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DMST 367 Echo 3 > Pulmonary hypertension > Flashcards

Pulmonary hypertension Flashcards

1
Q

Pulmonary hypertension is characterized by what? 2

A
  1. Elevated pulmonary arterial pressures
  2. Secondary RV failure
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2
Q

During RT heart failure, what is RV diastolic pressure like?

A

RV diastolic function is also usually abnormal

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3
Q

What happens during RT heart failure? 2

A
  1. RT heart pressures rise
  2. RV diastolic function is also usually abnormal
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4
Q

What is the hemodynamic definition of PHTN?

A

mPAP >25mmHg

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5
Q

During RT heart failure, when the RT heart pressures rise, what happens in the RV as a result?

A

RV almost always shows reduced function

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6
Q

What values do we look for to help use determine RT heart pressure rise? 3

A
  1. FAC
  2. TAPSE
  3. S’ values
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7
Q

What is the cause of pulmonary HTN?

A

Increased PA pressures

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8
Q

What are the hemodynamic values of Pulmonary Hypertension

A

mPAP >25mmHg

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9
Q

What is pulmonary arterial HTN?

A

Condition brough on by various causes characterized by structure changes in the pulmonary arteries

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10
Q

What is the cause of Pulmonary arterial HTN?

A

Structural changes in the lung arterioles

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11
Q

What are the hemodynamic values of pulmonary arterial HTN? 4

A
  1. mPAP >25mmHg
  2. PCWP >15mmHg
  3. RVSP >35 mmHG
  4. PVR > 3 WU
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12
Q

What are some things that are part of clinical history for PHTN? 4

A
  1. Respiratory symptoms
  2. Signs of RT CHF
  3. Scleroderma
  4. Associated Cardiac S/S
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13
Q

What are respiratory symptoms of PHTN? 4

A
  1. SOB
  2. cough
  3. Wheezing
  4. Hemoptysis
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14
Q

What are signs of RT CHF? 4

A
  1. Jugular vein congestion
  2. Peripheral edema
  3. Ascites
  4. Hepato-splenomegaly
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15
Q

What are associated cardiac S/S for PHTN? 6

A
  1. Auscultation
  2. Palpitations/ arrhythmias
  3. Chest pain
  4. Syncope
  5. Cor pulmonale
  6. Fatigue
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16
Q

What are auscultations we will see with associated cardiac S/S of PHTN? 2

A
  1. P2 increase - PV closure
  2. Holosystolic murmurs (TR)
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17
Q

What are normal right heart pressures? 3

A
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18
Q

What are cardiac causes of RT CHF? 6

A
  1. Left sided heart failure
  2. PV stenosis
  3. RV infarction
  4. Massive TR
  5. Congenital malformation
  6. Shunts
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19
Q

What are causes of increased RT sided pressures? 3

A

Pulmonary causes such as

  1. Parenchymal
  2. Vascular disease
  3. Cor pulmonale
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20
Q

Cor pulmonale is another term for what?

A

Pulmonary heart disease

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21
Q

What is Cor pulmonale?

A

Right sided heart failure secondary to lung conditions such as COPD

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22
Q

What does Cor pulmonale not include? 2

A
  1. RT heart failure secondary to LT sided dysfunction
  2. Congenital heart disease
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23
Q

What are acute symptoms of Cor pulmonale?

A

Occurs after sudden and severe stimulus with RV dilatation and failure (Pulmonary embolus)

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24
Q

Is there RVH with Cor Pulmonale?

A

No

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25
Q

What is McConnell’s sign?

A

One of the most distinct echo findings in patients with acute pulmonary embolism

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26
Q

What does McConnels sign look like? 4

A
  1. Distinct regional RV dysfunction
  2. Mid RV free wall - Akinetic, bulging
  3. Normal RV apex - tethered to LV
  4. LV Apex - hyperkinetic
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27
Q

What are three things we see with chronic Cor pulmonale?

A
  1. RVH
  2. RV dilation
  3. RA enlargement
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28
Q

What is Chronic Cor Pulmonale?

A

Prolonged pressure overload of the RV as it ejects into the high resistance vascular bed

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29
Q

What happens with RVH in terms of Chronic Cor pulmonale?

