Pulmonary Hypertension Flashcards
What is the prevalence of pulmonary hypertension?
1 - 12 million
2 - 8 million
3 - 4 million
4 - 500,000
2 - 8 million
- most common in 30-40s
- more common in women
- greater incidence in Afro-Caribbean females
What is the incidence of pulmonary hypertension?
1 - 4-6 million
2 - 2-5 million
3 - 1-2 million
4 - 250 - 500,000
3 - 1-2 million
Which of the following is NOT part of the pulmonary circulation?
1 - pulmonary arteries
2 - pulmonary veins
3 - pulmonary arterioles
4 - alveoli
5 - pulmonary capillaries
4 - alveoli
What is the normal pulmonary pressure?
1 - 10/25mmHg
2 - 25/10mmHg
3 - 100/50mmHg
4 - 120/80mmHg
2 - 25/10mmHg
- mean arterial pressure is 15mmHg
Pulmonary hypertension relates to an increase in the pressure in the pulmonary circulation. An increase in what is diagnostic of pulmonary hypertension?
1 - >25mmHg
2 - >50mmHg
3 - >100mHg
4 - >200mmHg
1 - >25mmHg
Pulmonary hypertension can be graded as mild, moderate and severe. If the normal pressure is 25-30mmHg (rest and exertion) what is classed as mild pulmonary hypertension?
1 - >65mmHg
2 - >45mmHg
3 - 36-45mmHg
4 - 26-35mmHg
4 - 26-35mmHg
Pulmonary hypertension can be graded as mild, moderate and severe. If the normal pressure is 25-30mmHg (rest and exertion) what is classed as moderate pulmonary hypertension?
1 - >65mmHg
2 - >45mmHg
3 - 36-45mmHg
4 - 26-35mmHg
3 - 36-45mmHg
Pulmonary hypertension can be graded as mild, moderate and severe. If the normal pressure is 25-30mmHg (rest and exertion) what is classed as severe pulmonary hypertension?
1 - >65mmHg
2 - >45mmHg
3 - 36-45mmHg
4 - 26-35mmHg
2 - >45mmHg
Commonly see:
- abnormal RV size and function
- paradoxical septal motion
- abnormal pulmonic valve motion
There are 5 groups of pulmonary hypertension (PHT) based on the classification, but which is most common?
1 - Pulmonary arterial hypertension (idiopathic)
2 - PHT due to left heart disease (left sides HF and/or valvular disease))
3 - PHT due to lung disease/hypoxia (COPD, ILD, obstructive sleep apnea)
4 - Chronic thromboembolic PHT (PE)
5 - PHT - multi-factorial mechanism
2 - PHT due to left heart disease (left sides HF and/or valvular disease))
- pressure builds up in pulmonary vein and then eventually into the pulmonary artery
What is the definition of left sided HF based on ejection fraction?
1 - <75%
2 - <50%
3 - <40%
4 - <25%
3 - <40%
- <50% moderate HF
The New York Heart Association (NYHA) is the guidelines to identify how much HF is affecting patients. How many levels are there?
1 - 3
2 - 4
3 - 5
5 - 6
2 - 4
Patients with pulmonary hypertension typically don’t present immediately as symptoms are non-specific and early diagnosis is difficult. What is the mean time from onset to diagnosis typically?
1 - 12 weeks
2 - 6 months
3 - 12 months
4 - >2 years
4 - >2 years
- 10% of cases symptoms preceded diagnosis by > 3 years
- has a high morbidity and mortality
Chronic lung disease such as COPD, ILD and obstructive sleep apnea can all cause an increase in pulmonary hypertension. How is this caused?
1 - blood flow is reduced in parts of the lungs
2 - alveoli are damaged and unable to exchange O2 and CO2
3 - lungs hyper inflate and increase constriction of blood vessels
4 - scar tissue in lungs spreads to pulmonary capillaries
2 - alveoli are damaged and unable to exchange O2 and CO2
- pulmonary blood vessels constrict to divert blood away from damaged lung tissue
- lots of damaged lung tissue causes lots of vasoconstriction and increased pulmonary pressure
If there is damaged lung tissue that cannot exchange O2 and CO2 the pulmonary blood vessels vasoconstrict to divert blood to health lung tissue. However, lots of damaged tissue in lung disease causes lots of vasoconstriction and increased pulmonary vascular resistance. What then happens to the heart?
