Pulmonary Hypertension and Cor Pulmonale Flashcards
What is pulmonary hypertension?
MAP >25 mmHg
What is the normal range for pulmonary pressure?
12-20 mmHg
What are causes of pulmonary venous hypertension (Left heart disease)?
LSVD (ischaemic)
Mitral regurgitation or stenosis
Cardiomyopathy (alcohol / viral)
What are causes of pulmonary arterial hypertension (PAH)?
Hypoxia (COPD, OSA (Obstructive sleep apnoea), Pulmonary fibrosis)
Multiple PEs (chronic thromboembolic PH)
Vasculitis (SLE/PAN/Systemic sclerosis)
Drugs
HIV
Cardiac left tpo right shunt (ASD/VSD)
Idiopathic
What is cor pulmonate?
Right sided heart failure caused by chronic pulmonary arterial hypertension
What are clinical features of cor pulmonate?
Dyspnoea Fatigue or Snycope Cyanosis Tachycardia Raised JVP RV heave Pansystolic murmur (tricuspid regurgitation)
What kind of ABG would cor pulmonate demonstrate?
Hypoxia without hypercapnia
What would be seen on the CXR of a cor pulmonale patient?
Enlarged RA and RV
Prominent pulmonary arteries
What would be seen on the ECG of a patient with Cor Pulmonale?
Right ventricular deviation
Right Ventricular hypertrophy
(ST depression, T wave inversion - V1-V4 and II, III, AvF leads)
How do you treat cor pulmonale?
Treat underlying cause
- Heart failure (diuretics)
- Pulmonary failure (24% oxygen)
What are clinical signs of Pulmonary hypertension? and right-sided Heart Failure?
Central cyanosis if hypoxic Pulmonary oedema Raised JVP RV heave at left parasternal edge Murmur of tricuspid regurg Hepatomegaly
How is primary pulmonary hypertension diagnosed?
Exclusion of other causes
How do you treat pulmonary hypertension?
Prophylactic anticoagulation (warfarin)
O2 if hypoxic
Pulmonary vasodilators (CCBs - oral nifedipine)
PDE-5 inhibitor (Tadalafil)
Prostanoids (iv epoprostenol)
Soluble granulate cyclase stimulator (oral ricociguat)
?Lung transplant
