Pulmonary hypertension and thromboembolism

Question 1

what is an SQT133 pattern? what does it suggest?

Answer 1

deep S wave in lead I
Q wave in III
inverted T wave in III

this “classic” finding is neither sensitive nor specific for pulmonary embolism; found in only 20% of patients with PE

Question 2

what is the primary imaging study for PE?

Answer 2

CT pulmonary angiography

Question 3

what is the gold standard study for PE diagnosis?

Answer 3

pulmonary angiography

Question 4

what is the primary therapy for all PE cases?

Answer 4

STAT anticoagulation

Question 5

what is used for massive PE with hemodynamic compromise?

Answer 5

thrombolytic therapy (TPA)

Question 6

what are indications for an IVC filter?

Answer 6

proximal DVT

absolute contraindication to anticoagulation

Question 7

when are calcium channel blockers used in PHTN?

Answer 7

small % of WHO group 1 patients with a positive response to vasodilator challenge

Question 8

PH treatment for WHO group 2

Answer 8

treat left sided heart disease

Question 9

PH treatment for WHO group 4

Answer 9

pulmonary thromboendarterectomy

Question 10

is PA pressure a target of therapeutic strategy?

Answer 10

no

Question 11

when should WHO group 1 PHTN considered?

Answer 11

1. evidence of right HF
2. dyspnea on exertion out of proportion (particularly young women)
3. high risk groups and family history
4. CT disease - SCLERODERMA

Question 12

what is the role of echo in PHTN?

Answer 12

good screening test but does not definitively diagnose or rule out

Question 13

what is needed for diagnosis and to guide therapy for PHTN?

Answer 13

RHC with vasodilator testing

Question 14

who are the only candidates for PHTN specific therapies?

Answer 14

WHO group 1 patients

Question 15

what is the most important prognostic marker in patients with group 1 PHTN?

Answer 15

RV function

Question 16

when is lung transplant indicated?

Answer 16

medically refractory patients

Question 17

most PHTN patients are in which class?

Answer 17

WHO group 2 - pulmonary venous HTN

Question 18

definition of PHTN

Answer 18

mean pulmonary arterial pressure derived from right heart catheterization equal to or more than 25 mm Hg

Question 19

what is normal mean pulmonary arterial pressure?

Answer 19

8-20 mm Hg

Question 20

WHO group 1 PHTN

Answer 20

pulmonary arterial HTN (precapillary PHTN)

Question 21

WHO group 2 PHTN

Answer 21

pulmonary venous HTN from left sided heart disease (postcapillary PHTN)

Question 22

WHO group 3 PHTN

Answer 22

PHTN from lung disease and/or hypoxia

Question 23

WHO group 4 PHTN

Answer 23

chronic thromboembolic PHTN

Question 24

WHO group 5 PHTN

Answer 24

PHTN with unclear multifactorial mechanisms

Question 25

PHTN from lung disease and/or hypoxia

Answer 25

WHO group 3 PHTN

Question 26

pulmonary venous HTN from left sided heart disease (postcapillary PHTN)

Answer 26

WHO group 2 PHTN

Question 27

PHTN with unclear multifactorial mechanisms

Answer 27

WHO group 5 PHTN

Question 28

pulmonary arterial HTN (precapillary PHTN)

Answer 28

WHO group 1 PHTN

Question 29

chronic thromboembolic PHTN

Answer 29

WHO group 4 PHTN

Question 30

how is a definitive diagnosis of PHTN made?

Answer 30

right heart catheterization

Question 31

what differentiates WHO group 1 from WHO group 2?

Answer 31

group 1 has normal wedge pressures (normal left heart pressures) - precapillary pulmonary artery HTN

group 2 has wedge pressures over 15 mm Hg - post-capillary pulmonary venous HTN from left sided heart disease