Pulmonary hypertension

Question 1

Define:

Answer 1

An increase in mean pulmonary arterial pressure above 25mmHg which can be caused by or associated with a wide variety of other conditions.

Question 2

Aetiology/risk factors:

Answer 2

o Idiopathic
o Problems with smaller branches of the pulmonary arteries
o Left ventricular failure
o Lung disease (e.g. COPD, interstitial lung disease)
o Thromboses/Emboli in the lungs

Question 3

Epidemiology:

Answer 3

• Idiopathic pulmonary hypertension is RARE

* More common in severe respiratory and cardiac disease

Question 4

Symptoms:

Answer 4

• Progressive breathlessness
• Weakness/tiredness
• Exertional dizziness and syncope
• LATE STAGE - oedema and ascites
• Angina and tachyarrhythmia

Question 5

Signs:

Answer 5

• Right ventricular heave
• Loud pulmonary second heart sound
• Murmur - pulmonary regurgitation
• Tricuspid regurgitation
• Raised JVP
• Peripheral oedema
• Ascites
• Hepatomegaly

Question 6

Investigations:

Answer 6

• CXR - exclude other lung diseases
• ECG - right ventricular hypertrophy and strain
• Pulmonary function tests
• LFTs - liver damage –> portal hypertension
• Lung biopsy - interstitial lung disease
• Echocardiography - assess right ventricular function
• Right Heart Catheterisation - directly measure pulmonary pressure and confirm the diagnosis