1 - LA reduces pressure and dilates
2 - RV has to increase pressure to pump blood
3 - RA increase pressure as pressure is reduced in RV
4 - pressure in all chambers is increased
2 - RV has to increase pressure to pump blood
- this leads to pulmonary hypertension
How does chronic thromboemboli cause pulmonary hypertension?
1 - clotting disorder leads to formation of multiple emboli
2 - emboli become trapped in pulmonary blood vessels and occulude vessels
3 - pulmonary blood vessels release histamine and serotonin that cause vasoconstriction
4 - all of the above
4 - all of the above
Congenital heart defects can cause pulmonary hypertension. Which of the following is NOT a common congenital heart defect that leads to pulmonary hypertension?
1 - Atrial septal defect
2 - Ventricular septal defect
3 - Patent ductus arteriosus
4 - Tricuspid valve defect
4 - Tricuspid valve defect
Congenital heart defects can cause pulmonary hypertension (PHT), such as:
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
How do these defect lead to increased pulmonary hypertension?
1 - increased blood into RV and into pulmonary circulation
2 - reduced blood flow in LV causes increased pressure in LA
3 - increased pressure on ventricular septum causes RV hypertrophy
4 - all of the above
1 - increased blood into RV and into pulmonary circulation
- essentially increases volume of blood and therefore causes PHT
- causes left to right sided shunt of blood
Stenosis of which valve is most likely to cause pulmonary hypertension?
1 - aortic valve
2 - tricuspid valve
3 - mitral valve
4 - pulmonary valve
3 - mitral valve
Congenital heart defects can cause pulmonary hypertension (PHT) due to:
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
This leads to increased blood flow into pulmonary circulation, causing pulmonary hypertension. If pulmonary pressure becomes so high it can exceed systemic circulation and cause what syndrome?
1 - Torsades de pointes
2 - Tetralogy of Fallot
3 - Takotsubo cardiomyopathy
4 - Eisenmenger syndrome
4 - Eisenmenger syndrome
- blood begins flowing from RV into LV
- deoxygenated blood is pumped around the body causing cyanosis
- causes right to left sided shunt of blood
50% of patients with familial pulmonary hypertension have which mutation?
1 - bone morphogenetic protein receptor 2 (BMPR2)
2 - mutL homolog 1 (MLH-1)
3 - tumour protein-1 (p53)
4 - CA-19
1 - bone morphogenetic protein receptor 2 (BMPR2)
Pulmonary arterial hypertension (PAH) can cause pulmonary hypertension. Which of the following conditions can cause PAH?
1 - Lupus
2 - infection (HIV)
3 - thyroid disorders
4 - inherited genetic mutations
5 - all of the above
5 - all of the above
Pulmonary arterial hypertension (PAH) can cause pulmonary hypertension. Order the following steps of how this typically occurs?
1 - narrow pulmonary blood vessels increases pulmonary pressure
2 - endothelial cells release thromboxane, endothelial-1 and serotonin causing pulmonary arterioles to constrict
3 - endothelial lining of blood vessels is damaged
4 - smooth muscle in pulmonary arterioles produce less nitric oxide and prostacyclin
5 - smooth muscle in pulmonary arterioles hypertrophies
3 - endothelial lining of blood vessels is damaged
2 - endothelial cells release thromboxane, endothelial-1 and serotonin causing pulmonary arterioles to constrict
5 - smooth muscle in pulmonary arterioles hypertrophies
4 - smooth muscle in pulmonary arterioles produce less nitric oxide and prostacyclin
1 - narrow pulmonary blood vessels increases pulmonary pressure
If a patient has pulmonary hypertension, what can this cause?
1 - right ventricular hypertrophy
2 - right sided HF
3 - cor pulmonale
4 - all of the above
4 - all of the above
- in this order
- cor pulmonale = right sided HF due to lung disease
Primary pulmonary hypertension (PPH) is generally idiopathic and is a diagnosis of exclusion. A number of patients with PPH may not present with any symptoms, or even know that they have this condition. But during pregnancy there is an increased haemodynamic demand of around 30-50% and an increase in circulating blood volume and CO, increasing strain on the cardiorespiratory system. What is the mortality rate of pregnant women with PPH?
