Pulmonary Hypertension Flashcards
what mean PAP on swan defines pulm HTN?
25mm Hg at rest
old definition of PAH on echo
systolic PAP > 40 (TR velocity 3-3.5m/s)
which drugs can cause PAH?
Fen-phen, amphetamines, cocaine, St. John’s Wort, SSRIs
name the most important connective tissue dz that causes PAH
scleroderma
name the most important virus associated with PAH
HIV
name a common congenital heart dz associ. w/ PAH
eisenmenger’s
what parasite can cause PAH?
schistosomiasis
what chemotherapy is associated with PAH due to pulmonary veno-occlusive dz?
bleomycin
are pleural effusions seen in IPAH?
no
what finding on right heart cath is suspicious for pulmonary veno-occlusive dz?
inconsistent PCWP tracings
if pt on cath table is given a PA vasodilator and they go into pulmonary edema, what should you think of?
pulmonary veno-occlusive dz
what to suspect when pt has severe PAH, pulm edema, high PCWP:LVEDP?
pulm veno-occlusive dz
Rx for pulmo veno-occlusive dz
diuretics, anticoagulant, O2, lung Tx
is bosentan recommended for pulmonary veno-occlusive dz?
no
WHO group classification for PAH
1- PAH 2- due to left heart dz 3- lung dz 4- chronic PE 5- multifactorial
***which of the WHO groups of PAH is often misdiagnosed as group 1 or idiopathic? How do you distinguish them?
WHO 4 (chronic PE) V/Q scan
for CHRONIC thromboembolic pulmonary htn (CTEPH), which test is more sensitive: CT-pulmonary angiography or V/Q scan?
V/Q scan
currently, what WHO group for PAH is sarcoidosis in?
5
with RVH/RAE, which lead has an increased p wave on ekg?
II
how to calculate RVSP (which equals PASP) on echo?
4v2 + RAP where v = velocity of TR jet and RAP os estimated form IVC size.
describe the 4 functional classes of PAH according to WHO
I- PAH without sxs
II- sxs with ordinary activity, but mild
III- sxs with minimal activity, severe
IV- sxs at rest
is RHC required to diagnose PAH?
yes
Rx for WHO 4 PAH
anticoagulation, thromboendarterectomy
Rx for WHO 5 PAH
underlying cause
which WHO group classes of PAH should be anti coagulated?
1 (idiopathic) and 4 (embolic)
which WHO group PAH gets a vasoreactivity test on RHC?
1
name 3 agents that can be used to perform a vasoreactivity test in PAH
adenosine, epoprostenol, inhaled NO
what is a positive test during a invasive hemodynamic vasoreactivity assessment of PAH?
decrease in mean PAP of 10 to less than 40 with increased or unchanged C.O.
what drugs do you use to treat PAH with vasoreactivity on RHC?
CCBs (dihydropyridine or diltiazem)
which drug improves functional capacity and survival for PAH WHO group I (idiopathic)?
flolan=epoprostenol=prostacyclin
Bosentan MOA
endothelia receptor antagonist
sildenafil/tadalafil MOA
PDE 5 inhibitors
algorithm for treating NYHA IV PAH
epoprostenol, if doesn’t work combo therapy then atrial septostomy or lung transplant
preferred treatment for NYHA II PAH
bosentan or sildenafil
components of PE severity index (PESI) [6] where even one point means 10% 30 d mortality
age >80, cancer, COPD, HR>110, BP< 90
for hemodynamically stable patients with PE, which is preferred: lovenox or UFH?
lovenox
for massive PE, which is preferred: UFH or lovenox?
UFH
what is associated with warfarin-induced skin necrosis?
Protein C deficiency
absolute contraindication to thrombolytics in massive PE (4)
h/o hemorrhagic stroke
active intracranial neoplasm
intracranial sx/trauma within 2 mo’s
active internal bleeding within 2 mo’s
when do you start CPAP for sOSA?
when apnea-hypopnea-index > 15 (AHI = apneic episodes + hypopneic episodes)
