Pulmonary Hypertension

Question 1

Pulmonary Hypertension: What is it?

Answer 1

Pulmonary hypertension= increased pressure in the pulmonary arteries >20mmHg. This causes increased back pressure in the RHS of the heart and into the systemic venous system due to the back flow of blood. This causes strain on theRHS of the heartas it tries to pump blood through the lungs.

Question 2

Pulmonary Hypertension: Classification

Answer 2

Type 1: Idiopathic, drugs/toxins, genetics or connective tissue disease (e.g., systemic lupus erythematous, HIV, congenital heart disease, portal hypertension)
Type 2: Left Heart Disease (e.g. myocardial infarction or systemic hypertension)
Type 3: Chronic Lung Disease (e.g., COPDorpulmonary fibrosis)
Type 4: Pulmonary vascular disease(e.g., pulmonary embolism)
Type 5: Miscellaneouscauses such as sarcoidosis, glycogen storage disease and haematological disorders

Question 3

Pulmonary Hypertension: Symptoms

Answer 3

• dysponea
• dysponea on exertion
• chest pain
• syncope
• peripheral oedema
• cyanosis

Question 4

Cor pulmonale: Symptoms

Answer 4

Often patients with early cor pulmonale areasymptomatic. Symptoms of cor pulmonale include:
- Shortness of breath
- Breathlessness of exertion
- Chest pain
- Syncope (dizziness and fainting)
- Peripheral oedema
- cyanosis

Signs of cor pulmonale on examination include:
- Hypoxia
- Cyanosis
- Raised JVP (due to a back-log of blood in thejugular veins)
- Peripheral oedema
- Parasternal heave
- Loud second heart sound
- Murmurs (e.g.,pan-systolicintricuspid regurgitation)
- Hepatomegalydue to back pressure in the hepatic vein (pulsatile intricuspid

Question 5

What is Cor pulmonale

Answer 5

Cor pulmonale= right-sided heart failurecaused byrespiratory disease. The increased pressure and resistance in thepulmonary arteries(pulmonary hypertension) limits theright ventriclepumping blood into the pulmonary arteries. This causes back-pressure into theright atrium,vena cavaandsystemic venous system.

Question 6

Causes of cor pulmonale

Answer 6

Causesof cor pulmonale are:

• COPD(the most common cause) - loss of capillary vascular bed and chronic hypoxic pulmonary vasoconstriction (HPV) due to alveolar wall destruction, and inflammation
• Pulmonary embolism
• Interstitial lung disease
• Cystic fibrosis
• Primary pulmonary hypertension