Pulmonary Hypertension Flashcards
What classify’s Pulmonary Hypertension
A increase of pulmonary Arterial Pressure greater than 25mmHg
What is the normal range for mean pulmonary arterial pressure
10-20mmHg
Is P. Hypertension always symptomatic
No, it can be asymptomatic and go unrecognized for years
What pulmonary symptom can P. hypertension cause
Chronic dyspnea
What kind of heart failure can P. Hypertension cause and why
Rightsided heart failure
Caused by back flow from pulmonary arteries.
What happens to the left ventricle when you have P. Hypertension
Due to the back flow, the right atrium is enlarged shrinking the size of the left ventricle
Who is affected by P. Hypertension
Individuals of all ages, races, and genders
What is the prevalence of P. Hypertension
Due to various root causes accurate prevalence is hard to generate
What gender is more likely to have P. Hypertension
Women more than men
3:1
What is group 1 pulmonary hyper tension examples of what can cause it
Idiopathic P. Hypertension
Drugs, toxins, certain diet medications
What is group 2 P. Hypertension
Left sided heart failure
Causes strain on pulmonary vasculature
What is poisseuilles formula
V(dot) = changePr^4/8nL
What can cause left sided heart failure that leads to P. Hypertension
SYSTOLIC AND DIASTOLIC DYSFUNCTION:
Pump dysfunction
VALVULAR DISEASE:
Valve dysfunction
What causes group 3 P. Hypertension
Chronic lung disease or chronic hypoxemia
Explain the relationship between the three groups of P. Hypertension and Poissuille’s law
Radius
Group three
(Lack of nitric oxide)
How do we diagnose P. Hypertension
Clinical findings and noninvasive testing
Features of P. Hypertension
JVD
Hepatomegaly (enlarged liver)
Peripheral edema
Ascites
Pleural effusion
Symptoms of R. Side Heart failure indicating P. Hypertension
Exertional chest pain
Exertional syncope
Weight gain from edema
Anorexia
Abdominal pain and swelling
Key Test for diagnosing P. Hypertension
Echocardiography
What can be seen on an echocardiography of a patient with P. Hypertension
Dilated R. Ventricle
R. Ventricular hypertrophy
Tricuspid valve regurgitation
What treatment do group 1 P. Hypertension patients get
Vasodilators
What TYPE of vasodilators do group 1 P. Hypertension patients take
Prostacyclin pathway agonist
Name the prostacyclin agonist
Iloprost (ventavis)
Treprostinil (Tyvaso)
Epopeostenol (Flolan)
Other name for Treprostinil
Tyvaso
Other name for Iloprost
Ventavis
Other name for Epoprostenol
Flolan
How is Iloprost taken
Inhaled 6-9x a day
How is Tyvaso taken
Inhalation
How is Treprostinil (remodulin) taken
Pump infusion (titrates)
When do we use nitric oxide
When we want to support BP, but don’t want to increase fluid
What two inhaled dilators are given to patients with acute management of PAH
Tyvaso
Ventavis
Define Cardiogenic PE
Abnormal accumulation of fluid in the pulmonary tissue and alveoli due to hydrostatic forces associated with LHF
Leading cause of death in the US
Heart disease
What are the two groups of pulmonary edema
Cardiogenic edema
Non-Cardiogenic edema
Does exudate or transudate have a lot of proteins
Exudative
Different pathophysiologies of non-Cardiogenic and Cardiogenic PE
Cardiogenic is low in protein and caused left side heart failure causing hydrostatic pressure change causing leaks through gap junction
Non is caused be damage to the AC membrane
What is a cytokines storm w/ non-Cardiogenic PE
Damage to the tissue directly or indirectly calls pro-inflammatory cytokines
Quality is excessively high and call neutrophils
Kills invaders and host tissue (multi system organ failure)
What role does neutrophils play in the development of non-Cardiogenic PE
Neutrophils release toxins that normally carefully apply to bacterial invaders
Cytokine storm causes abnormal tissue damage
Damaged cap endothelium can’t hold on proteins that normally balance fluid
What does ROS stand for
Reactive oxygen species
What does protease do in the alveoli
Breaks up protein
What is the cause of leaking of capillaries do to hydrostatic pressure
Hydrostatic pressure overcomes on oncotic pressure
Fills interstitial space until in fluids alveoli
Is Cardiogenic PE transudate or exudate
Exhudate
What are the two types of left heart failure
HF with reduced ejection fraction (HFrEF)
Systolic failure
HF with preserved Ejection Fraction (HFpEF)
Diastolic failure
What is the normal ejection fraction
50-70%
How is the left ventricle ejection fraction estimated
Cardiac ultrasound in an echocardiogram
Explain HFrEF
Left ventricle suffers from a reduced contractility
Explain HFpEF
Left ventricle doesn’t relax so cardiac output is reduced
HFpEF accounts for what percentage of HF patients
50%
Why might a patient experience alveoli shrinkage do to a pulmonary edema
Plasma washes out surfactant and leads to soapy solution and collapse due to surface tension
Why might a patient have pink sputum with pulmonary edema
The patient might have alveoli’s that are filled with RBCs
What causes iatrogenic pulmonary edema
When we over load a patient with fluids they can’t pump
Diagnostic criteria for the diagnosis of Cardiogenic PE
Clinical features with imaging and labs
Symptoms of Cardiogenic PE
Sensation of drowning
Sensation of suffocation
Altered mental status
Physical examination of a patient with Cardiogenic PE
Unable to speak in full sentences
Restless/thrashing
Position upright (orthopnea)
Cyanotic
Enlarged liver
Signs a patient with Cardiogenic PE is heading into shock
Low BP
Obtunded
Cold extremities
Poor cap refill
What do you hear on auscultation with Cardiogenic PE
Fine crackles that starts at the bases and moves up and coarsen as edema grows severe
Wheezing
Rhonchi
Heart murmur
Explain paroxysmal nocturnal dyspnea and why
Dyspnea while lying down
Fluid collets in legs and and creates manageable load for heart
While lying down gravity no longer holds down blood so heart is over worked
Pulmonary edema develops
How is orthopnea graded
One pillow
Two pillow
Three pillow
What features of patient history support heart failure
Rapid weight gain (water retention)
Excessive consumption of salt
Diuretics and others
How is BNP produced
As cardiac muscle stretches it produces BNP
This triggers the kidneys to release sodium into urine
What level of BNP is not indicative of heart failure
<100pg/mL
Greater suggest CHF
What heart abnormalities indicates heart failure
Atrial fibrillation
What is done to help patients with decompensated heart failure
Positive pressure
Oxygen
Diuretics
Vasoactive/vasodilators to reduce after load and or preload
Why is oxygen given with heart failure
When SpO2 is below 90%
What position should a patient be placed in when they are using 2-3 pillows
Fowler’s
What diuretic do we give patients with heart failure
Furosemide (Lasix)
Other name for Iloprost
Ventavis
Other name for Treprostinil
Tyvaso
Other name for epoeostenol
Flolan
Veletri
Other name for warafrin
Coumadin
Other name for Enoxaprin
Lovenox
Other name for apixaban
Eliquis
Other name for lasix
Furosemide
Lab test for abnormal heart function
B-type natriuretic peptide
BNP >100pg/mL
Troponin
BUN and Creatinine
