Pulmonary hypertension

Question 1

What is the mean pulmonary arterial pressure in a patient with pulmonary hypertension?

Answer 1

25 mmhg at rest

Question 2

What is the normal mean pulmonary arterial pressure?

Answer 2

10-20 mmHg

Question 3

What is cor pulmonale?

Answer 3

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

Question 4

What can pulmonary hypertension lead to?

Answer 4

Cor pulmonale
Right sided heart failure

Question 5

What does the echocardiogram or a normal heart look like compared to the echocardiogram of a heart experiencing pulmonary hypertension?

Answer 5

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

Question 6

Describe group 1 pulmonary hypertension

Answer 6

Idiopathic pulmonary hypertension

Question 7

Describe group 2 pulmonary hypertension

Answer 7

Associated with left heart disease

Question 8

How does left heart disease cause pulmonary hypertension?

Answer 8

Places backward stress on the pulmonary vasculature due to a systolic or diastolic dysfunction of valvular disease

Question 9

Describe group 3 pulmonary hypertension

Answer 9

Associated with chronic lung disease or chronic hypoxia

Question 10

What diseases are associated with group 3 pulmonary hypertension?

Answer 10

COPD
ILD
Sleep related disorders
Chronic exposure to high altitude

Question 11

Describe group 4 pulmonary hypertension

Answer 11

PH due to chronic thromboelbolic pulmonary hypertension

Question 12

Describe group 5 pulmonary hypertension

Answer 12

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

Question 13

Pulmonary hypertension is a clinical diagnosis, what does this mean?

Answer 13

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

Question 14

What are the signs and symptoms of right ventricular heart failure?

Answer 14

Exertional chest pain
Exertional syncope
Weight gain from edema
Anorexia?
Abdominal pain and swelling

Question 15

How may a patient with pulmonary hypertension present?

Answer 15

Dyspnea
Lethargy
Signs and symptoms of right ventricular failure

Question 16

What are some visual signs that can indicate pulmonary hypertension?

Answer 16

Peripheral edema
Ascites

Question 17

What is a key test to determine whether or not someone has pulmonary hypertension?

Answer 17

Echocardiogram

Question 18

What should be looked for in the echocardiogram of someone who thought to have pulmonary hypertension?

Answer 18

Dilated right ventricle
Right ventricular hypertrophy
Tricuspid valve regurgitation

Question 19

How do you treat pulmonary hypertension?

Answer 19

By treating the underlying causing

Question 20

How do you treat group 2 pulmonary hypertension?

Answer 20

Treat the left heart failure

Question 21

How do you treat group 3 pulmonary hypertension?

Answer 21

Treat causative lung disease

Question 22

How do you treat group 4 pulmonary hypertension?

Answer 22

Treat chronic emboli with anticoagulants

Question 23

What are some options for management of pulmonary hypertension?

Answer 23

Diuretics
Anticoagulants
Digoxin (some form of heart medicine)
Oxygen therapy
Physical activity

Question 24

Name 2 inhaled medications that are used to manage pulmonary hypertension

Answer 24

Iloprost = ventavis
Treprostinil = tyvaso

Question 25

Patients suffering from pulmonary hypertension occasionally have a wearable pump with them that continuously gives them medication. What medication is delivered by this pump?

Answer 25

Treprostinil = remodulin

Question 26

What are 2 phosphodiesterase 5 inhibitors used to control pulmonary hypertension?

Answer 26

Sildenafil
Tadalafil

Question 27

What medications can be used to acutely treat pulmonary hypertension?

Answer 27

Nitric oxide
Epoprostinol/prostaglandin = flolan

Question 28

Describe what the systemic pressure of a patient suffering from an exacerbation of pulmonary hypertension would look like and why

Answer 28

Systemic pressure would be low because of increased PVR which would limit blood flow to the left ventricle resulting in low systemic blood pressure

Question 29

Why is it important to recognize that a patient who is experiencing pulmonary hypertension has low blood pressure due to the increased PVR?

Answer 29

Because typical methods of raising blood pressure will be ineffective and may actually cause more harm than good