Pulmonary Hypertension and Cor Pulmonale Flashcards
What are the causes of pulmonary hypertension?
- pulmonary arterial HTN
- failure of left heart
- lung disease
- chronic thromboembolic pulmonary HTN
Which is the only reversible cause of pulmonary HTN?
thromboembolic pulmonary HTN
Which investigations would you conduct for pulmonary HTN?
CXR, ECG, bloods, PFTs, CTPA/HRCT, echo
Which bloods would you request in pulmonary HTN?
connective tissue disease screen, Hb, blood born virus screen, liver function, NTproBNP, renal function
Which CT changes will you see in pulmonary HTN?
dilated pulmonary artery (compare to abdominal aorta) and large right atria/ventricle relative to left side. Intraventricular septum looks thickened and does not deviate towards right side of heart (normal) due to increased pressure in pulmonary arteries.
What is the management of pulmonary HTN?
- General and supportive measures: physical rehab, birth control, infection prevention, diuretics, anti-coag
- CCB
- Nitric oxide pathway (sildenafil) + combination therapies
- Transplant referral (bilateral lung transplant)
What is the PA pressure in pulmonary HTN?
> 25 mmHg
List two causes of pulmonary HTN
Primary HTN/SLE Left heart failure Chronic lung disease e.g. COPD Pulmonary vascular disease e.g. PE Other: sarcoidosis
Three signs/symptoms of pulmonary hypertension
SoB tachy peripheral oedema raised JVP hepatomegaly syncope
Three investigations for pulmonary HTN?
ECG
CXR
Echo
Right heart catherterisation
Two features on ECG of pulmonary HTN?
RAD
Right ventricular hypertrophy
RBBB
One sign on CXR of pulmonary HTN?
dilated pulmonary arteries
r ventricular hypertrophy
One drug to treat primary pulmonary HTN?
epoprostenol
sildenafil
macitentan- endothelin receptor antagonist
Define cor pulmonale
RHF due to chronic pulmonary HTN
Two signs of cor pulmonale?
Raised JVP
Murmur
Ascites + peripheral oedema
Left parasternal heave
