Pulmonary Hypertension

Question 1

what sign on this xray indicates pulmonary hypertensino

Answer 1

retrosternal airspace is filled. there is an enlarged heart anterior-posterior. looks normal sized on A/P but laterally you can tell the heart is enlarged. this indicatespulmonary hypertension (not specific) because the increased pressures can play a role in cardiomegaly specifically of the right side.

Question 2

note the vascular changes in pulmonary hypertension causing hilar enlargement- the pulmonary arteries are enlarged.

Question 3

T/F the PFT spirometry is pretty indicative of pulmonary hypertension

Answer 3

false. most likely will have normal spirometry or slighty low dlcso.
- unless it’s end stage CHF in which the subsequent pleural edema and effusion might cause changes in pft.

Question 4

pulmary hypertension can cause ___ deviation on ECG.

Answer 4

Right axis deviation, RVH, and early RBBB pattern.

Question 5

pathobiology of pulmo-arterial hypertension (PAH)

Answer 5

usually comes out of the blue

• vascualr remodelling- vasoconstriction, leading to smooth muscle prolifeartion and thombosis and inflammation
• can also be caused by vasocontrictors or vasofilators, growth inhibitors or antithrombotic//thrombitc factors.

Question 6

normal small pulmonary artery –> porliferative pulmonary ___ ___ –> increase in pulmonary ___ ___ –> increases RV ___ –> RV ____ and dysfunction –> symptoms

Answer 6

normal small pulmonary artery –> porliferative pulmonary vascular disease –> increase in pulmonary vascualr resistance –> increases RV afterload –> RV hypertrophy and dysfunction –> symptoms

Question 7

which one is the heart that has pulmonary hypertension

Answer 7

the one on the right. You can see the adaptive RV. hypertrophy and the RV looks like the LV

Question 8

which CT pathway is overactivated in pulmonary hypertension? Which ones are suppressed?

Answer 8

too much activity in endothelin pathway causing thickening, not enough nitric oxide pathway or prostacyclin

Question 9

Question 10

Question 11

What side of the heart causes crackles and pulmonary edema

Answer 11

left heart failure causes crackles, but RHF/precapillary disase does not.

Question 12

main treatment for chronci thromboembolic-caused pulmonary hypertension

Answer 12

can progress to right heart failure like PAH in the absence of treatment

• main treatments are:
• lifelong anticoagulation
• pulmonary endarterectomy surgery can be curative