Pulmonary Hypertension Flashcards

1
Q

what mean PAP on swan defines pulm HTN?

A

25mm Hg at rest

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2
Q

old definition of PAH on echo

A

systolic PAP > 40 (TR velocity 3-3.5m/s)

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3
Q

which drugs can cause PAH?

A

Fen-phen, amphetamines, cocaine, St. John’s Wort, SSRIs

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4
Q

name the most important connective tissue dz that causes PAH

A

scleroderma

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5
Q

name the most important virus associated with PAH

A

HIV

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6
Q

name a common congenital heart dz associ. w/ PAH

A

eisenmenger’s

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7
Q

what parasite can cause PAH?

A

schistosomiasis

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8
Q

what chemotherapy is associated with PAH due to pulmonary veno-occlusive dz?

A

bleomycin

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9
Q

are pleural effusions seen in IPAH?

A

no

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10
Q

what finding on right heart cath is suspicious for pulmonary veno-occlusive dz?

A

inconsistent PCWP tracings

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11
Q

if pt on cath table is given a PA vasodilator and they go into pulmonary edema, what should you think of?

A

pulmonary veno-occlusive dz

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12
Q

what to suspect when pt has severe PAH, pulm edema, high PCWP:LVEDP?

A

pulm veno-occlusive dz

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13
Q

Rx for pulmo veno-occlusive dz

A

diuretics, anticoagulant, O2, lung Tx

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14
Q

is bosentan recommended for pulmonary veno-occlusive dz?

A

no

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15
Q

WHO group classification for PAH

A
1- PAH
2- due to left heart dz
3- lung dz
4- chronic PE
5- multifactorial
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16
Q

***which of the WHO groups of PAH is often misdiagnosed as group 1 or idiopathic? How do you distinguish them?

A
WHO 4 (chronic PE)
V/Q scan
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17
Q

for CHRONIC thromboembolic pulmonary htn (CTEPH), which test is more sensitive: CT-pulmonary angiography or V/Q scan?

A

V/Q scan

18
Q

currently, what WHO group for PAH is sarcoidosis in?

A

5

19
Q

with RVH/RAE, which lead has an increased p wave on ekg?

A

II

20
Q

how to calculate RVSP (which equals PASP) on echo?

A

4v2 + RAP where v = velocity of TR jet and RAP os estimated form IVC size.

21
Q

describe the 4 functional classes of PAH according to WHO

A

I- PAH without sxs
II- sxs with ordinary activity, but mild
III- sxs with minimal activity, severe
IV- sxs at rest

22
Q

is RHC required to diagnose PAH?

A

yes

23
Q

Rx for WHO 4 PAH

A

anticoagulation, thromboendarterectomy

24
Q

Rx for WHO 5 PAH

A

underlying cause

25
Q

which WHO group classes of PAH should be anti coagulated?

A

1 (idiopathic) and 4 (embolic)

26
Q

which WHO group PAH gets a vasoreactivity test on RHC?

A

1

27
Q

name 3 agents that can be used to perform a vasoreactivity test in PAH

A

adenosine, epoprostenol, inhaled NO

28
Q

what is a positive test during a invasive hemodynamic vasoreactivity assessment of PAH?

A

decrease in mean PAP of 10 to less than 40 with increased or unchanged C.O.

29
Q

what drugs do you use to treat PAH with vasoreactivity on RHC?

A

CCBs (dihydropyridine or diltiazem)

30
Q

which drug improves functional capacity and survival for PAH WHO group I (idiopathic)?

A

flolan=epoprostenol=prostacyclin

31
Q

Bosentan MOA

A

endothelia receptor antagonist

32
Q

sildenafil/tadalafil MOA

A

PDE 5 inhibitors

33
Q

algorithm for treating NYHA IV PAH

A

epoprostenol, if doesn’t work combo therapy then atrial septostomy or lung transplant

34
Q

preferred treatment for NYHA II PAH

A

bosentan or sildenafil

35
Q

components of PE severity index (PESI) [6] where even one point means 10% 30 d mortality

A

age >80, cancer, COPD, HR>110, BP< 90

36
Q

for hemodynamically stable patients with PE, which is preferred: lovenox or UFH?

A

lovenox

37
Q

for massive PE, which is preferred: UFH or lovenox?

A

UFH

38
Q

what is associated with warfarin-induced skin necrosis?

A

Protein C deficiency

39
Q

absolute contraindication to thrombolytics in massive PE (4)

A

h/o hemorrhagic stroke
active intracranial neoplasm
intracranial sx/trauma within 2 mo’s
active internal bleeding within 2 mo’s

40
Q

when do you start CPAP for sOSA?

A

when apnea-hypopnea-index > 15 (AHI = apneic episodes + hypopneic episodes)