Pulmonary Vascular Disease (Pulmonary Hypotension) Flashcards
What is pulmonary hypertension
A mean pulmonary artery pressure of > 25 mmHg
It is the elevated blood pressure in the pulmonary arterial or tree
What type of pulmonary hypertension can occur
Primary
Secondary to another condition
What does pulmonary hypertension cause
Thickening of the walls of the blood vessels
Increased smooth muscle causing an increased pressure in the system
What is the incidence of pulmonary hypertension
1-2 per million population
What happens when pulmonary hypertension is left untreated
It is a rapidly progressive condition which leads to premature death
Which type of pulmonary hypertension is more common
Secondary pulmonary hypertension
In which age group is pulmonary hypertension more common
Elderly
What are the causes of pulmonary hypertension
Idiopathic
Secondary to chronic respiratory disease
Secondary to left heart disease – leads to back pressure on the venous system
Chronic Thromboembolic PH (CTEPH) – not common but arises if there is primary PE
What are miscellaneous causes of pulmonary hypertension
Collagen vascular disease
Portal hypertension
Congenital heart disease (L to R shunt) – pressures will eventually even out
HIV infection
What are the symptoms of pulmonary hypertension
Exertional dyspnoea
Chest tightness
Exertional presyncope (feeling lightheaded/blacking out) or syncope
What are the signs of pulmonary hypertension
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly – swollen congested liver Ankle oedema
How do the signs tend to present
Subtly
Late
What type of investigations can be done for pulmonary hypertension
ECG Lung function tests Chest X-Ray – shows small abnormalities Echocariography – ultrasound of heart V/Q scan CTPA Right heart catheterisation
State 5 features of right heart catheterisation
Gives direct and accurate measure
Allows direct measure of pulmonary artery pressure
Measures wedge pressure
Measures cardiac output
How is a wedge pressure conducted and how
A catheter is placed as far as possible
The pressure measured is equivalent to the venous system
What treatment is available for pulmonary hypertension
Oxygen which can be given at home
Anticoagulation
Diuretics which reduces odema in ankles and abdomen
What should be treated if it is secondary pulmonary hypertension
The underlying condition
What are the specific treatments which can be given
Calcium channel antagonist e.g. amlodipine
Prostacyclin
Endothelin receptor antagonists
Phosphodiesterase inhibitors
Give examples of endothelin receptor antagonists
Bosentan
Ambrisentan
Give examples of phosphodiesterase inhibitors
Sildenafil
Tadalafil
What other treatments are avaliable
Thromoendarterectomy (CTEPH) to remove the clot from the tree
Lung or heart lung transplant
