Pulmonary Hypertension

Question 1

What is pulmonary hypertension?

Answer 1

Pulmonary hypertension is a condition characterised by elevated pressure in the pulmonary arteries, leading to strain on the right side of the heart.

Question 2

What are the normal pulmonary artery pressure values?

Answer 2

Normal pulmonary artery pressure is <25 mmHg at rest.

Question 3

What are the main types of pulmonary hypertension?

Answer 3

The five types include pulmonary arterial hypertension (PAH), PH due to left heart disease, PH due to lung diseases, PH due to chronic thromboembolic disease, and PH with unclear mechanisms.

Question 4

What is the most common cause of pulmonary hypertension?

Answer 4

Left heart disease is the most common cause of pulmonary hypertension.

Question 5

What are the common symptoms of pulmonary hypertension?

Answer 5

Symptoms include dyspnoea, fatigue, chest pain, syncope, and peripheral oedema.

Question 6

What are the signs of pulmonary hypertension on examination?

Answer 6

Signs include raised JVP, right ventricular heave, loud P2 heart sound, and signs of right heart failure such as peripheral oedema and hepatomegaly.

Question 7

What is pulmonary arterial hypertension (PAH)?

Answer 7

PAH is a subset of pulmonary hypertension caused by structural or functional changes in the pulmonary arteries, often idiopathic or associated with conditions like connective tissue diseases.

Question 8

What is the pathophysiology of pulmonary hypertension?

Answer 8

It involves increased pulmonary vascular resistance due to vasoconstriction, vascular remodelling, and thrombosis, leading to right ventricular strain.

Question 9

What are the risk factors for pulmonary hypertension?

Answer 9

Risk factors include connective tissue diseases, congenital heart disease, HIV, chronic lung disease, and family history.

Question 10

What investigations are used to diagnose pulmonary hypertension?

Answer 10

Investigations include echocardiography, right heart catheterisation, chest X-ray, ECG, and blood tests (e.g., BNP).

Question 11

What are the echocardiographic findings in pulmonary hypertension?

Answer 11

Findings may include elevated pulmonary artery systolic pressure, right ventricular hypertrophy, and dilatation.

Question 12

What is the gold standard for diagnosing pulmonary hypertension?

Answer 12

Right heart catheterisation is the gold standard for measuring pulmonary artery pressures and diagnosing pulmonary hypertension.

Question 13

What are the ECG findings in pulmonary hypertension?

Answer 13

ECG may show right axis deviation, right ventricular hypertrophy, and right atrial enlargement.

Question 14

What are the chest X-ray findings in pulmonary hypertension?

Answer 14

Findings may include enlarged pulmonary arteries, pruning of peripheral vessels, and right ventricular enlargement.

Question 15

What are the common causes of pulmonary arterial hypertension (PAH)?

Answer 15

Causes include idiopathic PAH, connective tissue diseases, congenital heart defects, and portal hypertension.

Question 16

What is chronic thromboembolic pulmonary hypertension (CTEPH)?

Answer 16

CTEPH is caused by unresolved pulmonary emboli leading to obstruction of pulmonary vessels and increased pulmonary artery pressure.

Question 17

What are the differential diagnoses for pulmonary hypertension?

Answer 17

Differential diagnoses include heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease, and pulmonary embolism.

Question 18

What is the role of BNP in pulmonary hypertension?

Answer 18

BNP (B-type natriuretic peptide) levels are often elevated due to right ventricular strain and can aid in diagnosis and monitoring of pulmonary hypertension.

Question 19

How is pulmonary hypertension classified?

Answer 19

It is classified into five groups: PAH (Group 1), PH due to left heart disease (Group 2), PH due to lung disease (Group 3), CTEPH (Group 4), and PH with unclear mechanisms (Group 5).

Question 20

What is the medical management of pulmonary hypertension?

Answer 20

Management includes vasodilators (e.g., prostacyclins, endothelin receptor antagonists, PDE-5 inhibitors), oxygen therapy, and anticoagulation.

Question 21

What is the role of oxygen therapy in pulmonary hypertension?

Answer 21

Oxygen therapy improves oxygenation, reduces pulmonary vasoconstriction, and is particularly beneficial in Group 3 PH due to lung diseases.

Question 22

What surgical options are available for pulmonary hypertension?

Answer 22

Surgical options include pulmonary endarterectomy for CTEPH and lung transplantation for severe cases.

Question 23

What lifestyle modifications are recommended for pulmonary hypertension?

Answer 23

Patients should avoid heavy exertion, maintain a healthy weight, stop smoking, and avoid high altitudes.

Question 24

What is the prognosis for pulmonary hypertension?

Answer 24

Prognosis depends on the underlying cause and treatment, but it can be poor without appropriate intervention, especially in idiopathic PAH.

Question 25

What are the complications of pulmonary hypertension?

Answer 25

Complications include right heart failure, arrhythmias, and sudden cardiac death.