Pulmonary hypertension Flashcards
How is pulmonary hypertension defined?
Mean pulmonary arterial pressure of more than 20mmHg at rest
How does pulmonary hypertension cause right heart strain?
Increased resistance in the pulmonary vasculature leads to increased pressure in the right ventricle
Increased pressure results in increased ventricular filling and stroke volume, which further increases pulmonary arterial pressure
Over time right ventricular hypertrophy develops
What are the groups of pulmonary hypertension?
Group 1 - idiopathic pulmonary hypertension
Group 2 - pulmonary hypertension due to left heart failure
Group 3 - due to chronic lung disease
Group 4 - due to pulmonary vascular disease
Group 5- miscellaneous causes
What conditions can cause group 2 pulmonary hypertension?
Heart failure
Valvular heart disease
HOCM
What conditions can cause group 3 pulmonary hypertension?
COPD
Interstitial lung disease
OSA
Chronic high altitude
What conditions can cause group 4 pulmonary hypertension?
PE
Pulmonary artery obstruction
What conditions can cause group 5 pulmonary hypertension?
Haematological disorders
Metabolic disorders
Sarcoidosis
What is the clinical presentation of pulmonary hypertension?
Shortness of breath
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema
What signs of pulmonary hypertension may be seen on examination?
Raised JVP
Right parasternal heave
Loud second heart sound
Pulmonary or tricuspid regurgitation
What investigations are initially performed in pulmonary hypertension?
ECG
CXR
BNP
Echocardiogram
What is the gold standard investigation for pulmonary hypertension?
Right heart catheterisation to directly measure pulmonary pressure
What ECG changes can occur in pulmonary hypertension?
P pulmonale (peaked P waves)
Right ventricular hypertrophy - tall R waves in V1 and V2, deep S waves in V5 and V6
Right axis deviation
RBBB
What changes may be seen on CXR in pulmonary hypertension?
Dilated pulmonary arteries
Right ventricular hypertrophy
What is the first line management of idiopathic pulmonary hypertension?
Calcium channel blockers - nifedipine and diltiazem
Pulmonary vasodilators
- Prostacyclin
- Phosphodiesterase type 5 inhibitors (sildenafil)
- Endothelin receptor antagonists
What are the complications of pulmonary hypertension?
Right heart failure
Pericardial effusion and tamponade
Hepatic congestion
