Pulmonary hypertension Flashcards
What is the mean pulmonary arterial pressure in a patient with pulmonary hypertension?
25 mmhg at rest
What is the normal mean pulmonary arterial pressure?
10-20 mmHg
What is cor pulmonale?
a condition that causes the right side of the heart to fail due to an enlarged and overworked right ventricle caused by a primary disorder of the respiratory system
What can pulmonary hypertension lead to?
Cor pulmonale
Right sided heart failure
What does the echocardiogram or a normal heart look like compared to the echocardiogram of a heart experiencing pulmonary hypertension?
In the normal heart, the left ventricle is the largest structure with the LA and RA being similar in size and the RV being slightly bigger than the atria
In a heart experiencing pulmonary hypertension, the left ventricle is significantly smaller with the RV and RA being drastically increased in size due to increase PVR
Describe group 1 pulmonary hypertension
Idiopathic pulmonary hypertension
Describe group 2 pulmonary hypertension
Associated with left heart disease
How does left heart disease cause pulmonary hypertension?
Places backward stress on the pulmonary vasculature due to a systolic or diastolic dysfunction of valvular disease
Describe group 3 pulmonary hypertension
Associated with chronic lung disease or chronic hypoxia
What diseases are associated with group 3 pulmonary hypertension?
COPD
ILD
Sleep related disorders
Chronic exposure to high altitude
Describe group 4 pulmonary hypertension
PH due to chronic thromboelbolic pulmonary hypertension
Describe group 5 pulmonary hypertension
Hypertension due to unclear multifactorial mechanisms such as
Polycythemia
Essential thrombocythemia
Sarcoidosis
Vasculitis
Metabolic disorders
Other conditions such as tumors that press on the pulmonary arteries or kidney disease
Pulmonary hypertension is a clinical diagnosis, what does this mean?
A clinical diagnosis is a diagnosis that cant be confirmed by a specific test, but by ruling other causes out and analyzing the signs and symptoms of the disease process
What are the signs and symptoms of right ventricular heart failure?
Exertional chest pain
Exertional syncope
Weight gain from edema
Anorexia?
Abdominal pain and swelling
How may a patient with pulmonary hypertension present?
Dyspnea
Lethargy
Signs and symptoms of right ventricular failure
What are some visual signs that can indicate pulmonary hypertension?
Peripheral edema
Ascites
What is a key test to determine whether or not someone has pulmonary hypertension?
Echocardiogram
What should be looked for in the echocardiogram of someone who thought to have pulmonary hypertension?
Dilated right ventricle
Right ventricular hypertrophy
Tricuspid valve regurgitation
How do you treat pulmonary hypertension?
By treating the underlying causing
How do you treat group 2 pulmonary hypertension?
Treat the left heart failure
How do you treat group 3 pulmonary hypertension?
Treat causative lung disease
How do you treat group 4 pulmonary hypertension?
Treat chronic emboli with anticoagulants
What are some options for management of pulmonary hypertension?
Diuretics
Anticoagulants
Digoxin (some form of heart medicine)
Oxygen therapy
Physical activity
Name 2 inhaled medications that are used to manage pulmonary hypertension
Iloprost = ventavis
Treprostinil = tyvaso
Patients suffering from pulmonary hypertension occasionally have a wearable pump with them that continuously gives them medication. What medication is delivered by this pump?
Treprostinil = remodulin
What are 2 phosphodiesterase 5 inhibitors used to control pulmonary hypertension?
Sildenafil
Tadalafil
What medications can be used to acutely treat pulmonary hypertension?
Nitric oxide
Epoprostinol/prostaglandin = flolan
Describe what the systemic pressure of a patient suffering from an exacerbation of pulmonary hypertension would look like and why
Systemic pressure would be low because of increased PVR which would limit blood flow to the left ventricle resulting in low systemic blood pressure
Why is it important to recognize that a patient who is experiencing pulmonary hypertension has low blood pressure due to the increased PVR?
Because typical methods of raising blood pressure will be ineffective and may actually cause more harm than good
