Pulmonary Hypertension Flashcards
What is PH?
A disease of the small pulmonary arteries characterised by vascular proliferation and remodelling
What does PH result in?
It results in a progressive increase in pulmonary vascular resistance
What are the main vascular changes in PH?
Vasoconstriction, smooth-muscle cell and endothelial cell proliferation, thrombosis
What are pre-capillary causes of PH?
Multiple small PEs, left-to-right shunts, primary
What are capillary causes of PH?
Emphysema, COPD
What are post-capillary causes of PH?
Backlog of blood causes secondary PH, LV failure
What are chronic hypoxaemia causes of PH?
Living at high altitude, COPD
What are PH symptoms?
Exertional dyspnoea, lethargy and fatigue, ankle swelling
What are PH signs?
Accentuated pulmonic component to the 2nd heart sound, tricuspid regurgitation murmur, fatigue, peripheral oedema, cyanosis
What are first line tests?
CXR, ECG, trans-thoracic echocardiogram
What is the gold standard investigation?
Right heart catheterisation
What general supportive management would you start?
Treat underlying cause, oral anticoagulants, diuretics if fluid retention, supplemental O2, supervised exercise training, avoiding pregnancy
What management is there for treatment-resistant patients?
Balloon atrial septostomy, lung transplantation
