pulmonary hypertension

Question 1

what is pulmonary hypertension

Answer 1

high blood pressure in the blood vessels that supply the lungs

resting mPAP is >25mmHg

Question 2

classificatios of pulmonary hypertension

Answer 2

mild 25-40
mod 40-55
severe 55+

Question 3

4 causes of pulmonary hypertension

Answer 3

1. pre capillary
2. capillary
3. post capillary
4. chronic hypoxemia

Question 4

examples of pre capillary pulmonary hypertension

Answer 4

• primary pulmonary hypertension
• pulmonary emboli

Question 5

examples of capillary pulmonary hypertension

Answer 5

COPD
asthma

Question 6

examples of post capillary pulmonary hypertension

Answer 6

LV failure

Question 7

examples of chronic hypoxemia pulmonary hypertension

Answer 7

COPD
high altitude

Question 8

pathophysiology of pulmonary hypertension

Answer 8

1. Reactive pulmonary vasoconstriction in response to hypoxemia (body thinks this is DEAD SPACE)
2. increased pulmonary vascular resistance and pressure
3. therefore endothelial damage
4. leads to → RVH and resp failure

Question 9

initial symptoms of pulmonary hypertension

Answer 9

EXERTIONAL DYSPNOEA + FATIGUE first

Question 10

later symptoms of pulmonary hypertension

Answer 10

RV failure signs:
- JVP distension
- peripheral oedema
- cannon A waves
- louder S2 than normal

Question 11

3 investigations for pulmonary hypertension

Answer 11

1. RH catheter - DIAGNOSTIC
2. chest x ray
3. ECG

Question 12

what does RH catheter do

Answer 12

measure pressure directly

Question 13

what does chest x ray for pulmonary hypertension show

Answer 13

RVH

Question 14

what does ECG for pulmonary hypertension show

Answer 14

Evidence of RA dilation
(‘p pumonale’ - peaked p waves)

Question 15

how to treat pulmonary hypertension

Answer 15

1. Sildenafil (VIAGRA!) - phosphodiesterase 5 inhibitor
2. calcium channel blocker - amlodopine
3. endothelium 1 antagonists/ prostaglandin analogues

Question 16

main complication of pulmony hypertension

Answer 16

cor pulmnale