Pulmonary Vascular Disease

Question 1

Pulmonary Hypertension/Cor Pulmonale ?

Answer 1

• Pulmonary hypertension is defined as a mean pulmonary arterial pressure of > 25 mmHg (normal = 15 mmHg).
• It is classified as either 1° (if the etiology is unknown) or 2°.
• 1° pulmonary hypertension most often occurs in young or middle-aged women.

Question 2

The main causes of 2° pulmonary hypertension include the following:

Answer 2

■ ↑ pulmonary venous pressure from left-sided heart failure or mitral valve disease.
■ ↑ pulmonary blood flow 2° to congenital heart disease with left-to-right shunt.
■ Hypoxic vasoconstriction 2° to chronic lung disease (e.g., COPD).
■ Thromboembolic disease.
■ Remodeling of pulmonary vessels 2° to structural lung disease.

Question 3

History/PE of Pulmonary Hypertension/Cor Pulmonale ?

Answer 3

■ Presents with dyspnea on exertion, fatigue, lethargy, syncope with exertion, chest pain, and symptoms of right-sided CHF (edema, abdominal disten- tion, JVD).
■ Inquire about a history of COPD, interstitial lung disease, heart disease, sickle cell anemia, emphysema, and pulmonary emboli.
■ Exam reveals a loud, palpable S2 (often split), a systolic ejection murmur, an S4, or a parasternal heave.

Question 4

Diagnosis of Pulmonary Hypertension/Cor Pulmonale ?

Answer 4

■ CXR shows enlargement of central pulmonary arteries.
■ ECG demonstrates RVH.
■ Echocardiogram and right heart catheterization may show signs of right
ventricular overload and may aid in the diagnosis of the underlying cause.

Question 5

TTT of Pulmonary Hypertension/Cor Pulmonale ?

Answer 5

Supplemental O2, anticoagulation, vasodilators, and diuretics if symptoms of right-sided CHF are present. Treat underlying causes of 2° pulmonary hyper- tension.

Question 6

Pulmonary Thromboembolism ?

Answer 6

Occlusion of the pulmonary vasculature by a blood clot. Ninety-five percent of emboli originate from DVTs in the deep leg veins. Often leads to pulmonary infarction, right heart failure, and hypoxemia.

Question 7

VIRchow’s triad for venous thrombosis ?

Answer 7

• Vascular trauma
• Increased coagulability
• Reduced blood flow
  (stasis)