03c: Pulm HT Flashcards
Which pressure is measured to define Pulm HT?
Pulm artery P (over 25 mmHg at rest)
Group 1 PAH, aka (X), includes which causes of PAH?
X = pulm arterial HT
- Idiopathic (sporadic or heritable) PAH
- PAH due to disease that targets small pulm arterioles
Group 2 PH includes which causes of Pulm HT?
“Pulm venous HT”
PH due to:
- LV dysfunction
- L side valve disease
Group 3 PH includes which causes of Pulm HT?
Pulm HT associated with disorders of respiratory system or hypoxemia
Group 4 PH includes which causes of Pulm HT?
Pulm HT caused by chronic thromboembolic disease
Group 5 PH includes which causes of Pulm HT?
Pulm HT from misc causes
T/F: PAH (pulm arterial hypertension) is used exclusively for Group 1 classification.
True
COPD patient presents with Pulm HT. The PH would fall into which group?
3
Sarcoidosis patient presents with Pulm HT. The PH would fall into which group?
5 (sarcoid granulomas likely serve to extrinsically compress vasculature)
List some of the many causes of PAH.
- Idiopathic or Heritable
- CVD
- HIV or drug-induced
- Portal HT
- Shunts
List some of the many causes of PH.
- COPD
- Obstructive sleep apnea
- PE
- Chronic thromboembolitic disease
- L heart disease
Patient with abnormal BMPR2 (bone morphogenetic protein receptor type II) is at high risk for:
PAH (heritable)
Patient comes in for yearly physical and confides in you that she takes anorexigens (appetite suppressants). You must warn her that she’s at risk for:
Pulmonary arterial HT
(PH/PAH) occurs in about (X) fraction of HIV patients.
PAH;
X = 1/200
T/F: Cocaine/amphetamine use increases risk of developing PAH by 3 fold.
True
(PH/PAH) in diabetic patient commonly due to (X), which puts them in Group (1/2/3/4/5).
PH;
X = LV dysfunction
2
Endothelial dysfunction that leads to PH includes (increase/decrease) NO, prostacyclin, thromboxane, and endothelin-1 production.
Decrease: NO, prostacyclin
Increase: thromboxane, endothelin-1
List the possible etiologies/causes for PAH
- Vasomediator imbalance
- Ion channel defect (impaired K channel)
- Inflammation
- Dysregulated angiogenesis
Most patients with early PH present with (X) symptom(s). What is the rationale behind this?
Dyspnea on exertion, lethargy and fatigue;
Inability to increase CO
As PHT progresses, (R/L) heart failure develops and which additional symptoms would patient present with?
RV;
- Exertional chest pain and syncope
- Peripheral edema
HIV Patient presents with exertional dyspnea, cough and lethargy. You hear splitting of the (first/second) heart sound and are immediately worried he has (X).
Second;
X = Pulmonary hypertension
Aside from BMPR2, genetic abnormalities in which proteins can predispose one to (X) disease?
X = PAH
- Activin receptor-like kinase I
- Serotonin receptors and transporters
What would CXR look like in PHT? List the things you would look for.
Normal mainly
- Pulm a (may be enlarged)
- RV/RA (may be enlarged)
List the things you’d look for on Echo when suspecting PHT. Star the MAIN finding you’re interested in.
- RA/RV size/thickness
- Mean Pulm a pressure*
- LV, EF%
