Respiratory - Pulmonary Hypertension

Question 1

How is pulmonary hypertension defined?

Answer 1

Mean pulmonary arterial pressure of more than 20mmHg

Question 2

How is pulmonary hypertension classified?

Answer 2

Group 1- Idiopathic pulmonary hypertension
Group 2- LHF
Group 3- Chronic lung disease
Group 4- Pulmonary vascular disease (PE)
Group 5- Miscellaneous (sarcoidosis)

Question 3

What are the signs of pulmonary hypertension?

Answer 3

Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema

Question 4

What are the signs of pulmonary hypertension on ECG?

Answer 4

Right-sided heart strain
Peaked P waves
Right ventricular hypertrophy (tall R waves in V1 and V2, deep S waves in V5 and V6)
Right axis deviation
Right bundle branch block

Question 5

What are the signs of pulmonary hypertension on CXR?

Answer 5

Dilated pulmonary arteries
RVHT

Question 6

What investigations are used for pulmonary hypertension?

Answer 6

ECG
CXR
Raised NT-proBNP
Echocardiogram

Question 7

How is idiopathic pulmonary hypertension managed?

Answer 7

Poor prognosis, 2-3 years if untreated

CCBs
IV prostaglandins (epoprostenol)
Endothelin receptor antagonists (macitentan)
Phophodiesterase-5 inhibitors (sildenafil)

Supportive treatment