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Disease II > Pulmonary Hypertension > Flashcards

Pulmonary Hypertension Flashcards

1
Q

What classify’s Pulmonary Hypertension

A

A increase of pulmonary Arterial Pressure greater than 25mmHg

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2
Q

What is the normal range for mean pulmonary arterial pressure

A

10-20mmHg

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3
Q

Is P. Hypertension always symptomatic

A

No, it can be asymptomatic and go unrecognized for years

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4
Q

What pulmonary symptom can P. hypertension cause

A

Chronic dyspnea

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5
Q

What kind of heart failure can P. Hypertension cause and why

A

Rightsided heart failure

Caused by back flow from pulmonary arteries.

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6
Q

What happens to the left ventricle when you have P. Hypertension

A

Due to the back flow, the right atrium is enlarged shrinking the size of the left ventricle

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7
Q

Who is affected by P. Hypertension

A

Individuals of all ages, races, and genders

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8
Q

What is the prevalence of P. Hypertension

A

Due to various root causes accurate prevalence is hard to generate

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9
Q

What gender is more likely to have P. Hypertension

A

Women more than men

3:1

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10
Q

What is group 1 pulmonary hyper tension examples of what can cause it

A

Idiopathic P. Hypertension

Drugs, toxins, certain diet medications

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11
Q

What is group 2 P. Hypertension

A

Left sided heart failure

Causes strain on pulmonary vasculature

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12
Q

What is poisseuilles formula

A

V(dot) = changePr^4/8nL

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13
Q

What can cause left sided heart failure that leads to P. Hypertension

A

SYSTOLIC AND DIASTOLIC DYSFUNCTION:

Pump dysfunction

VALVULAR DISEASE:

Valve dysfunction

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14
Q

What causes group 3 P. Hypertension

A

Chronic lung disease or chronic hypoxemia

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15
Q

Explain the relationship between the three groups of P. Hypertension and Poissuille’s law

A

Radius

Group three
(Lack of nitric oxide)

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16
Q

How do we diagnose P. Hypertension

A

Clinical findings and noninvasive testing

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17
Q

Features of P. Hypertension

A

JVD
Hepatomegaly (enlarged liver)
Peripheral edema
Ascites
Pleural effusion

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18
Q

Symptoms of R. Side Heart failure indicating P. Hypertension

A

Exertional chest pain

Exertional syncope

Weight gain from edema

Anorexia

Abdominal pain and swelling

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19
Q

Key Test for diagnosing P. Hypertension

A

Echocardiography

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20
Q

What can be seen on an echocardiography of a patient with P. Hypertension

A

Dilated R. Ventricle

R. Ventricular hypertrophy

Tricuspid valve regurgitation

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21
Q

What treatment do group 1 P. Hypertension patients get

A

Vasodilators

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22
Q

What TYPE of vasodilators do group 1 P. Hypertension patients take

A

Prostacyclin pathway agonist

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23
Q

Name the prostacyclin agonist

A

Iloprost (ventavis)

Treprostinil (Tyvaso)

Epopeostenol (Flolan)

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24
Q

Other name for Treprostinil

A

Tyvaso

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25
Other name for Iloprost
Ventavis
26
Other name for Epoprostenol
Flolan
27
How is Iloprost taken
Inhaled 6-9x a day
28
How is Tyvaso taken
Inhalation
29
How is Treprostinil (remodulin) taken
Pump infusion (titrates)
30
When do we use nitric oxide
When we want to support BP, but don’t want to increase fluid
31
What two inhaled dilators are given to patients with acute management of PAH
Tyvaso Ventavis
32
Define Cardiogenic PE
Abnormal accumulation of fluid in the pulmonary tissue and alveoli due to hydrostatic forces associated with LHF
33
Leading cause of death in the US
Heart disease
34
What are the two groups of pulmonary edema
Cardiogenic edema Non-Cardiogenic edema
35
Does exudate or transudate have a lot of proteins
Exudative
36
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
37
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)
38
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
39
What does ROS stand for
Reactive oxygen species
40
What does protease do in the alveoli
Breaks up protein
41
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
42
Is Cardiogenic PE transudate or exudate
Transudate
43
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
44
What is the normal ejection fraction
50-70%
45
How is the left ventricle ejection fraction estimated
Cardiac ultrasound in an echocardiogram
46
Explain HFrEF
Left ventricle suffers from a reduced contractility
47
Explain HFpEF
Left ventricle doesn’t relax so cardiac output is reduced
48
HFpEF accounts for what percentage of HF patients
50%
49
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
50
Why might a patient have pink sputum with pulmonary edema
The patient might have alveoli’s that are filled with RBCs
51
What causes iatrogenic pulmonary edema
When we over load a patient with fluids they can’t pump
52
Diagnostic criteria for the diagnosis of Cardiogenic PE
Clinical features with imaging and labs
53
Symptoms of Cardiogenic PE
Sensation of drowning Sensation of suffocation Altered mental status
54
Physical examination of a patient with Cardiogenic PE
Unable to speak in full sentences Restless/thrashing Position upright (orthopnea) Cyanotic Enlarged liver
55
Signs a patient with Cardiogenic PE is heading into shock
Low BP Obtunded Cold extremities Poor cap refill
56
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
57
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
58
How is orthopnea graded
One pillow Two pillow Three pillow
59
What features of patient history support heart failure
Rapid weight gain (water retention) Excessive consumption of salt Diuretics and others
60
How is BNP produced
As cardiac muscle stretches it produces BNP This triggers the kidneys to release sodium into urine
61
What level of BNP is not indicative of heart failure
<100pg/mL Greater suggest CHF
62
What heart abnormalities indicates heart failure
Atrial fibrillation
63
What is done to help patients with decompensated heart failure
Positive pressure Oxygen Diuretics Vasoactive/vasodilators to reduce after load and or preload
64
Why is oxygen given with heart failure
When SpO2 is below 90%
65
What position should a patient be placed in when they are using 2-3 pillows
Fowler’s
66
What diuretic do we give patients with heart failure
Furosemide (Lasix)
67
Other name for Iloprost
Ventavis
68
Other name for Treprostinil
Tyvaso
69
Other name for epoeostenol
Flolan Veletri
70
Other name for warafrin
Coumadin
71
Other name for Enoxaprin
Lovenox
72
Other name for apixaban
Eliquis
73
Other name for lasix
Furosemide
74
Lab test for abnormal heart function
B-type natriuretic peptide BNP >100pg/mL Troponin BUN and Creatinine

Disease II (14 decks)

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