Pulmonary Hypertension Flashcards
what is the definition of pulmonary hypertension
consistently increased pulmonary arterial pressure, >20mmHg, under resting conditions
what is the aetiology of pulmonary HTN
primary causes
secondary causes
what are the primary causes of pulmonary HTN
idiopathic
what are the secondary causes of pulmonary HTN
left heart disease -mitral valve disease -LV failure -LA myxoma/thrombosis COPD recurrent PE increased pulmonary blood flow -atrial/ventricular septal defect -patent ductus arteriosus CTDs -SLE -systemic sclerosis amiodarone
what is the epidemiology of pulmonary HTN
primary HTN common in young females
what history is associated with pulmonary HTN
dyspnoea on exertion chest pain syncope fatigue symptoms of underlying cause
what examination findings are associated with pulmonary HTN
inspection
-raised JVP
palpation
-left parasternal heave indicating RV hypertrophy
auscultation
-loud pulmonary component of hs2
-hs3/hs4 may be heard
-early diastolic murmur(Graham-Steel murmur) due to pulmonary regurg may be present
-pansystolic murmur if tricuspid regurg develops
what investigations would be performed in suspected pulmonary HTN
1 CXR 2 ECG 3 echo -visualise RV hypertrophy/RA dilation 4 lung function tests -assess for chronic lung disease 5 VQ scan -assess for PE 6 cardiac catheterisation -assess severity and right heart pressures -assess response to vasodilators 7 high resolution CT-thorax -image pulmonary arteries 8 lung biopsy -assess structural lung changes
what would you look for on a CXR in suspected pulmonary HTN
cardiomegaly (RV enlargement, RA dilation) prominent main pulmonary arteries signs of cause -COPD -calcified mitral valves
what would you look for on a ECG in suspected pulmonary HTN
RV hypertrophy
-prominant R wave in V1
-T inversion in V1 and V2
-RAD
RA enlargement
-peaked P wave in II indicating ‘P pulmonale’
limb leads exhibit low voltage (R<5mm in COPD)
what is p pulmonale
tall, narrow, peaked P waves in II, III, aVF characteristic of cor pulmonale
what is cor pulmonale
alteration of structure and function of RV caused by a primary disorder between the respiratory system and the heart
i.e. pulmonary HTN
