Pulmonary Hypertension Flashcards
What is pulmonary hypertension and what does it cause on CXR?
Increased resistance and pressure of blood in pulmonary arteries. It causes dilation of pulmonary arteries and right ventricular hypertrophy.
What are the causes of pulmonary hypertension?
- Primary PH or connective tissue disease i.e SLE
- Left sided heart failure due to MI or systemic hypertension
- Pulmonary vascular problems i.e PE
- Chronic lung disease i.e COPD
- Miscellaneous: sarcoidosis, haematological, glycogen storage disease
Signs and symptoms of pulmonary hypertension?
SOB, tachycardia, syncope, hepatomegaly, Raised JVP and peripheral oedema
What ECG changes would you see in pulmonary hypertension?
Right axis deviation
Right bundle branch block
Right ventricular hypertrophy: large R waves on V1-3 and large S waves on leads 4-6
What other investigations can you do for pulmonary hypertension?
Raised NT-proBNP (right ventricular failure)
Echo- pulmonary arterial pressure
Prognosis for pulmonary hypertension?
Poor- 30-40% 5 year survival
Primary pulmonary hypertension management?
- IV Prostanoids (epoprostenol)
- Endothelium receptor antagonists (macitentan)
- Phosphodiesterase 5 inhibitors (sildenafil)
Management of secondary pulmonary hypertension?
Treat underlying cause i.e SLE or PE
What is cor pulmonale?
Right sided heart failure caused by respiratory disease.
Common causes of cor pulmonale?
COPD most common, PE, cystic fibrosis, interstitial lung disease, primary pulmonary hypertension
Presentation of cor pulmonale?
SOB, hypoxia, cyanosis, peripheral oedema, hepatomegaly, syncope, chest pain, raised jvp, 3rd heart sound, tricuspid regurgitation murmurs. When you have tricuspid regurgitation, blood flowing backwards causes pulsation heaptomegaly
Management of cor pulmonale?
Treat underlying cause/symptoms. Long term oxygen therapy
