Pulmonary Hypertension

Question 1

Definition

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

Aetiology/Risk factors

Answer 2

· Pulmonary hypertension has a variety of causes

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

Presenting symptoms

Answer 4

· Progressive breathlessness

· Weakness/tiredness

· Exertional dizziness and syncope

· LATE STAGE - oedema and ascites

· Angina and tachyarrhythmia

Question 5

Signs 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

Investigations

Answer 6

· CXR - exclude other lung diseases

· ECG - right ventricular hypertrophy and strain

· Pulmonar

· 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