pulmonary hypertension/cor pulmonale

Question 1

-Increased mean pulmonary arterial pressure
-Can be caused by various diseases, drugs, toxins, genetic abnormalities,
or may be idiopathic

Answer 1

pulmonary hypertension

Question 2

pulmonary arterial hypertension (PAH)

Answer 2

group 1

Question 3

Primarily
elevation of pressure in the
pulmonary artery system alone
(PAH)

Answer 3

Pre-capillary PH

Question 3

Pressure
elevations within the
pulmonary venous and
pulmonary capillary systems
(pulmonary venous
hypertension, Group 2)

Answer 3

Post-capillary PH

Question 4

• Prominent pulmonary component of S2
• Pansystolic tricuspid regurgitation murmur
• Diastolic pulmonary insufficiency murmur (Graham Steel)
• Third heart sound (S3), suggesting significant right
  ventricular dysfunction

Answer 4

physical exam pulmonary hypertension

Question 5

• Women > Men
• 30-60s
• Dyspnea common but patients may be asymptomatic
• Fatigue
• Weakness
• Angina
• Near syncope
• Syncope
• Peripheral edema
• Abdominal distension
• Orthopnea
• Dry cough
• Exercise-induced nausea and vomiting

Answer 5

pulmonary hypertension symptoms

Question 6

initial test of choice if suspicious of PH

Answer 6

TTE (BUT NOT DIAGNOSIS)

An systolic pulmonary artery pressue (sPAP) of 35–40 mm Hg or higher on an echocardiogram suggests pulmonary hypertension

Question 7

how to confirm diagnosis of PH

Answer 7

right heart catheterization (tells you what type) –> mean pulmonary artery pressure of 25mmHg or greater at rest is considered diagnostic for pulmonary hypertension

Question 8

pulmonary hypertension treatment

Answer 8

1. nitric oxide pathway: sildenafil (viagra) (vasodilator)
2. diuresis
3. keep oxygen >90%
4. anticoagulant

Question 9

• Right heart failure NOT due to left heart failure
• Right ventricular hypertrophy, dilatation or both as a result of pulmonary hypertension (defined as
  pulmonary artery mean pressure [PAP] > 20 mm Hg) resulting from pulmonary disorders involving lung
  parenchyma, impaired bellows function, or altered ventilatory drive

Answer 9

cor pulmonale

Question 10

what most of the time causes Cor pulmonale

Answer 10

• Seen in 40% of patients with COPD on autopsy
• Other causes of cor pulmonale include:
• Pulmonary hypertension
• OSA
• Restrictive lung disease
• Pulmonary embolism (usually chronic)
• Pneumoconiosis (dust inhalation)
• Adult Respiratory Distress Syndrome (ARDS)
• Cystic Fibrosis (CF)
• Neuromuscular diseases (muscular dystrophy)

Question 11

• Signs and symptoms (similar to CHF)
• Initial symptoms usually reflect those of the underlying disease
• Coughing
• Wheezing
• Weakness
• Fatigue
• Dyspnea
• Later symptoms
• Edema of lower extremities, liver enlargement, JVD
• Weakness
• Chest discomfort

Answer 11

cor pulmonale

Question 12

cor pulmonale treatment

Answer 12

1. treat COPD
2. Vasodilators
3. treat RHF (diuretics/furosemide)

Question 13

cor pumonale diagnosis

Answer 13

• R heart cath
• elevated pro BNP >33