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YR6: RESPIRATORY > Pulmonary hypertension > Flashcards

Pulmonary hypertension Flashcards

1
Q

What is pulmonary hypertension?

A

Raised mean pulmonary arterial pressure >20mmHg

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2
Q

What are the 5 groups of causes of pulmonary hypertension?

A

Pulmonary arterial hypertension
Left heart disease
Chronic lung disease
Pulmonary artery obstruction
Multi-factoral

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3
Q

Give 3 causes of pulmonary arterial hypertension

A

Idiopathic
Hereditary
Drug induced: Methamphetamine

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4
Q

List 3 conditions associated with pulmonary arterial hypertension

A

CTDs e.g. systemic sclerosis
Congenital heart disease e.g. L-R shunt, Eisenmenger syndrome
HIV

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5
Q

Give 3 conditions that lead to left heart disease causing PH

A

Congestive HF: HFrEF, HFpEF
Aortic stenosis
Mitral stenosis

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6
Q

Give 3 chronic lung diseases causing PH

A

COPD
OSA
Interstitial lung disease

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7
Q

What causes pulmonary artery obstruction leading to PH

A

Chronic thromboembolic pulmonary hypertension (CTEPH)
Recurrent micro thrombi narrow the cross-sectional area

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8
Q

Give 3 symptoms of PH

A

Dyspnoea +/or syncope on exertion
Chest pain
Fatigue

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9
Q

Give 4 signs of pulmonary hypertension

A

Jugular venous distension
Loud + palpable 2nd heart sound
Nail clubbing
Cyanosis

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10
Q

What investigation can be used if high clinical suspicion of pulmonary hypertension?

A

TTE
to noninvasively identify markers of elevated pulmonary artery pressure.

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11
Q

If TTE suggests PH, which investigations can be used to evaluate the most common underlying causes?

A

ECG
CXR
BNP
Pulmonary function testing

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12
Q

Which test is diagnostic of PH if TTE is equivocal, aetiology remains unclear or PH is severe?

A

Right heart catheterisation
Raised mean pulmonary arterial pressure

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13
Q

What may be seen on ECG in pulmonary hypertension?

A

RAD
RV hypertrophy
p pulmonale

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14
Q

What may be seen on CXR in pulmonary hypertension?

A

Prominent right heart border

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15
Q

If PH is not explained by left heart disease or chronic lung disease, what investigation should be performed? Why?

A

V/Q scan to exclude chronic thromboembolic PH

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16
Q

Describe management of acute. pulmonary hypertension

A

Admit to ICU
Identify + treat any precipitating factors e.g. SVT, PE, sepsis
O2 with HFNC
Haemodynamic support; target euvolaemia (careful balance of IV diuretics for vol overload + IV fluid challenges for hypovolemia)

17
Q

Describe long term management of pulmonary arterial hypertension

A

Vasoreactivity testing-
Vasoactive: CCBs
Nonvasoactive: other vasodilator

Aims to decrease pulmonary vascular resistance
.

18
Q

Describe long term treatment of PH

A

Tx of underlying cause in non-PAH causes of PH

19
Q

What is cor pulmonale?

A

Altered structure/ impaired function of RV due to PH resulting from a primary disorder of the respiratory or pulmonary artery system

20
Q

What is cor pulmonale aka?

A

Pulmonary heart disease
Because is caused by RV dysfunction resulting from lung disease NOT cardiac disease

21
Q

How does pulmonary hypertension cause acute cor pulmonale?

A

Sudden increase in RV afterload results in RV dilatation + dysfunction

22
Q

What are the causes of acute cor pulmonale?

A

Acute massive PE (most common)
ARDS

23
Q

List 6 possible clinical features of acute cor pulmonale

A

Chest pain
Dyspnoea
Hypotension
Tachycardia
Syncope
Sx of DVT

24
Q

How does pulmonary hypertension lead to chronic cor pulmonale?

A

Increased RV afterload leads to progressive RV hypertrophy that over time leads to RV dilatation + dysfunction

25
Q

What are the causes of chronic cor pulmonale?

A

Lung parenchyma: COPD, ILD, bronchiectasis
Pulmonary vasculature: PAH, CTEPH
Chronic hypoxia: OSA, NM disorders

26
Q

What is the most common cause of chronic cor pulmonale?

A

COPD

27
Q

What investigations should be performed in cor pulmonale?

A

Acute: Ix for PE
Chronic: Echo + Ix for PH

28
Q

What is seen on echo in cor pulmonale?

A

RV dilation, hypertrophy or dysfunction.

29
Q

Describe management of cor pulmonale

A

Depends on cause
Acute: stabilisation + Tx of PE/ ARDS

YR6: RESPIRATORY (38 decks)

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