Pulmonary Hypertension

Question 1

Define

Answer 1

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

Question 2

Causes

Answer 2

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

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

Question 6

Investigation

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