Pulmonic And Systemic Hypertension Flashcards
What is central
Venous pressure?
The pressure of the superior and inferior vena cava. CVP=RAP
Causes of abnormal CVP/RAP
- anything That creates volume/pressure overload can increase CVP
- elevated RV systolic pressure (artery and lung htn)
- TR from RA/RV overload
-RV pressure overload, can cause RV dilation/hypertrophy
How do you estimate RAP/CVP?
1) measure IVC at end inspiration and end expiration
2) IVC size and difference in size during respiration est RAP
Values to determine RAP?
< 2.1 and > 50% = 3mmhg
< 2.1 and < 50% = 8mmhg
>2.1 and > 50% = 8mmhg
>2.1 and < 50% = 15mmhg
Symptoms/causes of heart failure from htn
- Enlargement and failure of RV
- caused by increased vascular resistance or high blood pressure in the lungs (PHTN)
2 types of heart failure
- chronic cor pulmonale
- Acute cor pulmonale
What is chronic cor pulmonale
- develops gradually
- associated with obstructive pulmonary disease
What is acute cor pulmonale
- emergency situation
- sudden dilation and dysfunction of RV
- caused by pulmonary embolism
PHTN definition
- A condition in which high blood pressure affects arteries of the lungs & right side of the heart
- abnormal value for PHTN is > 25mmhg PAP
What is a pulmonary embolism
A condition in which a blood vessel in the lungs gets blocked by a blood clot
What causes pulmonary embolisms
Majority of pulmonary emoboli arise from a blood clot from deep vein thrombosis of the lower limb or other body parts
Symptoms of Pulmonary embolisms(non echo)
- Shortness of breath
- respiratory distress
- chest pain
Echo findings that support pulminary embolism
- severe RVE
- elevated RVSP (due to clot restricting flow to lungs)
- increases in TR
Causes of Systemic HTN
-overweight
- pregnancy
- excessive sodium consumption
- sleep apnea
- cv diseases like atherosclerosis
- Ao coarctation (narrowing of descending Aorta)
Pressure Stages of systemic HTN
- NL: < 120/80 mmhg
- Elevated: systolic between 120-129 and diastolic >80
- Stage 1: systolic 130-139 and diastolic 80-89
- stage 2: systolic >140 and diastolic >90
-HTN crisis: systolic >180 and diastolic >120
What causes the first and second heart sound
1st sound: AV valves closing
2nd sound: SL valves closing
Role of echo identifying abnormalities caused by systemic HTN
1) Determine if there’s left ventricular hypertrophy
2) assess LV systolic and diastolic fxn
3) measure aorta for dilation
What are the normal and abnormal values for LV wall thickness
Men: 0.6-1.0, 1.1-1.3, 1.4-1.6, >1.6
Women: 0.6-0.9, 1.0-1.2, 1.3-1.5, >1.5
What are the normal and abnormal values of left ventricular mass
Men: 88-224, 225-258, 259-292, >292
Women: 67-162, 163-186, 187-210, >210
Normal values relative wall thickeness
Men: 0.24-0.42
Women: 0.22-0.42
Equation for Lv wall thickness and mass comparison
(IVS+PW)/LVIDd
What is the formula for estimation RVSP
RVSP=4(Vtr)^2+RAP
Values for grading severity in PHTN (PA Pressure)
Normal: 18-25mmhg
Mild: 35-45mmhg
Moderate: 45-60mmhg
Severe: > 60mmhg
Equation for severity of PHTN when TR is present
TRvmax + CVP = PAP
Echo findings in significant PHTN
- increased RVSP
- RVE/RAE/PA dilation
- septal flattening in Psax (D shaped)
- TR (dependent on PASP and TR severity)
- PR (dependent on PA dilation and PASP)
- dilated IVC with less than 50% collapse
Abnormal Values for aorta dilation
Root: >3.7cm
Ascending aorta: >4cm
What are the values to determine concentric remodeling
If RWT is > 0.42 and LV mass < 95 in women and < 115 in men
What are the values to determine if Lv wall thickness and mass have normal geometry
If RWT is <0.42 and LV mass is <95 in F and <115 in M
What are the values to determine if Lv wall thickness and mass have concentric hypertrophy
If RWT is >0.42 and LV mass is > 95 in F and > 115 in M
What are the values to determine if Lv wall thickness and mass have eccentric hypertrophy
If RWT is <.42 and > 95 in F and > 115 in M
