Pulmonary Hypertension

Question 1

Definition

Answer 1

Elevated blood pressure in the pulmonary arterial tree

Question 2

What is considered as pulmonary hypertension?

Answer 2

> 25 mmHg

Question 3

Classification

Answer 3

Primary/idiopathic - unknown cause, usually in young people

Secondary - usually in older people, as a result of other conditions

Question 4

Aetiology

Answer 4

Idiopathic
Left heart disease
Chronic respiratory disease - COPD
Congenital heart disease (L to R shunt) 
HIV infection 
Sarcoidosis

Question 5

Symptoms

Answer 5

Chest tightness
Dyspnoea
Presyncope/syncope

Question 6

Clinical signs

Answer 6

Elevated JVP
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly- back pressure on venous system, leakage of fluid out 
Ankle oedema

Question 7

Investigations

Answer 7

ECG
Lung function tests- lung disease common cause of this
CXR
Echocardiography-measure velocity of regurgitant right ventricle , indirect or indirect measure
V/Q scan
CTPA- look for changes chronic thromboembolic pulmonary hypertension
Right heart catheterisation- direct measure and more reliable
allows direct measure of pulmonary artery pressure
measurement of wedge pressure
measurement of cardiac output

Question 8

Treatment

Answer 8

Anticoagulation
Diuretics
Amlodipine
Prostacyclin
Riociguat