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MEDICINE II > Pulmonary Hypertension > Flashcards

Pulmonary Hypertension Flashcards

1
Q

T/F Most common causes of pulmonary hypertension are left heart or primary lung disease

A

T

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2
Q

Pulmonary HTN has a mean pulmonary artery pressure of greater than ______

A

20 mmHg

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3
Q

T/F: If left untreated, pulmonary hypertension could cause decompensated right heart failure

A

T

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4
Q

T/F: Apoptosis resistance is one of the factor influencing pulmonary arterial hypertension

A

T

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5
Q

Explain the pathobiology of pulmonary arterial hypertension

A

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

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6
Q

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

A

F
… it results in severely INCREASED PVR that promotes RIGHT HEART FAILURE, defined by DECREASED CO and PAP

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7
Q

This occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure

A

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

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8
Q

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

A

Decreased bioactive sex hormones

  • must be INCREASED
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9
Q

Most patients with pulmonary htn present with:

A

dyspnea and fatigue

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10
Q

T/F: In early phases of PH, PE is often normal

A

T

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11
Q

In advanced phases of PH, the ff signs of right ventricular failure can be seen

A

Ascites
Elevated JVP
Bipedal edema

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12
Q

T/F: Accentuated P2 as a component of S1 is one of the CVS findings in PH

A

F
Accentuated p2 as a component of S2

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13
Q

T/F There is a holosystolic tricuspid regurgitation murmur in PH

A

T

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14
Q

This imaging may show RV hypertrophy or RV Strain

A

Electrocardiography (ECG)

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15
Q

T/F: An enlargement of PA or RV can be seen in a chest Xray

A

T
It is seen as obliteration of the retrosternal space

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16
Q

This is the most important initial screening test for PH which provides an estimated pulmonary artery systolic pressure

A

Electrocardiography with agitated saline (bubble)

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17
Q

____ mmHg supports diagnosis of PH

A

> 35 mmHg

18
Q

Gold standard for diagnosis and severity assessment

A

Right heart catheterization

  • measures pressure directly by inserting catheter into the PA
19
Q

This is the classic PH finding when using pulmonary function and lung imaging (pulmonary lung function test)

A

Isolated finding of reduced DLCo (Diffusing Capacity of the lungs for Carbon Monoxide)

20
Q

Using Assessment of pulmonary arterial thrombosis, nocturnal desaturation is a common finding in PH

A

F
Nocturnal desaturation is a finding using sleep study

21
Q

T/F All patients with PH should undergo sleep study, even in the absence of sleep-disordered breathing

A

T

22
Q

T/F a patient with prior PH is at risk for CTEPH

A

T
CTEPH is chronic thromboembolic pulmonary HTN, a PH subtype with characterized vascular fibrosis

23
Q

Why is antinuclear antibodies, rheumatoid factor, and anti-scl-70 Abs are tested in all patients with PH?

A

The PH could be caused by underlying rheumatic disease

24
Q

Why is liver function, hepatitis serology requested in px with PH?

A

Liver disease can cause portal HTN, which would also cause pulmonary HTN

25
Q

They are used to detect right ventricle dysfunction for labs of px with PAH

A

BNP and NT-proBNP

26
Q

Explain vasoreactivity Testing for idiopathic or hereditary PAH

A

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

27
Q

T/F If post-capillary PH or the pulmonary veins are affected, the most likely cause would be right heart failure

A

F : it’s LEFT HEART

28
Q

Chronic lung disease-pulmonary hypertension (CLD-Ph) is due to pulmonary (artery/vein) problems

A

Artery

29
Q

Chronic thromboembolic pulmonary hypertension (CTEPH) is due to pulmonary (artery/vein) problems

A

artery

30
Q

T/F:: PH may only be classified if RHC was performed

A

T

31
Q

Isolated (precapillary/postcapillary) PH occurs due to primary lung disease, CTEPH, PAH

A

precapillary

32
Q

Isolated (precapillary/postcapillary) PH occurs in patients with mitral valve disease, left ventricular systolic dysfunction, or heart failure with preserved ejection fraction

A

Postcapillary

33
Q

T/F PAH is NOT the same with pulmonary hypertension

A

T
It is a type of PH, as PH can also occur in the venous system

34
Q

T/F PAH has a hemodynamic criteria of:
sustained resting mPAP >20 mmHg
PVR >/3.0 WU
PAWP or LVEDP of >15 mmHg

A

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)

35
Q

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

A

Eisenmenger’s syndrome

36
Q

Most common cause of pulmonary hypertension

A

PH Associated with Left Heart Disease (Group 2)

37
Q

Hallmark of PH-LHD

A

Elevated left arterial pressure with resulting pulmonary VENOUS hypertension

38
Q

T/F PH in the setting of mitral stenosis or regurgitation is an indication for surgical valve intervention

A

T

39
Q

Second most common cause of PH

A

PH Associated with Lung Disease (Group 3)

40
Q

T/F Sarcoidosis is globally among the most common causes of PH, wherein it develops in the setting of hepatosplenic disease and portal HTN

A

F
Must be schistosomiasis

41
Q

Goal in treating PAH

A

Dilate the arteries

MEDICINE II (4 decks)

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