Pulmonary Hypertension Flashcards
T/F Most common causes of pulmonary hypertension are left heart or primary lung disease
T
Pulmonary HTN has a mean pulmonary artery pressure of greater than ______
20 mmHg
T/F: If left untreated, pulmonary hypertension could cause decompensated right heart failure
T
T/F: Apoptosis resistance is one of the factor influencing pulmonary arterial hypertension
T
Explain the pathobiology of pulmonary arterial hypertension
Cell proliferation d/t apoptosis resistance or dysregulated metabolism, + fibroblasts lead to hypertrophic, fibrotic, and plexogenic remodeling of the small distal pulmonary arterioles -» decreases vascular compliance -» increases resistance and promotes in situ thrombosis
T/F: In pulmonary htn, the effacement of pulmonary arterioles results in severely decreased PVR that promotes left heart failure, defined by increased CO and PAP
F
… it results in severely INCREASED PVR that promotes RIGHT HEART FAILURE, defined by DECREASED CO and PAP
This occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure
Right Ventricular Pulmonary Arterial Uncoupling (RVPA uncoupling)
- occurs at the expense of energy normally reserved to maintain optimal blood perfusion through the alveolar-capillary interface for blood oxygenation
The ff are likely systemic manifestations secondary to changes in cardiopulmonary hemodynamics, except
Overactivation of neurohumoral signaling
Chronic Kidney Disease
Decreased bioactive sex hormones
Volitional muscle atrophy
Decreased bioactive sex hormones
- must be INCREASED
Most patients with pulmonary htn present with:
dyspnea and fatigue
T/F: In early phases of PH, PE is often normal
T
In advanced phases of PH, the ff signs of right ventricular failure can be seen
Ascites
Elevated JVP
Bipedal edema
T/F: Accentuated P2 as a component of S1 is one of the CVS findings in PH
F
Accentuated p2 as a component of S2
T/F There is a holosystolic tricuspid regurgitation murmur in PH
T
This imaging may show RV hypertrophy or RV Strain
Electrocardiography (ECG)
T/F: An enlargement of PA or RV can be seen in a chest Xray
T
It is seen as obliteration of the retrosternal space
This is the most important initial screening test for PH which provides an estimated pulmonary artery systolic pressure
Electrocardiography with agitated saline (bubble)
____ mmHg supports diagnosis of PH
> 35 mmHg
Gold standard for diagnosis and severity assessment
Right heart catheterization
- measures pressure directly by inserting catheter into the PA
This is the classic PH finding when using pulmonary function and lung imaging (pulmonary lung function test)
Isolated finding of reduced DLCo (Diffusing Capacity of the lungs for Carbon Monoxide)
Using Assessment of pulmonary arterial thrombosis, nocturnal desaturation is a common finding in PH
F
Nocturnal desaturation is a finding using sleep study
T/F All patients with PH should undergo sleep study, even in the absence of sleep-disordered breathing
T
T/F a patient with prior PH is at risk for CTEPH
T
CTEPH is chronic thromboembolic pulmonary HTN, a PH subtype with characterized vascular fibrosis
Why is antinuclear antibodies, rheumatoid factor, and anti-scl-70 Abs are tested in all patients with PH?
The PH could be caused by underlying rheumatic disease
Why is liver function, hepatitis serology requested in px with PH?
Liver disease can cause portal HTN, which would also cause pulmonary HTN
They are used to detect right ventricle dysfunction for labs of px with PAH
BNP and NT-proBNP
Explain vasoreactivity Testing for idiopathic or hereditary PAH
The vasoreactivity testing aims to know how much blood vessels can relax (reduce pressure) if given a certain drug. In this case, inhaled NO or epoprostenol is given.
A good response (decrease in mPAP by >/10mmHg to <40 mmHg without a decrease in CO) can be given long term calcium channel blockers for treatment
T/F If post-capillary PH or the pulmonary veins are affected, the most likely cause would be right heart failure
F : it’s LEFT HEART
Chronic lung disease-pulmonary hypertension (CLD-Ph) is due to pulmonary (artery/vein) problems
Artery
Chronic thromboembolic pulmonary hypertension (CTEPH) is due to pulmonary (artery/vein) problems
artery
T/F:: PH may only be classified if RHC was performed
T
Isolated (precapillary/postcapillary) PH occurs due to primary lung disease, CTEPH, PAH
precapillary
Isolated (precapillary/postcapillary) PH occurs in patients with mitral valve disease, left ventricular systolic dysfunction, or heart failure with preserved ejection fraction
Postcapillary
T/F PAH is NOT the same with pulmonary hypertension
T
It is a type of PH, as PH can also occur in the venous system
T/F PAH has a hemodynamic criteria of:
sustained resting mPAP >20 mmHg
PVR >/3.0 WU
PAWP or LVEDP of >15 mmHg
F
sustained resting mPAP >20 mmHg
PVR >/3.0 WU
PAWP or LVEDP of <15 mmHg
LVEDP is elevated in left heart failure (ex. postcapillary PH)
It is a pathologic consequence of progressive pulmonary vascular remodeling due to a large L-R shunt that is associated with cyanosis, hyperviscosity, weakness, and shortened lifespan
Eisenmenger’s syndrome
Most common cause of pulmonary hypertension
PH Associated with Left Heart Disease (Group 2)
Hallmark of PH-LHD
Elevated left arterial pressure with resulting pulmonary VENOUS hypertension
T/F PH in the setting of mitral stenosis or regurgitation is an indication for surgical valve intervention
T
Second most common cause of PH
PH Associated with Lung Disease (Group 3)
T/F Sarcoidosis is globally among the most common causes of PH, wherein it develops in the setting of hepatosplenic disease and portal HTN
F
Must be schistosomiasis
Goal in treating PAH
Dilate the arteries
