Pulmonary Vascular Diseases Flashcards
what are two mechanisms used by pulmonary system to counter the increased CO and maintain a low pressure system?
recruitment of vessels
distension of vessels
what is the cutoff for pulmonary hypertension pressure?
mean pulmonary pressure has to be greater than 20 mmHg
what is normal mean pulmonary pressure?
about 14 mmHg
what is the pulmonary artery wedge pressure considered equal to?
left atrial pressure
what three things can cause increase in pulmonary pressure?
increased left atrial pressure
CO elevation
pulmonary vascular resistance
what is the common cause of elevated cardiac output that can be problematic in terms of pulmonary hypertension?
left to right shunts like an ASD, AV fistula
name the five classes of pulmonary hypertension
pulmonary artery hypertension left heart failure pulmonary hypertension pulmonary hypertension from lung disease from PE Unclear/mixed
what is the common cardiac physical finding with PH?
loud P2
what is the main screening tool for pulmonary hypertension?
echo
what is used to actually diagnose pulmonary hypertension?
swan ganz catheter
do individuals with PAH have high or low levels of NO?
low levels of NO
what is an obstructive lung disease that commonly leads to pulmonary hypertension?
emphysema
what are two restrictive lung diseases that leads to PH?
sarcoidosis or ILD
name the classes of PH in order from 1-5
1- PAH pulmonary arterial hypertension 2- from left heart disease 3- from lung disease or hypoxia 4- from pulmonary artery obstructions 5- unclear
PAH leads to what changes in the vessels?
vasoconstriction of smooth muscle, thickening of arterial walls and decreased lumen size
what are three classes of causes of PAH?
idiopathic
congenital
drug/toxins
connective tissue diseases
for diagnosis of PH, what must LAP be and what must mPAP be?
LAP less than 15 mmHg
mPAP higher than 20 mmHg
name the three pathways we can target to treat pulmonary hypertension
cGMP
prostacyclin
Endothelin-1 pathway
name the three endothelin pathway drugs for PH
bosentan
ambrisentan
macitentan
name the three NO pathway PH drugs
Sidenafik
Tadalafil
Riociguat
name the four prostacyclin pathway PH drugs
Epoprostenol
Treprostinil
Iloprost
Selexipag
what is the mechanism of prostacyclin PH drugs?
increase the amounts of cAMP that induces vasodilation
what is the mechanism of endothelin PH drugs?
they are antagonists of endothelin receptors to prevent endothelin from having constriction effects
and they increase NO levels
what is the mechanism of NO drugs for PH?
they inhibit PDE5 allowing NO to lead to increase in cGMP and more vasodilation
what group of PH can have calcium channel blockers for treatment?
group 1…PAH that responds to blockade
name the three common symptoms of PE?
dyspnea
pleuritic chest pain
hemoptysis
which heart sound is increased in PE?
P2
what is the extra heart sound heard with PE?
S3
name the three tests to use for PE
Ct angiogram
V/Q scanning
D dimer
