Pulmonary Hypertension Flashcards
How is pulmonary hypertension characterized?
Elevated pulmonary arterial pressures and secondary RV failure
As right heart pressures rise to moderate or severe levels, the RV almost always shows reduced what?
FAC, TAPSE, and s’ values
If PC is high, where is the problem?
LA
If PC is low, where is the problem?
RV
Describe pre-capillary PHTN values:
mPAP: >25mmHg
PCWP: ≤15mmHg
PVR: ≥3 wood units
Describe post-capillary PHTN values:
mPAP: >25mmHg
PCWP: ≥15mmHg
What are respiratory symptoms of PHTN? (5)
- SOB
- Coughing
- Wheezing
- Hemoptysis
- Intercostal retraction
What are signs of right side heart failure? (4)
- Jugular vein congestion
- Peripheral edema
- Ascites
- Hepatosplenomegaly
What are associated cardiac symptoms of PHTN? (5)
- Palpitations
- Chest pain
- SOBOE
- Orthopnea
- Syncope
What is the normal RA and IVC pressure?
0-4 mmHg
What is the normal RV sys/diast pressure?
<25/<10
What is the normal pulmonary artery syst/diast pressure?
<25/<10
What is the RVSP with pulmonary hypertension?
> 35-40 mmHg
What is the most common cause of right sided heart failure?
Left side heart failure
What are two general pulmonary causes of elevated Rt sided pressures?
Parenchymal and vascular diseases
Acute pulmonary embolism is most often caused by what?
DVT
What is Eisenmenger’s Syndrome?
Shunt reversal in patients with significant shunt that have developed PHTN as a result
Chronic volume overload leads to what?
Permanent lung damage which raises pulmonary pressures
What direction does a heart shunt go and what direction does eisenmenger’s syndrome go?
Regular shunt = Left to right
Eisenmenger’s = Right to left due to high pulm pressures causing PHTN from the normal shunt they had originally
Anything that causes pressure or volume overload to the RV will lead to what?
RVH, and RV and TV annular dilation (TR)
Chronic elevation of RT heart pressures often lead to what? (3)
- Dilated coronary sinus (veins in RA)
- Reopening of the PFO (patent foramen ovale)
- Dilated main PA
Post capillary PHTN usually involves what?
LV systolic dysfunction, LV diastolic dysfunction, or valvular disease
Paradoxical septal motion (septal bounce) appears as what, and could be caused by what?
Appears as a double dip, may be caused by RBBB or LBBB
RVPO is the etiology that causes what?
Increased PRESSURE to the right heart
RVVO is the etiology that causes what?
Increased VOLUME to the right heart
PSAX D-sign is only seen when with RVVO?
Diastole
PSAX D-sign is seen when with RVPO?
Both systole and diastole
Describe what is used to calculate PAH with SPAP (RVSP)?
- Using the TR maximum vel + RAP
2. Using VSD peak velocity
Describe what is used to calculate PAH with MPAP?
- Using PW in the PA + RAP
2. Using PR early diastolic velocity (CW or PW)
Describe what is used to calculate PAH with PAEDP?
- Using PR end-diastolic velocity
Severe TR will appear as what on the spectral trace?
Dense, triangular
When a VSD is present, what should we use to calculate the RVSP?
VSD Jet
If we take the blood pressure and minus the pressure gradient from the VSD jet, what can we estimate?
RVSP
Describe the formula if we were to estimate RVSP using a VSD:
RVSP = SBP - (4Vvsd)2
MPAP number should correspond to what?
PCWP
MPAP = ?
MPAP = 79 - (0.45 X PAT) [Pulmonary acceleration time]
The PG from the early diastolic velocity tells us what?
MPAP
The RVEDP is estimated from what?
EDV of the PR jet
Describe the normal SPAP (RVSP) value:
18-25 mmHg
Describe the severe SPAp (RVSP) value:
> 70 mmHg
Describe the normal value for RVOT-AT:
≥120 ms
Describe the normal value for mPAP:
<25 mmHg
Describe the severe RVOT-AT:
<60 ms
Describe the severe mPAP:
> 50 mmHg
Describe normal PAEDP:
4-12 mmHg
What is Cor Pulmonale?
RV failure due to rising pressures from ejecting into a high resistance vascular bed causing RVH leading to dilation and failure