A

It is initially normal function, but subsequently deteriorates

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30
Q

What happens with RV dilation with Cor pulmonale? 2

A
  1. TR
  2. Systolic dysfunction
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31
Q

What are Echo findings with chronic elevation of RT heart pressures? 3 (anatomy)

A
  1. Dilated coronary sinus
  2. Reopening of the PFO
  3. Dilated main PA
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32
Q

What is a general point of echo findings in PHTN?

A

Anything that causes pressure or volume overload to RV will lead to RVH and TV annular dilation&raquo_space;»> TR

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33
Q

What are the 3 things that are part of the role of Echo in PHTN?

A
  1. Identify cause of PHTN
  2. Estimate pulmonary pressures
  3. Identify associated 2D features
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34
Q

What are some things we look for to identify the cause of PHTN with echo? 3

A
  1. LT sided causes
  2. Shunting
  3. Embolus
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35
Q

What are some things we can do to estimate pulmonary pressures with Echo? 2

A
  1. TR jet
  2. Other calculations
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36
Q

What are some things we can do with echo in terms of identifying 2D features? 3

A
  1. Chamber size
  2. Chamber shape
  3. Septal deviation
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37
Q

What are some LT CHF 2D echo features that cause cause PHTN? 6

A
  1. LV enlargement
  2. LV hypokinesis
  3. LVH
  4. Cardiomyopathy
  5. LA enlargement
  6. Mitral/ Aortic valve disease
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38
Q

What are some things we can look for with echo to determine LT HF? 5

A
  1. MS/ MR
  2. AS/ AR
  3. Systolic dysfunction
  4. Diastolic dysfunction
  5. Arrhythmia
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39
Q

Under normal cardiac pressure, a shunt will do what to the right side?

A

Increase the volume of flow to the RT heart

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40
Q

Increased RT heart pressures may cause a shunt to do what?

A

Open or widen

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41
Q

What is Eisenmenger’s syndrome?

A

Shunt reversal in patients with significant shunt that have developed PHTN either as a result of or in additional to the shunt

42
Q

In terms of Eisenmenger’s syndrome, with existing shunts, chronic volume overload leads to what? (lungs)

A

Permanent lung damage which raises pulmonary pressures

43
Q

During Eisenmenger’s syndrome which direction is the shunt going?

A

Instead of Left to right, it goes right to left due to high pulmonary pressures

44
Q

Is the flow with Eisenmenger’s syndrome Biphasic, monophasic, or multiphasic?

A

May also be biphasic

45
Q

Acute pulmonary embolism is often caused by what?

46
Q

What is mortality rates for acute Pulmonary embolism in North América?

47
Q

What is treatment options for Pulmonary embolism? 2

A
  1. Ranges from treating the DVT to lung resection
  2. IVC filters can prevent thromboemboli from reaching the right heart
48
Q

What does SPAP stand for?

A

Systolic pulmonary arterial pressure

49
Q

What is SPAP equivalent to? (assuming no PS)

50
Q

What are two things associated with using SPAP?

A
  1. Using TR maximum velocity + RAP
  2. Using VSD peak velocity
51
Q

What are additional methods of calculation of pulmonary pressures? 2

A
  1. PAEDP
  2. mPAP
52
Q

What do we use to calculate PAEDP?

A

PR end diastolic velocity

53
Q

What does PAEDP stand for?

A

PA end diastolic pressures

54
Q

What does mPAP stand for?

A

Mean pulmonary artery pressure

55
Q

What are somethings we use to calculate mPAP? 2

A
  1. PR peak velocity (CW or PW)
  2. PAT (RVAcT)
56
Q

What do we see with SPAP on doppler?4

A
  1. TV regurgitation
  2. PI
  3. IVC collapsible
  4. Arrhythmia on ECG
57
Q

What is the formula for RVSP?

A

RVSP = RAP + TVpg

58
Q

What are the three values for RAP?

59
Q

What is the formula for TVpg?

A

bernoulli 4Vtr^2

60
Q

What is PHTN RVSP?

61
Q

What should the TR peak velocity be with PHTN?

62
Q

How do we determine RAP?

A

Young patients may have IVC > 21mm

63
Q

What is a doppler pitfall of PHTN?

A

TR jet overestimation
Chin vs beard

64
Q

Whys is there an issue with chin vs beard for TR?

