Pulmonary Hypertension Flashcards
Define pulmonary HTN?
Increased resistance and pressure in the pulmonary arteries - commonly leading to RH strain.
Mean pulmonary arterial pressure of more than 20mmHg.
What are the five different classification of pulmonary hypertension?
Group 1 - idiopathic or connective tissue disease (hereditary)
Group 2 - left heart failure e.g MI or systemic HTN
Group 3 - Chronic lung disease such as COPD
Group 4 - pulmonary vascular disease such as PE
Group 5 - Miscellaneous (sarcoidisosis, haemtological disorders etc)
What diagnostic tool is used to confirm pulmonary arterial hypertension?
Right heart catheterisation
What are the signs and symptoms of pulmonary HTN?
Difficulty breathing
Fatigue
Chest pain
Weakness
Dizziness
Syncope
Symptoms tend to be worse on exertion.
May develop signs of right-sided heart failure (hepatomegaly, ascites, elevated JVP etc)
What are some physical signs of pulmonary hypertension?
Cyanosis
Left parasternal heave
Signs on ausculatation of the heart: tricuspid regurg, pulmonary regurg, accentuation of pulmonary components of S2.
What are some complications fo pulmonary hypertension?
Cor pulmonale - Right-sided heart failure
Arryhtmias - atrial flutter and atrial fibrillation
Haemoptysis
Dilation of pulmonary arteries –> aneurysms, dissection, compression of bronchi and compression fo recurrent laryngeal nerve (hoarse voice)
What is the basic pathophysiology in pulmonary HTN?
Many factors contributing to inc blood volume/dec blood vessel diameter in the pulmonary arteries.
Vasoconstriction and thickening arterial walls lead to inc resistance to blood flow in the pulmonary system.
Leads to increased workload of the right ventricle -> cor pulmonale
What investigations should be done for a patient with suspected pulmonary HTN?
Bedside: ECG, echo (may add right heart catheterization)
Bloods: BNP, ABG, NT-proBNP, HIV test (Due to association)
Imaging: CXR (PA dilation, enlargement RV), High res CT.
Other: PFT (rule out chronic lung disease as a cause), 6minute walking distance to assess symptoms and severity.
What ECG changes can indicate right heart strain such as that seen in pulmonary HTN?
P pulmonale (peaked P waves)
RV hypertrophy (tall R waves in V1/V2 and deep S in V5/V6)
Right axis deviation
Right Bundle Branch Block.
What is the relevant aetiology of pulmonary HTN?
Genetic predisposition - BMPR2 mutation, familial history, idiopathic
Environmental triggers: tobacco, appetite depressant drugs, HIV, schistosomiasis, amphetamines, cocaine.
Associated conditions: connective tissue disease, congenital heart disease (left to right shunts), liver disease (portal hypertension), HIV.
What supportive management may be offered to a patient with pulmonary HTN?
Anticoagulation
Diuretics
May require O2 therapy
May need vaccinations to prevent respiratory infections, may need treatment to prevent anaemia.
What is the medical treatment for pulmonary hypertension?
If positive reaction to vasodilator test (CCB) treat with CCB often nifedipine
If negative reaction to vasodilator offer an endothelin receptor antagonist(bosentan), PGI2 agonist (iloprost/epoprsotenol), PDE-5 inhibitors (sildenafil)
