Causes of pulmonary hypertension?
The causes of pulmonary hypertension can split into 5 groups:
Group 1 – Primary pulmonary hypertension or connective tissue disease such as systemic lupus erythematous (SLE)
Group 2 – Left heart failure usually due to myocardial infarction or systemic hypertension
Group 3 – Chronic lung disease such as COPD
Group 4 – Pulmonary vascular disease such as pulmonary embolism
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders
Signs and symptoms of pulmonary hypertension?
Shortness of breath is the main presenting symptom.
Other signs and symptoms are:
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema.
Investigations for pulmonary hypertension?
ECG
X ray
A raised NT-proBNP blood test indicating right ventricular failure
Echo can be used to estimate pulmonary artery pressure
ECG changes with pulmonary hypertension
The right sided heart strain causes ECG changes such as:
- Right ventricular hypertrophy seen as larger R waves on the right sided chest leads (V1-V3) and S waves on the left sided chest leads (V4-6)
- Right axis deviation
- Right bundle branch block
Chest Xray changes with pulmonary hypertension?
Dilated pulmonary arteries
Right ventricular hypertrophy
Prognosis of pulmonary hypertension
The prognosis is quite poor with a 30-40% 5-year survival from diagnosis. This can increase to 60-70% where specific treatment is possible.
Primary pulmonary hypertension can be treated with:
IV prostanoids (eg epoprostenol)
Endothelin receptor antagonist (eg macitentan)
Phosphodiesterase-5-inhibitors (eg sildenafil)
Secondary pulmonary hypertension is managed by?
treating the underlying cause such as pulmonary embolism or SLE
