Pulmonary hypertension

Question 1

Definition

Answer 1

Increase in BP in pulmonary artery over 25mmhg

Question 2

Investigations

Answer 2

ECHO
ECG
Lung function tests 
V/Q scan 
Right heart cauterisation: 
measures pulmonary artery pressure
measures wedge pressure 
measures cardiac output

Question 3

Signs

Answer 3

• peripheral oedema
• Elevated JVP
• Hepatomegaly
• Right ventricular heave

Question 4

Symptoms

Answer 4

• chest tightness
• dyspnoea
• syncope/presyncope

Question 5

Treatment for underlying disease

Answer 5

• O2 if hypoxic
• anticoagulants if related to thromboembolectomy
• diuretics for peripheral oedema

Question 6

Aetiology

Answer 6

Primary:
-idiopathic
-occurs in the younger generation
-progresses rapidly 
-if not treated then can lead to premature death
Secondary: occurs in older population in response to:
-Idiopathic 
-Left heart disease- back flow of blood in the pulmonary system leads to hypertension 
-Chronic respiratory disease 
-Pulmonary thromboembolic hypertension
-Miscellanous: 
portal hypertension 
HIV infection 
Congenital heart shunt 
Collagen vascular heart disease

Question 7

Specific treatment

Answer 7

• prostacyclin
• Calcium channel antagonists
• Endothelial receptor antagonists
• phosphodiesterase inhibitors

Question 8

Wedge pressure

Answer 8

An indirect approximation of the pressure of the atrium by inserting a catheter into the pulmonary artery

Question 9

Surgical treatment?

Answer 9

Thromboendarectomy

lung transplant

Question 10

Cor pulmonale

Answer 10

Enlargement of the right side of the heart due to hypertension of the lungs
Hypertension of the lungs makes it more difficult for the right side ventricle to pump blood out into the lung
- in acute disease this leads to extension of the ventricles
- in chronic disease this leads to parallel hypertrophy

Question 11

How does right ventricle hypertrophy lead to systolic/ diastolic heart failure associated with cor pulmonale

Answer 11

-more muscle= less room for blood to fill into so diastolic heart failure
-Less 02 to the heart as the coronary artery is squished
-Increased demand of o2 due to increase in muscle
This causes weaker contraction so can lead to systolic heart failure

Question 12

Symptoms of cor pulmonale

Answer 12

• SOB
• edema
• hepatomegaly
• Jugular venous distension

Question 13

Treatment of Cor pulmonale

Answer 13

02
Digoxin: increases heart contractility
Diuretics: reduce fluid build up