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Case 4: Infective Endocarditis > Pulmonary Hypertension > Flashcards

Pulmonary Hypertension Flashcards

1
Q

Definition of pulmonary hypertension

A

Pulmonary blood pressure of above 20mmHg

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2
Q

What happens during hypoxia to pulmonary circulation & systemic circulation

A

Pulmonary constriction because shunting blood away from low oxygen region that increase pressure that increase blood pressure
Systemic vasodilation of capillaries

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3
Q

5 classifications of pulmonary hypertension

A

Passive/venous pulmonary hypertension
Vasoconstrictive pulmonary hypertension
Obstructive/obliterative pulmonary hypertension
Hyperkinetic pulmonary hypertension
Idiopathic pulmonary hypertension

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4
Q

What is 2 passive pulmonary hypertension causes

A
  1. Raised left atrial pressure due to mitral valve stenosis or regurgitation
  2. Left ventricular failure (systemic hypertension, cardiomyopathies, valvular disease, MI)
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5
Q

What is the cause of hyperkinetic pulmonary hypertension

A

Left to right shunts that can be either pre-tricuspid or post-tricuspid

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6
Q

When is it classified as obstructive or obliterative pulmonary hypertension

A

Occur when 2/3 of pulmonary vascular cross sectional area is blocked/destroyed

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7
Q

What is the 2 types of vasoconstrictive pulmonary hypertension

A

Hypoxic vasoconstrictive pulmonary hypertension
Reactive vasoconstrictive pulmonary hypertension

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8
Q

What is hypoxic vasoconstrictive pulmonary hypertension

A

Hypoxia leads to vasoconstriction of small pulmonary veins & direct blood away from poor ventilated zones to good ventilated zones

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9
Q

What is reactive vasoconstrictive pulmonary hypertension

A

In response to increase pulmonary blood pressure or flow (hyperkinetic or passive pulmonary hypertension)

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10
Q

Identify 5 population group where idiopathic pulmonary hypertension is common

A

Females 20-40
Familial
Porto-systemic shunting
Initiation by slimming agents & herbal teas- injures endothelium
Plexogenic pulmonary arteriopathy

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11
Q

What is the 3 pulmonary hypertension mechanism in emphysema

A

Obliterative pulmonary hypertension causes capillary destruction
Hypoxic pulmonary hypertension causes reduced alveolar PO2
Increased viscosity of blood due to polycythaemia which increases the chances of thromboemboli

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12
Q

What is the 3 macroscopic pathologies with pulmonary hypertension

A

Right atrial & ventricular hypertrophy & dilation
Dilation & atherosclerosis of pulmonary arteries
Observation of causative disease

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13
Q

What is cor pulmonale

A

Right ventricular hypertrophy as result of primary respiratory disease affecting structure &/ functions of the lungs

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14
Q

What is the normal systemic circulation pressure

A

Low pressure system of 10-14mmg

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15
Q

What is the appearance of the arterioles in the pulmonary circulation

A

Media only contains elastic tissue and not smooth muscles

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16
Q

When is pulmonary hypertension reversible & irreversible

A

40-70mmHg is still reversible w/ only medial hypertrophy of muscular pulmonary arteries
50-80mmHg is irreversible w/ initimal fibrosis, plexiform lesions & fibrinoid necrosis

17
Q

Why does passive pulmonary hypertension occur

A

No valves in pulmonary veins meaning rai in atrial pressure is directly transmitted to pulmonary capillaries
If increase in left atrial pressure above 18mmHg causes reflex vasoconstriction

18
Q

What is the changes observed at passive pulmonary hypertension

A

Arterial & sclerotic changes in pulmonary veins

19
Q

What is 2 examples of pre-tricuspid shunt

A

Atrial septal defect
Patent foremen ovale

20
Q

When does pulmonary hypertension occur in pre-tricuspid shunt

A

Middle aged

21
Q

What is a examples of post-tricuspid shunt

A
  1. Ventricular septal defect
22
Q

When does pulmonary hypertension occur in pre-tricuspid shunt

A

Early

23
Q

What is the end result of hyperkinetic pulmonary hypertension

A

Shunt reversal

24
Q

When is it obstructive pulmonary hypertension w/ 2 causes

A

Blockage of the lumen of pulmonary vessel due to widespread pulmonary thromboembolism or extensive tumor embolism

25
Q

When is it obliterative pulmonary hypertension w/ 2 causes

A

Destruction of pulmonary blood vessel due to emphysema, arteritis or pulmonary fibrosis

26
Q

When is it obliterative pulmonary hypertension w/ 2 causes

A

Destruction of pulmonary blood vessel due to emphysema, arteritis or pulmonary fibrosis

27
Q

What is the disadvantage of hypoxic vasoconstrictive pulmonary hypertension

A

Both lungs are affected leading to much vasoconstriction & no oxygen exchange

28
Q

What is the disadvantage of hypoxic vasoconstrictive pulmonary hypertension

A

Both lungs are affected leading to much vasoconstriction & no oxygen exchange

Case 4: Infective Endocarditis (10 decks)

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