Pulmonary Hypertension + Cor Pulmonale Flashcards
What is normal pulmonary BP
20/8
When is it pulmonary hypertension
> 25
What causes primary hypertension
Young women
HIV
Appetite suppressant drugs
Familial
What causes secondary hypertension
Systemic HTN = most common Chronic respiratory disease - COPD Left heart disease - MS / AS / LVH / MI Hypoxaemia - vasoconstriction Pulmonary vascular disease - PE Obstructive sleep apnoea
What are miscellaneous causes
Congenital
Systemic sclerosis - cause fibrosis
SLE
Hepatic cirrhosis
What are the S+S
Exertional SOB
Tight chest
Exertional syncope
Peripheral oedema + ascites
Signs Loud, palpable 2nd HS (P2) = early sign Elevated JVP Parasteranal / RV heave due to hypertrophy = later sign Hepatomegaly - pulsatile
What does pulmonary hypertension leads to
R ventricular failure known as cor-pulmonale Pulmonary regurgitation (TR) - known as Graham Steele murmur
How do you investigate pulmonary hypertension
CXR / ECHO - RV enlarged and dilated pulmonary artery ECG - RVH / RAD / RBBB ECHO to estimate pulmonary pressure V/Q or CT pulmonary angiogram
How do you treat pulmonary hypertension
Treat underlying condition Oxygen Anti-coagulation Diuretics CCB - dilate if respond Phoshpiderase 4inhibitor (Sildenafil) Endothelian antagonist if don't Endarectomy to remove clots Supportive for resp failure etc.
What is cor pulmonale
RHF due to pulmonary hypertension secondary to hypoxaemia
What confirms pulmonary hypertension
CTPA or V/Q
Example of phosphiderase inhibitor
Sildenafil - cause vasodilation
SE of phosphhidease inhibitor
Visual - blue discolouration
GI
Headache
What are CI
On nitrates
Hypotension
Recent stroke or MI as will be on nitrates
What is cor pulmonate
RHF due to pulmonary hypertension 2 to hyperaemia
What causes cor pulmonate
Chronic lung disease
- COPD / fibrosis/ bronchiectasis / severe asthma / CF
Pulmonary vascular disorder
- PE / vasculitis / PPH / ARDS / sickle
Neuromuscular / skeletal disease
- Chest wall deformity / scoliosis
- MG
- MS
Hypoventilation
- OSA / enlarged adenoids
Cerebrovascular
What are the symptoms
Dyspnoea Fatigue Syncope Cyanosis Tachycardia Raised JVP RV heave Loud P2 Pansystolic murmur from tricuspid regurg Hepatomegaly Oedema
How do you investigate
FBC ABG CXR ECG ECHO to look at pulmonary flow
What does FBC show
Secondary polycythaemia due to chronic hypoxia
What does ABG show
Hypoxia
Hypercapnia
What does CXR show
Enlarged RA + RV
Prominent pulmonary arteries
What will ECG show
R axis deviation
RVH
How do you Rx
Treat cause Treat resp failure Treat cardiac failure Venesection if haemtacrit >55% LTOT often needed Heart / lung transplant if young
