Respiratory: Pulmonary Hypertension Flashcards
Define what is meant by pulmonary hypertension [1]
Pulmonary hypertension is defined as a mean pulmonary arterial pressure of more than 25 mmHg at rest when assessed with right heart catheterization
Pulmonary hypertension is an umbrella term for many different diseases which lead to increased pressure in the pulmonary arteries
Describe the general pathophysiology of pulmonary hypertension
In general, pulmonary hypertension occurs when the pulmonary arteries become narrowed due to hypoxic pulmonary vasoconstriction or thrombosis, thickened or damaged causing increased pressure in the vessels.
This causes strain on the right side of the heart. And can causes right ventricular hypertrophy
The causes of pulmonary hypertension can be classified into five groups.
What are they? [5]
Group 1 Idiopathic pulmonary hypertension or connective tissue disease (e.g., systemic lupus erythematous)
Group 2 – Left heart failure, usually due to myocardial infarction or systemic hypertension
Group 3 – Chronic lung disease (e.g., COPD or pulmonary fibrosis)
Group 4 – Pulmonary vascular disease (e.g., pulmonary embolism)
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorder
What ECG changes would you expect to see of someone with pulmonary hypertension? [4]
All indicate right sided heart strain:
P pulmonale: peaked P waves
Right ventricular hypertrophy (tall R waves in V1 and V2 and deep S waves in V5 and V6)
Right axis deviation
Right bundle branch block
What blood test might indicate pulmonary hypertension? [1]
Raised NT‑proBNP blood test result indicates right ventricular failure
What imaging would you use to investigate pulmonary artery pressure? [1]
Echocardiogram can be used to estimate the pulmonary artery pressure
Name and state the drug classes used to treat idiopathic pulmonary hypertension [4]
Idiopathic pulmonary hypertension may be treated with:
Calcium channel blockers
Intravenous prostaglandins e.g., epoprostenol
Endothelin receptor antagonists e.g., macitentan
Phosphodiesterase-5 inhibitors e.g., sildenafil