pulmonary hypertension

Question 1

what do we hear when we listen to lungs?

Answer 1

generally clear

Question 2

what do we hear when we listen to the leart

Answer 2

loud second heart sound (P2) due to late closure of pulmonic valve

Question 3

What do we find in group V ?

Answer 3

trash bag diseases such as inflamm/infiltrative lung disease (like sarcoidosis) and compression of the pulmonary vessels (tumor etc)

Question 4

how do we cure group IV ph

Answer 4

this is chronic thromboembolic disease. cure by pulmonary endarterectomy

Question 5

idiopathic pulmonary hypertension

Answer 5

proliferative vasculopathy characterized by vasoconstriction, cell proliferation, fibrosis, thrombosis of the pulmonary arteries

Question 6

what are some of the imbalances in humoral mediators that lead to pah?

Answer 6

too much thromboxin A2,\ andendothelin. too little prostacyclin and NO (unopposed vasoconstriction and proliferation)

Question 7

what specific histological changes do we see with Pah?

Answer 7

hyperplasia of intima, hypertrophy of media, in situ thrombi

Question 8

what do we see on pfts for pah?

Answer 8

normal EXCEPT DLCO is markedly decreased

Question 9

what is the diagnostic procedure for pah?

Answer 9

right heart catheterization! use pulmonary capillary wedge pressure to measure left sided heart pressure + ensure normal functioning.

Question 10

medical therapy for group 1 pah?

Answer 10

calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 inhibitors (up reg NO production), prostacyclin derivatives