pulmonary hypertension

Question 1

summarise the key features of pulmonary hypertension?

Answer 1

an increase in mean pulmonary arterial pressure which can be associated with a wide variety of other conditions

Question 2

outline the aetiology/ risk factors of pulmonary hypertension?

Answer 2

idiopathic
problems with smaller branches of pulmonary arteries
left ventricular failure
lung disease ( COPD, interstitial lung disease)
thromboses/emboli in lungs

( cor pulmnonale is right heart failure caused by chronic arterial hypertension)

Question 3

what are the risk factors for pulmonary hypertension?

Answer 3

females

appetite suppressants ( aminorex)

BMPR2 mutations

Question 4

summarise the epidemiology for pulmonary hypertension

Answer 4

idiopathic pulmonary hypertension is RARE

more common in severe respiratory and cardiac disease

Question 5

what are the presenting symptoms of pulmonary hypertension?

Answer 5

progressive breathlessness
weaknes/ tiredness 
exertional dizziness/syncope 
LATE STAGE- oedema and ascites 
angina and tachycarrythmia

Question 6

what are the signs of pulmonary hypertension on physical examination?

Answer 6

Right ventricular heave 
Loud pulmonary second heart sound 
Murmur - pulmonary regurgitation (graham-steel murmur) 
Tricuspid regurgitation 
Raised JVP 
Peripheral oedema 
 Ascites 
Cyanosis 
Syncope is uncommon but worrisome

Question 7

what are the appropriate investigations for pulmonary hypertension?

Answer 7

CXR- Exclude other lung disease

ECG

pulmonary function tests ( mild reductions in lung volume or normal)

LFTs- liver damage-> Portal hypertension

lung biopsy-> interstitial lung disease

Echo- assess right ventricular function

right catheterisation- directly measure pulmonary pressure and confirm diagnosis

bloods

Question 8

what is the use of right catheterisation to diagnose pulmonary hypertension?

Answer 8

directly measure pulmonary pressure and confirm diagnosis

Question 9

what does the ECG show in pulmonary hypertension?

Answer 9

right ventricular hypertension and strain

tall R waves and small S wave in lead V1

small R wave and large S wave in lead v5/6

Right axis deviation

Question 10

what do bloods show in pulmonary hypertension?

Answer 10

BNP elevated

FBC- as a baseline and see if haemoglobinopathy is the cause

LFTs- see if liver disease and portal HT is the cause

TFTs- check if thyroid disease is the cause

HIV serology- see if HIV is cause