Pulmonary Hypertension

Question 1

Define Pulmonary Hypertension

Answer 1

Consistently increased pulmonary arterial pressure (>20mmHg) in resting conditions

Question 2

Aetiology of Pulmonary Hypertension

Answer 2

Primary: idiopathic (young females)

Secondary: Left heart disease (mitral valve disease, LV failure, LA myxoma/thrombosis)
Chronic lung disease (COPD)
Recurrent pulmonary emboli
Increased pulmonary blood flow (ASD, VSD, patent ductus arterioles)
Connective tissue disease (SLE, systemic sclerosis)
Drugs (amiodarone)

Question 3

Risk factors for Pulmonary Hypertension

Answer 3

Obesity
Family history 
Cardiopulmonary pathology 
Liver disease
HIV
Recurrent PE
Cocaine
High altitude

Question 4

Symptoms of Pulmonary Hypertension

Answer 4

SOB on exertion
Chest pain
Syncope
Fatigue 
Symptoms of underlying cause

Question 5

Signs of Pulmonary Hypertension on examination

Answer 5

Raised JVP (prominent A wave)
Left parasternal heave (LVH)
Auscultation: S3/S4 | pulmonary regurgitation (Graham-Steel murmur - early diastolic) | Tricuspid regurgitation (pan systolic murmur)
Severe - RHF

Question 6

Investigations for Pulmonary Hypertension

Answer 6

ECG: RVH (RAD, Prominent R wave V1, T wave inversion), P-pulmonale (peaked P wave due to RA enlargement)

CXR: Cardiomegaly (RA+RV enlargement), prominent main pulmonary arteries, signs of cause)
Echo: assess RVH for dilation + underlying cause
Lung function tests: assess for chronic lung disease
VQ scan: assess for PE
CT: Image pulmonary arteries

Cardiac catheterisation: Assess severity + RH pressures
Lung biopsy: assess structural lung changes