Pulmonary Hypertension

Question 1

What is the definition of 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

What is the aetiology 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 lungs

Question 3

What is the epidemiology of pulmonary hypertension?

Answer 3

Idiopathic pulmonary hypertension is RARE

More common in severe respiratory and cardiac disease

Question 4

What are 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

What are the signs of pulmonary hypertension upon physical examination?

Answer 5

Right ventricular heave

Loud pulmonary second heart sound

Murmur - pulmonary regurgitation

Tricuspid regurgitation

Raised JVP

Peripheral oedema

Ascites

Question 6

What are the appropriate investigations of 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