Pulmonary hypertension

Question 1

How does it most commonly develop?

Answer 1

Result of left heart disease

Question 1

What are the possible causes of pulmonary hypertension (PH) based on systolic pressure measurement?

Answer 1

> 40mmHg, but this varies with age and weight

Question 2

What are the two main categories of pulmonary hypertension based on underlying causes?

Answer 2

Pulmonary venous hypertension and pulmonary arterial hypertension.

Question 3

What are some conditions that can lead to pulmonary venous hypertension?

Answer 3

1. Left ventricular systolic dysfunction
2. Mitral regurgitation or stenosis
3. Cardiomyopathy (e.g., alcohol-related)

Question 4

What are the primary and secondary forms of pulmonary arterial hypertension?

Answer 4

Primary arterial hypertension is a primary disease of the pulmonary arteries or arterioles

Secondary arterial hypertension occurs due to underlying diseases or known risk factors, commonly heart diseases (e.g., congenital shunts) and lung fibrosis (e.g., COPD)

Question 5

What are some common symptoms of pulmonary hypertension?

Answer 5

Fatigue, dyspnea, chest pain, and central cyanosis if hypoxic

Question 6

What signs may be present on examination of a patient with pulmonary hypertension?

Answer 6

1. Dependent edema
2. Elevated jugular venous pressure (JVP)
3. Right ventricular heave at the left parasternal edge
4. Murmur of tricuspid regurgitation
5. loud P2,
6. enlarged liver (pulsatile)

Question 7

Typical investigations for diagnosing pulmonary hypertension?

Answer 7

1. ECHO doppler
2. Right heart catheterization to confirm (FIRST)
3. ECG (right axis deviation)
4. CXR

Question 8

Pharmacologic treatments for pulmonary hypertension?

Answer 8

Warfarin, oxygen therapy, CCB

Question 9

Potential complications of pulmonary hypertension?

Answer 9

Pulmonary edema, right ventricular hypertrophy.

Question 10

Definition and features of cor pulmonale?

Answer 10

Right-sided heart enlargement and failure due to pulmonary hypertension

Characterised by RV hypertrophy, and dilation, leading to venous congestion, edema, and cardiomegaly.

Question 11

A 55-year-old female with a history of systemic sclerosis presents to the emergency department complaining of worsening shortness of breath, fatigue and severe ankle swelling. She has been recently diagnosed with pulmonary hypertension and has been started on bosentan, an endothelin-A receptor antagonist.

What should be monitored whilst shes on this treatment

Answer 11

Liver function tests

Question 12

A 70-year-old man with a background of severe COPD is reviewed by his GP. He currently smokes 20 cigarettes per day, and has done so for 50 years. He is currently on maximal inhaler therapy. Today, the GP notices swelling of both his ankles, extending to the lower third of his calves. He also has a raised jugular venous pressure.

Which complication of COPD has this patient likely developed? and why?

Answer 12

Cor pulmonale

= Cor pulmonale is defined as hypertrophy and subsequent failure of the right ventricle of the heart.

Question 13

A 75-year-old with long-standing COPD presents to the emergency department with worsening shortness of breath, a productive cough and swelling of both feet.

She is investigated appropriately and started on Furosemide 80 mg.

Which of the following signs is most likely to be seen in this patient?

Answer 13

Split-second heart sound with loud pulmonary component

= This is a likely finding in someone who has cor pulmonale. Cor pulmonale is right-sided heart failure secondary to long-standing pulmonary disease resulting in pulmonary arterial hypertension. There is increased blood flow into the pulmonary artery and this causes the pulmonary component (p2) to be louder

Question 14

What is the main limb complication of uncontrolled hypertension?

Answer 14

Peripheral vascular disease

Question 15

A 72-year-old man presents to the clinic with a gradual worsening of shortness of breath. He reports dyspnea after mild exertion, such as climbing stairs and taking the trash outside, as well as dizziness and mild chest pain. He has a past medical history of chronic obstructive pulmonary disease (COPD) and hyperlipidemia, and he has been smoking for 50 years. On physical examination, the patient’s lungs are clear to auscultation, and the patient has noticeable jugular venous distention and swelling in the lower legs.

Based on the patient’s symptoms and past medical history, which is the most likely cause of the patient’s right ventricular hypertrophy?

Answer 15

Pulmonary hypertension