PULMONARY HYPERTENSION Flashcards
What is pulmonary hypertension?
Increased resistance and blood pressure in pulmonary arteries which causes a strain on the R. Side of the heart trying to pump blood through the lungs = this causes a back pressure of blood into the systemic venous system
What are the causes of pulmonary hypertension?
Group 1 – Primary pulmonary hypertension or connective tissue disease (such as SLE which increases resistance in vessels)
Group 2 – Left HF (usually due to MI or systemic hypertension)
Group 3 – Chronic lung disease e.g. COPD
Group 4 – Pulmonary vascular disease e.g. PE
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders
What are signs and symptoms of pulmonary hypertension?
SOB (may have orthopnoea if caused by HF)
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema
What investigations should you do for pulmonary hypertension?
NT-proBNP- will be raised due to right ventricular failure
ECG - right sided heart strain changes
CXR
Echo - used to estimate pulmonary artery pressure (mean pressure >25mmHg at rest)
What ECG changes will you see with pulmonary hypertension?
Right ventricular hypertrophy seen as larger R waves in V1-3 and S waves on V4-6
RAD
RBBB
What CXR changes will you see with pulmonary hypertension?
Dilated pulmonary arteries
Right ventricular hypertrophy
How is pulmonary hypertension managed?
Cannot be cured
Lifestyle measures - avoid factors that worsen symptoms
Anticoagulation to prevent clots
Diuretics to remove fluid from HF
Oxygen
Digoxin
Specialist:
Endothelin receptor antagonists
PDE5 inhibitors
Prostaglandins
Soluble guanylate cyclase stimulators
CCB
Surgery - lung transplant or pulmonary thromboendarterectomy
Whats the prognosis of pulmonary hypertension?
40% 5 year survival without treatment
70% with treatment
Whats the most common cause of pulmonary hypertension?
Left heart disease e.g. HF or valvular dysfunction -> back up of blood in pulmonary veins and capillary bed -> increased pressure in pulmonary arteries
How does chronic lung disease cause pulmonary hypertension?
Chronic lung diseases can cause hypoxic vasoconstriction -> shuttles blood away from damaged areas of lungs and towards healthy lung tissue
if widespread lung disease then we get widespread vasoconstriction of pulmonary arterioles -> increases pulmonary vascular resistance -> harder for R.ventricle to pump out blood so to make the same amount of blood flow through the pulmonary arterioles, the right side of the heart generates increased pressure = pulmonary hypertension
What is chronic thromboembolic pulmonary hypertension?
a condition where there is elevated blood pressure in the pulmonary arteries caused by chronic blood clots (thromboembolic), which obstruct the free flow of blood through the lungs e.g. due to a clotting disorder
How can PEs cause pulmonary hypertension?
They can block pulmonary vessels which increases resistance to blood flow and cause endothelial cell release of histamine and serotonin -> constriction of pulmonary arterioles
= rise in pulmonary blood pressure
What are complications of pulmonary hypertension?
Pulmonary oedema - harder for gas exchange to happen
R.ventricle hypertrophy -> r.sided HF (cor pulmonale)
