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Pulmonary > Pulmonary Hypertension > Flashcards

Pulmonary Hypertension Flashcards

1
Q

What is the definition of pulmonary hypertension and what is normal?

A

Pulmonary hypertension = mean pulmonary artery pressure > 25 mmHg
nl mean pulmonary artery pressure is 15-18 mmHg

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2
Q

True or False: An increase in pulmonary arterial pressure is always due to an increase in pulmonary vascular resistance

A

False: Increased PAP can be due to

  • increased PVR
  • increased LAP
  • increased CO (relatively rare by itself)
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3
Q

What is the definition of pre-capillary pulmonary hypertension?

A

Pulmonary ARTERIAL hypertension (PAH)

PCWP

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4
Q

What is the definition of post-capillary pulmonary hypertension?

A

Pulmonary VENOUS hypertension (PVH)

PCWP > 15 mmHg

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5
Q

Which type of pulmonary hypertension includes a cause by increased LAP?

A

PVH

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6
Q

What are the criteria for PAH?

A

Mean PAP > 25 mmHg PLUS

PLUS 3 WU

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7
Q

What are the 5 WHO groups of PH?

A
  1. PAH
  2. PH due to left heart disease (PVH)
  3. PH due to lung diseases or hypoxia
  4. Thromboembolic pulmonary HTN
  5. PH with unclear/multifactorial mechanisms
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8
Q 
What class of WHO pt with 
mPAP = 45 mmHg
PCWP = 20 mmHg
CO = 5 L/min
PVR = 5 WU
A

group 2 PH due to LH disease b/c PCWP >15

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9
Q

What are some causes of acute pulmonary hypertension?

A

pneumonia (hypoxic vasoconstriction)
thromboembolic disease
hypoxia (high altitude)

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10
Q

What is the pathophysiology of a PE on the RV? What are the 2 types of PE causing RV problems?

A

PE leads to RV strain (submassive (1)) or failure (massive (2))
This causes increased myocardial O2 demand, decreased myocardial O2 delivery, and eventually leads to death

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11
Q

What are the classic findings for PE on an EKG that you will probably never see?

A

SI, QIII, T III

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12
Q

What is the most common EKG finding for PE?

A

sinus tachycardia

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13
Q

What are 2 findings for PE on a CXR?

A

PE CXR are normally normal
however, can see:
- hampton’s hump = infarcted lung
- westermarks sign = hypoperfusion

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14
Q

What is the gold standard for diagnosing a PE?

A

angiogram (rarely performed)

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15
Q

What is an unexpected finding on a CXR for PE?

A

large infiltrate

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16
Q

What are the key features of idiopathic PAH?

A
  • rare and fatal
  • occurs in young women 3:1 F:M
  • 3rd -4th decade of life
  • prognosis w/o tx is 3 years, w/ tx 7 yrs
17
Q

What is the hemodynamic course of PAH in regards to PVR, PAP, and CO?

A
  • progressive increase in PVR pressure
  • increase in PAP until stage IV when heart can’t pump against PVR anymore and then PAP decreases
  • CO continually decreases from the beginning
18
Q

What will you hear on auscultation of the lungs for PAH?

A

normal lungs, no rales

19
Q

A patient has 6 months of progressive dyspnea, edema, loud P2, echo shows RVSP 80 mmHg. What do you do next?

A

Right heart cath to confirm the RVSP/PAP

20
Q

what is the best treatment for PAH?

A

treat the underlying cause and use vasodilators

21
Q 
A patient with right heart cath shows:
mPAP = 45 mmHg
PCWP = 10
CO = 5 L/min
PVR = 7 WU
what class of WHO does he have?  Patient has no response to NO, V/Q is negative, what do you do next?
A

WHO Class 1 PAH

treat with sildenafil a vasodilator

22
Q

Patient previously treated with Sildenafil has RH cath showing
mPAP = 43 mmHg
PCWP = 10 mmHg
CO = 3 L/min
PVR = 11 WU
What should you do next? When would you add a CCB?

A

Add IV epoprostenol which is the most potent vasodilator

in order to add CCB, must first respond to vasodilator

23
Q

True or False: You treat PVH the same way you treat PAH

A

False: PAH is treated with vasodilators which work on the arterial side and will cause pulmonary edema

24
Q 
Pt with RH cath shows
mPAP = 26 mmHg
PCWP = 20
CO = 3
PVR = 2 WU
What WHO classification? What's treatment?
A 
WHO class 2 PVH
treat with diuretics due to LHF

Pulmonary (32 decks)

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