A
  1. The beard is an effect of spectral broadening
  2. The beard can be minimized by increasing the reject, decreasing compression
65
Q

What are some RVSP technical factors?3

A
  1. Peak velocity using CW is angle dependent (use colour doppler to align CW cursor to TR jet direction)
  2. Do not include feathering
  3. Do not measure unless the peak velocity is clearly seen
66
Q

In terms of PHTN- Jet interrogation what must we do? 4

A

Interrogate peak velocity including multiple windows including

  1. PLAX TV view
  2. PSAX TV optimized
  3. A4C both on and off axis
  4. Subcostal window
67
Q

When do we measure PAEDP velocity?

A

End diastole

68
Q

Do we use CW or PW for PAEDP tracing?

A

PW sometimes if low velocity

69
Q

What is the formula for PAEDP?

A

4Vpr^2 + RAP

70
Q

Calculate

71
Q

How do we measure PW with mPAP?

A

Measure PW with sample volume placed in the RVOT

72
Q

What are some tips for PAT? 2

A
  1. Increase sweep speed
  2. Measure interval between onset of pulmonary flow and peak velocity
73
Q

As mPAP increases what happens to PAT?

A

It decreases

74
Q

normal mPAP is what?

75
Q

What does each arrow signify?

A

Left = mPAP measurement
Right = PAEDEP measurement

76
Q

What is the values for SPAP in terms of pulmonary hypertension?

77
Q

What are the PAT values for pulmonary hypertension?

78
Q

What are the pulmonary pressures for mPAP?

79
Q

What are the pulmonary pressure for PAEDP?

80
Q

What are some things we look for in terms of PHTN in 2D PLAX? 2

A
  1. RV size
  2. LV looks compressed
81
Q

What are some things we look for in M-mode for PHTN?

A

Paradoxical IVS motion

82
Q

What are somethings we look for in 2D in terms of PHTN in PSAX? 3

A
  1. RV dilated
  2. D shape LV (Flattened IVS)
  3. PA dilation
83
Q

What are some things we look for in A4C in 2D for PHTN? 4

A
  1. Both IVS and IAS bow towards the left heart
  2. RVE, RAE
  3. RV hypokinesis
  4. RV forms cardiac apex
84
Q

What are some things we look for sub4c for PHTN? 4

A
  1. Same as A4C
  2. RVH
  3. ASD/ PFO
  4. IVC distention
85
Q

What is the RV response to high afterload?

A

1 Hypertrophy The LV will respond to high afterload, or pressure overload, with increase in muscle mass followed many years later with dilation and failure
2. Dilation

86
Q

Often when the RV dilates as a result of a RV response to high preload, it leads to what?

A

A lack of coaptation of the TV leaflets, which will either cause or worsen the degree of TR

87
Q

What does this image demonstrate?

A

Normal PLAX M-mode of IVS and Paradoxical Septal motion

88
Q

What is the cause of paradoxical septal motion?

A

RV Pressure EDP much higher than LVEDP

89
Q

What are some RT side echo features of PHTN? 9

A
  1. Morphology 2/D
  2. Enlarged RV
  3. Hypokinetic RV
  4. Septal shifting
  5. Enlarged RA (IAS bowing)
  6. TR
  7. Dilated PA
  8. PR
  9. IVC/SVC - dilated
90
Q

What should we see with PHTN 2D? 3

A
  1. RV apical dominance
  2. RV > LV size
  3. IV shifted LT
91
Q

What should a RV look like? 2

A
  1. RV in the A4C should be less than 2/3
  2. LV should dominate (occupy) the apex
92
Q

What does a Mild RV size look like?

A
  1. RV >2/3 of the LV but RV cavity is still smaller than the LV
  2. RV apex is still more basal than LV apex
93
Q

What does a Moderate RV size and systolic function look like?

A

RV and LV are equal in size and share the apex

94
Q

What does a severely large RV look like?

A

RV > LV size and RV occupies the apex

95
Q

What is the normal length of RV dimension?

96
Q

What is the normal length for Mid cavity Diameter for RV?

97
Q

What does RV pressure overload look like?

A

D sign that
1. Does not change
2. Seen in both Systole and Diastole

98
Q

What does RV volume overload look like?

A

D sign that is only seen in diastole

99
Q

What is normal TAPSE?

100
Q

What does PHTN look like with RV TAPSE?

A

RV does not contract well against high afterload

DMST 367 Echo 3 (27 decks)

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