Pulmonary Vascular Disease Flashcards
What is pulmonary vascular disease?
An increase in mean pulmonary arterial pressure >25mmHg at rest or >35mmHg with exercise
What can pulmonary hypertension be classified as?
- Group I - Idiopathic
- Group II - PH secondary to left heart disease
- Group III - PH secondary to lung disease and hypoxia
- Group IV - Chronic thromboembolic pulmonary hypertension
- Group V - Pulmonary hypertension due to misc causes
What is the most common type of pulmonary hypertension?
Secondary to left heart disease
Is idiopathic pulmonary hypertension common?
No, it is rare
What happens to pressures in idiopathic pulmonary hypertension?
Increased pulmonary artery pressure, normal pulmonary capillary wedge pressure
How does idiopathic pulmonary hypertension present?
- SOB on exertion
- Fatigue
What can cause type II pulmonary hypertension?
Systolic, diastolic, or valvular heart disease
What can cause type III pulmonary hypertension?
- COPD
- ILD
- High altitutudes
How do patients with type IV pulmonary hypertension typically present?
- SOB on exertion
- Fatigue
- Oedema
- Angina type pain
What can cause type V pulmonary hypertension?
- Sarcoidosis
- Histocytosis X
What confirms a diagnosis of pulmonary hypertension?
Right heart catheterisation
What other tests should be done in pulmonary hypertension?
- Bloods
- Autoimmune screening, esp for scleroderma
- ECG
- Spirometry
- Echo
What does the management of pulmonary hypertension involve?
Treating underlying cause
How can the initial management of pulmonary hypertension be determined?
Carry out vasodilator testing
What should be offered in pulmonary hypertension if vasodilator testing positive?
Calcium channel blocker
What should be offered in pulmonary hypertension if vasodilator testing negative?
- Prostaglandin analgoues
- Endothelin receptor antagonists
- Phosphodiesterase inhibitors
What other management can be used in pulmonary hypertension?
- Oxygen
- Diuretics
- Anticoagulation with warfarin
What is cor pulmonale?
Alteration in structure and function of right ventricle secondary to lung disease
What lung disease most commonly causes cor pulmonale?
Pulmonary hypertension
What are the clinical features of cor pulmonale?
- Worsening shortness of breath
- Fatigue
- Oedema
- Haemoptysis
What is the diagnosis of cor pulmonale made based on?
Echocardiography and right heart catheterisation
What is found on ECG in cor pulmonale?
Right ventricular hypertrophy and peaked P waves
What does treatment of cor pulmonale involve?
- Treating underlying cause
- Stop smoking
What are the further management options for cor pulmonale?
- Long-term oxygen therapy
- Diuretics
- Long-acting calcium channel blocker, e.g. nifedipine
- Transplantation in severe, intractable disease
