Pulmonary Hypertension Flashcards
Suspect pulmonary hypertension in any pt with
Unexplained (no underlying heart/lung disease) dyspnea, especially on exertion
Pulmonary arterial hypertension characterized by
mPAP >25 at rest or >30 w exercise
Pulmonary hypertension group 1 + treatment
Pulmonary arterial hypertension (idiopathic/familial)
Drug/toxin induced
CHD
PPHN
Tx: pulmonary vasodilators, atrial septostomy, lung/heart transplant
Pulmonary hypertension group 2 + treatment
LVF: diuretics, beta blockers, ACE inhibitor
mitral stenosis: surgery
Pulmonary hypertension group 3
Lung disease
COPD: O2 therapy
ILD: O2 therapy
sleep disordered breathing: CPAP/BiPAP
ARDS
Pulmonary hypertension group 4
Thrombi/emboli
Anticoagulants, thrombolytics, pulmonary thromboendarterectomy
Pulmonary hypertension group 5 + treatment
Miscellaneous, treat underlying cause
Physical signs of pulmonary hypertension
Tachycardia at rest
Reduced pulse pressure
Desat w exertion
Signs of cor pulmonale in advanced stages
Recommending diagnostic tests for pulmonary hypertension
Gold standard: PA catheter (mild: mPAP <35, mod: 35-45, severe: >45)
IV/inhaled prostocyclins or INO (positive response: mPAP decreases by 10 or more)
Echocardiography
Chest CT
CXR
Electrocardiogram
Serum troponin
BNP
PFT/6MWT/CP exercise test
Treatment/DM
Pulmonary vasodilator therapy
Diuretics
Oral Thrombolytic therapy
O2 therapy
Vaccines
Lifestyle modifications
Pulmonary vasodilator therapy
Calcium channel blocker
Prostacyclins
PDE-5 inhibitors
ERAs
Calcium channel blockers only indicated for
PAH positive response to vasodilator test (INO)
First line therapy for newly diagnosed pts (group 1 or WHO 2+3)
ERA and PDE-5 inhibitor
Severe symptoms DM
Continuous parenteral prostacyclin therapy
When to use INO (adults)
PH w ARDS
PAH/acute RVF
