Pulmonary Vascular Diseases Flashcards

1
Q

what are two mechanisms used by pulmonary system to counter the increased CO and maintain a low pressure system?

A

recruitment of vessels

distension of vessels

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2
Q

what is the cutoff for pulmonary hypertension pressure?

A

mean pulmonary pressure has to be greater than 20 mmHg

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3
Q

what is normal mean pulmonary pressure?

A

about 14 mmHg

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4
Q

what is the pulmonary artery wedge pressure considered equal to?

A

left atrial pressure

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5
Q

what three things can cause increase in pulmonary pressure?

A

increased left atrial pressure
CO elevation
pulmonary vascular resistance

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6
Q

what is the common cause of elevated cardiac output that can be problematic in terms of pulmonary hypertension?

A

left to right shunts like an ASD, AV fistula

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7
Q

name the five classes of pulmonary hypertension

A
pulmonary artery hypertension
left heart failure pulmonary hypertension
pulmonary hypertension from lung disease
from PE
Unclear/mixed
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8
Q

what is the common cardiac physical finding with PH?

A

loud P2

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9
Q

what is the main screening tool for pulmonary hypertension?

A

echo

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10
Q

what is used to actually diagnose pulmonary hypertension?

A

swan ganz catheter

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11
Q

do individuals with PAH have high or low levels of NO?

A

low levels of NO

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12
Q

what is an obstructive lung disease that commonly leads to pulmonary hypertension?

A

emphysema

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13
Q

what are two restrictive lung diseases that leads to PH?

A

sarcoidosis or ILD

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14
Q

name the classes of PH in order from 1-5

A
1- PAH pulmonary arterial hypertension
2- from left heart disease
3- from lung disease or hypoxia
4- from pulmonary artery obstructions
5- unclear
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15
Q

PAH leads to what changes in the vessels?

A

vasoconstriction of smooth muscle, thickening of arterial walls and decreased lumen size

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16
Q

what are three classes of causes of PAH?

A

idiopathic
congenital
drug/toxins
connective tissue diseases

17
Q

for diagnosis of PH, what must LAP be and what must mPAP be?

A

LAP less than 15 mmHg

mPAP higher than 20 mmHg

18
Q

name the three pathways we can target to treat pulmonary hypertension

A

cGMP
prostacyclin
Endothelin-1 pathway

19
Q

name the three endothelin pathway drugs for PH

A

bosentan
ambrisentan
macitentan

20
Q

name the three NO pathway PH drugs

A

Sidenafik
Tadalafil
Riociguat

21
Q

name the four prostacyclin pathway PH drugs

A

Epoprostenol
Treprostinil
Iloprost
Selexipag

22
Q

what is the mechanism of prostacyclin PH drugs?

A

increase the amounts of cAMP that induces vasodilation

23
Q

what is the mechanism of endothelin PH drugs?

A

they are antagonists of endothelin receptors to prevent endothelin from having constriction effects

and they increase NO levels

24
Q

what is the mechanism of NO drugs for PH?

A

they inhibit PDE5 allowing NO to lead to increase in cGMP and more vasodilation

25
Q

what group of PH can have calcium channel blockers for treatment?

A

group 1…PAH that responds to blockade

26
Q

name the three common symptoms of PE?

A

dyspnea
pleuritic chest pain
hemoptysis

27
Q

which heart sound is increased in PE?

A

P2

28
Q

what is the extra heart sound heard with PE?

A

S3

29
Q

name the three tests to use for PE

A

Ct angiogram
V/Q scanning
D dimer