Pulmonary hypertension Flashcards
What is pulmonary hypertension?
Raised mean pulmonary arterial pressure >20mmHg
What are the 5 groups of causes of pulmonary hypertension?
Pulmonary arterial hypertension
Left heart disease
Chronic lung disease
Pulmonary artery obstruction
Multi-factoral
Give 3 causes of pulmonary arterial hypertension
Idiopathic
Hereditary
Drug induced: Methamphetamine
List 3 conditions associated with pulmonary arterial hypertension
CTDs e.g. systemic sclerosis
Congenital heart disease e.g. L-R shunt, Eisenmenger syndrome
HIV
Give 3 conditions that lead to left heart disease causing PH
Congestive HF: HFrEF, HFpEF
Aortic stenosis
Mitral stenosis
Give 3 chronic lung diseases causing PH
COPD
OSA
Interstitial lung disease
What causes pulmonary artery obstruction leading to PH
Chronic thromboembolic pulmonary hypertension (CTEPH)
Recurrent micro thrombi narrow the cross-sectional area
Give 3 symptoms of PH
Dyspnoea +/or syncope on exertion
Chest pain
Fatigue
Give 4 signs of pulmonary hypertension
Jugular venous distension
Loud + palpable 2nd heart sound
Nail clubbing
Cyanosis
What investigation can be used if high clinical suspicion of pulmonary hypertension?
TTE
to noninvasively identify markers of elevated pulmonary artery pressure.
If TTE suggests PH, which investigations can be used to evaluate the most common underlying causes?
ECG
CXR
BNP
Pulmonary function testing
Which test is diagnostic of PH if TTE is equivocal, aetiology remains unclear or PH is severe?
Right heart catheterisation
Raised mean pulmonary arterial pressure
What may be seen on ECG in pulmonary hypertension?
RAD
RV hypertrophy
p pulmonale
What may be seen on CXR in pulmonary hypertension?
Prominent right heart border
If PH is not explained by left heart disease or chronic lung disease, what investigation should be performed? Why?
V/Q scan to exclude chronic thromboembolic PH
Describe management of acute. pulmonary hypertension
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)
Describe long term management of pulmonary arterial hypertension
Vasoreactivity testing-
Vasoactive: CCBs
Nonvasoactive: other vasodilator
Aims to decrease pulmonary vascular resistance
.
Describe long term treatment of PH
Tx of underlying cause in non-PAH causes of PH
What is cor pulmonale?
Altered structure/ impaired function of RV due to PH resulting from a primary disorder of the respiratory or pulmonary artery system
What is cor pulmonale aka?
Pulmonary heart disease
Because is caused by RV dysfunction resulting from lung disease NOT cardiac disease
How does pulmonary hypertension cause acute cor pulmonale?
Sudden increase in RV afterload results in RV dilatation + dysfunction
What are the causes of acute cor pulmonale?
Acute massive PE (most common)
ARDS
List 6 possible clinical features of acute cor pulmonale
Chest pain
Dyspnoea
Hypotension
Tachycardia
Syncope
Sx of DVT
How does pulmonary hypertension lead to chronic cor pulmonale?
Increased RV afterload leads to progressive RV hypertrophy that over time leads to RV dilatation + dysfunction
What are the causes of chronic cor pulmonale?
Lung parenchyma: COPD, ILD, bronchiectasis
Pulmonary vasculature: PAH, CTEPH
Chronic hypoxia: OSA, NM disorders
What is the most common cause of chronic cor pulmonale?
COPD
What investigations should be performed in cor pulmonale?
Acute: Ix for PE
Chronic: Echo + Ix for PH
What is seen on echo in cor pulmonale?
RV dilation, hypertrophy or dysfunction.
Describe management of cor pulmonale
Depends on cause
Acute: stabilisation + Tx of PE/ ARDS
