Pulmonary Hypertension Flashcards
Define pulmonary arterial hypertension.
Pulmonary arterial hypertension exists when the mean
pulmonary artery pressure is greater than 25 mmHg at rest or
more than 30 mmHg with exertion.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 97.
What is idiopathic pulmonary arterial hypertension?
diopathic pulmonary arterial hypertension (PAH) was formerly
named primary pulmonary hypertension and is a form of PAH
that is present without pre-existing myocardial disease,
congenital heart disease, left sided heart disease, or respiratory
abnormalities.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 97.
What is the most effective treatment for secondary
PAH?
Treatment of the primary disorder
McCance KL, Huether SE. Pathophysiology: The Biologic
Basis for Disease in Adults and Children. Maryland Heights,
MO: Mosby Elsevier; 2010: 1298.
What symptoms would a patient with PAH exhibit?
Fatigue, abdominal distension, weakness, breathlessness,
angina pectoris, and syncope.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 98.
What would a physical examination of a patient with
PAH reveal?
Jugular venous distension, hepatomegaly, ascites, and upon
auscultation, murmurs associated with pulmonic insufficiency
and/or tricuspid regurgitation, an S3 gallop, a parasternal lift,
and a prominent pulmonic component of S2.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 98.
Why would a right-sided heart catheterization be
performed on a patient with PAH?
It provides a definitive diagnosis of PAH, determines disease
severity, and also determines which patients will benefit from
therapy with a vasodilator.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 98.
McCance KL, Huether SE. Pathophysiology: The Biologic
Basis for Disease in Adults and Children. Maryland Heights,
MO: Mosby Elsevier; 2010: 1298.
How does PAH affect right ventricular wall stress?
PAH increases right ventricular wall stress.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 99.
List treatments for PAH.
Diuretics, anticoagulation, oxygen, inhaled nitric oxide (NO),
medications such as calcium channel blockers, prostacyclins,
phosphodiesterase inhibitors, and endothelin receptor
antagonists. Patients who fail to respond to medical
interventions require lung transplantation.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 100.
How do hypercarbia, hypoxia, and acidosis affect the
pulmonary vascular resistance?
They all increase the pulmonary vascular resistance.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 100.
Should medications for the treatment of PAH be
continued throughout the perioperative period?
Yes
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 100.
What is the result of chronic hypoxemia on the
pulmonary vasculature?
Chronic hypoxemia causes pulmonary vasoconstriction and
vascular remodeling, resulting in severe fibrosis, hypertrophy of
smooth muscle, and luminal narrowing.
McCance KL, Huether SE. Pathophysiology: The Biologic
Basis for Disease in Adults and Children. Maryland Heights,
MO: Mosby Elsevier; 2010: 1297.
At what point is PAH no longer reversible?
When the medial smooth muscle layer has hypertrophied, PAH
is no longer reversible.
McCance KL, Huether SE. Pathophysiology: The Biologic
Basis for Disease in Adults and Children. Maryland Heights,
MO: Mosby Elsevier; 2010: 1298.
What would a chest radiograph of a patient with PAH
display?
Enlarged pulmonary arteries, enlargement of the right atrium
and ventricle, parenchymal lung disease.
McCance KL, Huether SE. Pathophysiology: The Biologic
Basis for Disease in Adults and Children. Maryland Heights,
MO: Mosby Elsevier; 2010: 98.
Why are patients with PAH at risk for sudden death
in the immediate postoperative period?
Sudden death can occur in this patient population due to fluid
shifts, dysrhythmias, pulmonary emboli, and worsening PAH.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 101.
Why would the maintenance of sinus rhythm for a
patient undergoing surgery with PAH be critical?
Sufficient filling of the right and left ventricles is dependent on
the atrial “kick”.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 100.
