Pulmonary Hypertension

Question 1

definition

Answer 1

Defined as elevation in pulmonary diastolic (>15mmHg) and systolic (> 20 mmHg) pressures (mean >20 mmHg)

Question 2

secondery - most common

Answer 2

Secondary to left heart disease 50%

Secondary to pulmonary disease/hypoxia 25%

Thrombotic/embolic diseases

Eisenmenger’s syndrome (reversed congenital shunts- ASD/VSD/PDA) and heartworm disease- 10% of canine PH cases

Miscellaneous (compressive lesions- neoplasia/granuloma)

Primary (idiopathic) (considered extremely rare

Question 3

Clinical signs

Answer 3

A leading cause of syncope
Exercise intolerance
Rarely dyspnea, cough
Signs of right-sided CHF such as Ascites / Pleural effusion
Split S2
**A much-louder-than-expected right apical systolic (TR) murmur
Decrescendo diastolic murmur (secondary to PI) (rare)
Other murmurs secondary to an underlying cardiac disease (most commonly MR, occasionally PDA unless Eissenmenger’s physiology has already developed)

Question 4

Chest x-rays

Answer 4

Underlying disease (MR, PDA, pulmonary pathologies)

Right heart enlargement

*Vascular patterns, pulmonary arterial enlargement

Question 5

Diagnosis

Answer 5

Echocardiography:
Volume overload and excessive myocardial contractions may over-estimate pressure gradients
Right ventricular enlargement and hypertrophy
Pulmonary artery /aorta ratio >1
Flattening of ventricular septum

Question 6

Treatment

Answer 6

Sildenafil or tadalafil (PDE-5 inhibitor)-
Effective as sole Tx with Eisenmenger’s syndrome – phlebotomy to reduce polycythemia with other cases
Pimobendan (PDE-3 inhibitor) for dogs with MR may also improve PH
When severe, add sildenafil

יש להיזהר במצבי MRשלא לטפל בצורה אינטנסיבית מדי – הפחתה משמעותית
של יתר לחץ דם ריאתי בבת אחת יכולה להעלות בבת אחת את ה- PLלצד שמאל, ולגרום כך לאי
ספיקה שמאלית.

Question 7

prognosis

Answer 7

Moderate to severe PH carries a grave prognosis, if the underlying cause cannot be controlled

Concurrent right congestive heart disease is a negative prognostic factor