Pulmonary hypertension and thromboembolism Flashcards
what is an SQT133 pattern? what does it suggest?
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
what is the primary imaging study for PE?
CT pulmonary angiography
what is the gold standard study for PE diagnosis?
pulmonary angiography
what is the primary therapy for all PE cases?
STAT anticoagulation
what is used for massive PE with hemodynamic compromise?
thrombolytic therapy (TPA)
what are indications for an IVC filter?
proximal DVT
absolute contraindication to anticoagulation
when are calcium channel blockers used in PHTN?
small % of WHO group 1 patients with a positive response to vasodilator challenge
PH treatment for WHO group 2
treat left sided heart disease
PH treatment for WHO group 4
pulmonary thromboendarterectomy
is PA pressure a target of therapeutic strategy?
no
when should WHO group 1 PHTN considered?
- evidence of right HF
- dyspnea on exertion out of proportion (particularly young women)
- high risk groups and family history
- CT disease - SCLERODERMA
what is the role of echo in PHTN?
good screening test but does not definitively diagnose or rule out
what is needed for diagnosis and to guide therapy for PHTN?
RHC with vasodilator testing
who are the only candidates for PHTN specific therapies?
WHO group 1 patients
what is the most important prognostic marker in patients with group 1 PHTN?
RV function
when is lung transplant indicated?
medically refractory patients
most PHTN patients are in which class?
WHO group 2 - pulmonary venous HTN
definition of PHTN
mean pulmonary arterial pressure derived from right heart catheterization equal to or more than 25 mm Hg
what is normal mean pulmonary arterial pressure?
8-20 mm Hg
WHO group 1 PHTN
pulmonary arterial HTN (precapillary PHTN)
WHO group 2 PHTN
pulmonary venous HTN from left sided heart disease (postcapillary PHTN)
WHO group 3 PHTN
PHTN from lung disease and/or hypoxia
WHO group 4 PHTN
chronic thromboembolic PHTN
WHO group 5 PHTN
PHTN with unclear multifactorial mechanisms
PHTN from lung disease and/or hypoxia
WHO group 3 PHTN
pulmonary venous HTN from left sided heart disease (postcapillary PHTN)
WHO group 2 PHTN
PHTN with unclear multifactorial mechanisms
WHO group 5 PHTN
pulmonary arterial HTN (precapillary PHTN)
WHO group 1 PHTN
chronic thromboembolic PHTN
WHO group 4 PHTN
how is a definitive diagnosis of PHTN made?
right heart catheterization
what differentiates WHO group 1 from WHO group 2?
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
