Pulmonary Hypertension

Question 1

Pulmonary Hypertension

Answer 1

mean pa more then 25 mmHg right heart cath
normal 8-20 mmHg
uncertain 21-24 mmHg

Question 2

heritable PAH types:

Answer 2

heritable
bmpr2 - induces apoptsis, excessive endo growth- auto dom
alk1- endoglin with or without hemohaggic telangectaisa

Question 3

Pul veno occlusive disease

Answer 3

may account for 10% pphtn
fibrosis of veins-
lung bx defin diagnosis

Question 4

Pulmonary hypertension CTE

Answer 4

VQ distinguishes from primary pah- more sensitive than ct scan

Question 5

Pulmonary Artery Hypertension rx

Answer 5

diuretics, O2 (in hypoxemia), anticoag inr 2, exercise-
>class 1 then invasive (adenosine, epoprostenol, nitr oxide)
if mean pap falls 10mmHg with increased or unchanged co
trial of ccb, dihydropyridines
5 yr survival advantage

Question 6

advanced pulmonary hypertension therapy

Answer 6

prostanoids: epoprostenol, treprostinil, iloprost
endothelin receptor antagonists: endothelin 1, bostentan, ambrisentan
phosphodiesterase type 5 inhibitor- only sildenafil improved oxygenation- can be added to bostentan and epoprostanol

Question 7

Pulmonary Embolism types

score for pretest prob

Answer 7

massive (hypotension) submassive (all others)
score high>6, <2 low
dvt symptom (3), no dx to explain (3), tachycard (1.5),immobil (1.5), prior dvt, pe (1.5), malig (1), hemoptysis (1)

Question 8

acute pulmonary embolism treatment
reversible risk factor
unprovoked
recurrent

Answer 8

reversible risk factor: 3mth inr 2.5 goal
unprovoked:consider indef if no bleeding risk- reassess after 3 mths
recurrent- indefinite warfarin rx

Question 9

thrombolytics in pulmonary embolism/ mortality

Answer 9

no mortality benefit

may improve short term physiology

Question 10

Obstructive Sleep apnea

cpap

Answer 10

> 15 AHI cpap

apnea hypopnea index