1 - 1-2%
2 - 10-15%
3 - 20-25%
4 - 30-50%
4 - 30-50%
- these patients if identified are often advised not to get pregnancy or have a termination
All of the following are symptoms that patients can present with if they have pulmonary hypertension, EXCEPT which one?
1 - SOB
2 - orthopnea (SOB when supine)
3 - weakness and fatigue
4 - exertional dizziness and syncope
5 - nausea and vomiting
6 - palpitations
7 -parasternal heave and palpable P2
5 - nausea and vomiting
- can occur but not common
- orthopnea = causes as increased venous return when supine which increases blood flow and pulmonary hypertension
All of the following are clinical signs of pulmonary hypertension, EXCEPT which one?
1 - pulmonary and peripheral oedema
2 - raised JVP
3 - clubbing and cyanosis
4 - splinter haemorrhage
5 - organomegaly (liver and spleen)
6 - tachycardia with RV heave
4 - splinter haemorrhage
- present in infective endocarditis
Which of the following blood tests may confirm a patient with severe pulmonary hypertension?
1 - raised ESR
2 - raised CRP
3 - raised LFTs
4 - raised TFTs
3 - raised LFTs
- hepatomegaly can cause an increase in LFTs
When trying to diagnose pulmonary hypertension what is a common sign on an ECG?
1 - saddle like ST segments
2 - ST elevation
3 - right ventricular hypertrophy with strain
4 - prolonged PR interval
3 - right ventricular hypertrophy with strain
Although not as specific as echocardiogram, what is typically the 1st line imaging approach in pulmonary hypertension?
1 - ultrasound
2 - DEXA
3 - chest X-ray
4 - MRI
3 - chest X-ray
May identify:
- enlarged heart
- enlarged pulmonary artery
- enlarged hilar vessels
Echocardiogram can be performed in a patient with suspected pulmonary hypertension, and is the 1st line imaging used for diagnosing a patient. Which 2 of the following are we likely to see on an echocardiogram?
1 - increased pressure in pulmonary artery
2 - increased pressure in pulmonary vein
3 - increased pressure in RV
4 - increased pressure in LV
1 - increased pressure in pulmonary artery
3 - increased pressure in RV
Which approach is used to confirm a diagnosis of pulmonary hypertension following echocardiogram?
1 - heart catheterisation
2 - MRI
3 - ultrasound doppler
4 - open surgery
1 - heart catheterisation
Stenosis of which valve is most likely to cause pulmonary hypertension?
1 - aortic valve
2 - tricuspid valve
3 - mitral valve
4 - pulmonary valve
3 - mitral valve
Irrespective of the cause, which of the following is NOT an initial treatment given to patients?
1 - oxygen
2 - Ca2+ channel blocker (Amlodipine, Diltiazem, Verapamil)
3 - Na+ channel blocker (Flecainide)
4 - anticoagulants
3 - Na+ channel blocker (Flecainide)
In addition to oxygen, Ca2+ channel blocker and anticoagulants, there are 3 classes of medications that are also given. Which of the following is NOT one of these medications?
1 - prostacyclin
2 - endothelin 1 antagonist
3 - corticosteroids
4 - phosphodiesterase 5 inhibitor
3 - corticosteroids
- prostacyclin = potent vasodilator with antiplatelet aggregatory
- endothelin 1 = this is a vasoconstrictor, so antagonist dilates blood vessels
- phosphodiesterase 5 inhibitor = increases cGMP which increases blood flow and vasodilation
Which of the following are surgical options in a patient with severe pulmonary hypertension?
1 - Atrial Septostomy
2 - Pulmonary Thromboendarterectomy (CTEPH)
3 - Lung Transplant and Heart-Lung Transplant
4 - all of the above
4 - all of the above
- depends on severity and tissue affected
What is the survival of patients with pulmonary hypertension since the medications have improved?
1 - 1-2 years
2 - 3-5 years
3 - 7-10 years
4 - 15-20 years
3 - 7-10 years
