Pulmonary Hypertension (pathology) Flashcards
1
Q
What is pulmonary hypertension?
A
Elevated BP in pulmonary arterial tree
Mean pulmonary a. pressure> 25 mmHg
2
Q
What causes pulmonary hypertension?
A
Atrial/ventricular septal defect- left heart ↑ pressure than right heart- bc of thicker walls= right heart hypertrophy = hypertrophy of pulmonary arterial wall
3
Q
What is primary vs secondary pulmonary hypertension?
A
Primary = idiopathic RARE Secondary = common (especially in elderly)
4
Q
What are the features of primary pulmonary hypertension?
A
- collagen vascular disease
- L to R shunt
- HIV
- portal hypertension
5
Q
What is are the features of secondary pulmonary hypertension?
A
- To LH disease (MS or LVF)
- To COPD, ILD
- Chronic thromboembolic PH CTEPH- unresolved PE
- Sarcoidosis
6
Q
Presentation of pulmonary hypertension
A
- SOB on exertion
- chest tightness
- exertional syncope/presyncope
- haemoptysis = hypertrophy of pulmonary a.
7
Q
Signs of pulmonary hypertension
A
- ↑↑ JVP
- right ventricular heave
- loud pulmonary S2
- hepatomegaly
- ankle oedema
8
Q
Investigation of pulmonary hypertension
A
- ECG
- Tall R wave=RV hypertrophy
- P pulmonale-large P wave= enlargement of LA
- lung function test – underlying pathology
- CXR
- Echo =definitive investigation
- > measure PaP indirectly
- V/Q scan
- CT Pulmonary a. -for PE/chronic changes
- right heart catheterisation
9
Q
General management/treatment of pulmonary hypertension
A
- Treat underlying condition
- O2
- Anticoagulation to prevent thrombosis in idiopathic PH and CTEPH
- Diuretics for peripheral oedema
10
Q
Specific management/treatment of pulmonary hypertension
A
- Endothelin receptor antagonists BOSENTAN/AMBRISENTAN
- Phosphodiesterase inhibitors SILDENAFIL
- Prostaglandins
- RIOCIGUAT
- Prostacyclin agonist
- CCB
11
Q
Surgery for pulmonary hypertension
A
Surgery in tertiary care
- thromboendoarterectomy for CTEPH
- lung transplant
