Pulmonary Hypertension Flashcards
What is the definition of pulmonary hypertension and what is normal?
Pulmonary hypertension = mean pulmonary artery pressure > 25 mmHg
nl mean pulmonary artery pressure is 15-18 mmHg
True or False: An increase in pulmonary arterial pressure is always due to an increase in pulmonary vascular resistance
False: Increased PAP can be due to
- increased PVR
- increased LAP
- increased CO (relatively rare by itself)
What is the definition of pre-capillary pulmonary hypertension?
Pulmonary ARTERIAL hypertension (PAH)
PCWP
What is the definition of post-capillary pulmonary hypertension?
Pulmonary VENOUS hypertension (PVH)
PCWP > 15 mmHg
Which type of pulmonary hypertension includes a cause by increased LAP?
PVH
What are the criteria for PAH?
Mean PAP > 25 mmHg PLUS
PLUS 3 WU
What are the 5 WHO groups of PH?
- PAH
- PH due to left heart disease (PVH)
- PH due to lung diseases or hypoxia
- Thromboembolic pulmonary HTN
- PH with unclear/multifactorial mechanisms
What class of WHO pt with mPAP = 45 mmHg PCWP = 20 mmHg CO = 5 L/min PVR = 5 WU
group 2 PH due to LH disease b/c PCWP >15
What are some causes of acute pulmonary hypertension?
pneumonia (hypoxic vasoconstriction)
thromboembolic disease
hypoxia (high altitude)
What is the pathophysiology of a PE on the RV? What are the 2 types of PE causing RV problems?
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
What are the classic findings for PE on an EKG that you will probably never see?
SI, QIII, T III
What is the most common EKG finding for PE?
sinus tachycardia
What are 2 findings for PE on a CXR?
PE CXR are normally normal
however, can see:
- hampton’s hump = infarcted lung
- westermarks sign = hypoperfusion
What is the gold standard for diagnosing a PE?
angiogram (rarely performed)
What is an unexpected finding on a CXR for PE?
large infiltrate
What are the key features of idiopathic PAH?
- 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
What is the hemodynamic course of PAH in regards to PVR, PAP, and CO?
- 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
What will you hear on auscultation of the lungs for PAH?
normal lungs, no rales
A patient has 6 months of progressive dyspnea, edema, loud P2, echo shows RVSP 80 mmHg. What do you do next?
Right heart cath to confirm the RVSP/PAP
what is the best treatment for PAH?
treat the underlying cause and use vasodilators
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?
WHO Class 1 PAH
treat with sildenafil a vasodilator
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?
Add IV epoprostenol which is the most potent vasodilator
in order to add CCB, must first respond to vasodilator
True or False: You treat PVH the same way you treat PAH
False: PAH is treated with vasodilators which work on the arterial side and will cause pulmonary edema
Pt with RH cath shows mPAP = 26 mmHg PCWP = 20 CO = 3 PVR = 2 WU What WHO classification? What's treatment?
WHO class 2 PVH treat with diuretics due to LHF
