Pulmonary hypertension

Question 1

Define pulmonary hypertension

Answer 1

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

Question 2

Explain the aetiology/risk factors of pulmonary hypertension

Answer 2

Pulmonary hypertension has a variety of causes
Idiopathic

Problems with smaller branches of the pulmonary arteries

Left ventricular failure

Lung disease (e.g. COPD, interstitial lung disease)

Thromboses/Emboli in the lung

Question 3

Summarise the epidemiology of pulmonary hypertension

Answer 3

Idiopathic pulmonary hypertension is RARE

More common in severe respiratory and cardiac diseas

Question 4

Recognise the presenting symptoms of pulmonary hypertension

Answer 4

Progressive breathlessness
Weakness/tiredness
Exertional dizziness and syncope

LATE STAGE-
Oedema and ascites
Angina and tachyarrhythmia

Question 5

Recognise the signs of pulmonary hypertension on physical examination

Answer 5

Right ventricular heave
Loud pulmonary second heart sound
Murmur -pulmonary regurgitation, Tricuspid regurgitation

Raised JVP
Peripheral oedema
Ascites

Question 6

Identify appropriate investigations for pulmonary hypertension

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