Pulmonary Hypertension

Question 1

what mean PAP on swan defines pulm HTN?

Answer 1

25mm Hg at rest

Question 2

old definition of PAH on echo

Answer 2

systolic PAP > 40 (TR velocity 3-3.5m/s)

Question 3

which drugs can cause PAH?

Answer 3

Fen-phen, amphetamines, cocaine, St. John’s Wort, SSRIs

Question 4

name the most important connective tissue dz that causes PAH

Answer 4

scleroderma

Question 5

name the most important virus associated with PAH

Answer 5

HIV

Question 6

name a common congenital heart dz associ. w/ PAH

Answer 6

eisenmenger’s

Question 7

what parasite can cause PAH?

Answer 7

schistosomiasis

Question 8

what chemotherapy is associated with PAH due to pulmonary veno-occlusive dz?

Answer 8

bleomycin

Question 9

are pleural effusions seen in IPAH?

Answer 9

no

Question 10

what finding on right heart cath is suspicious for pulmonary veno-occlusive dz?

Answer 10

inconsistent PCWP tracings

Question 11

if pt on cath table is given a PA vasodilator and they go into pulmonary edema, what should you think of?

Answer 11

pulmonary veno-occlusive dz

Question 12

what to suspect when pt has severe PAH, pulm edema, high PCWP:LVEDP?

Answer 12

pulm veno-occlusive dz

Question 13

Rx for pulmo veno-occlusive dz

Answer 13

diuretics, anticoagulant, O2, lung Tx

Question 14

is bosentan recommended for pulmonary veno-occlusive dz?

Answer 14

no

Question 15

WHO group classification for PAH

Answer 15

1- PAH
2- due to left heart dz
3- lung dz
4- chronic PE
5- multifactorial

Question 16

***which of the WHO groups of PAH is often misdiagnosed as group 1 or idiopathic? How do you distinguish them?

Answer 16

WHO 4 (chronic PE)
V/Q scan

Question 17

for CHRONIC thromboembolic pulmonary htn (CTEPH), which test is more sensitive: CT-pulmonary angiography or V/Q scan?

Answer 17

V/Q scan

Question 18

currently, what WHO group for PAH is sarcoidosis in?

Answer 18

5

Question 19

with RVH/RAE, which lead has an increased p wave on ekg?

Answer 19

II

Question 20

how to calculate RVSP (which equals PASP) on echo?

Answer 20

4v2 + RAP where v = velocity of TR jet and RAP os estimated form IVC size.

Question 21

describe the 4 functional classes of PAH according to WHO

Answer 21

I- PAH without sxs
II- sxs with ordinary activity, but mild
III- sxs with minimal activity, severe
IV- sxs at rest

Question 22

is RHC required to diagnose PAH?

Answer 22

yes

Question 23

Rx for WHO 4 PAH

Answer 23

anticoagulation, thromboendarterectomy

Question 24

Rx for WHO 5 PAH

Answer 24

underlying cause

Question 25

which WHO group classes of PAH should be anti coagulated?

Answer 25

1 (idiopathic) and 4 (embolic)

Question 26

which WHO group PAH gets a vasoreactivity test on RHC?

Answer 26

1

Question 27

name 3 agents that can be used to perform a vasoreactivity test in PAH

Answer 27

adenosine, epoprostenol, inhaled NO

Question 28

what is a positive test during a invasive hemodynamic vasoreactivity assessment of PAH?

Answer 28

decrease in mean PAP of 10 to less than 40 with increased or unchanged C.O.

Question 29

what drugs do you use to treat PAH with vasoreactivity on RHC?

Answer 29

CCBs (dihydropyridine or diltiazem)

Question 30

which drug improves functional capacity and survival for PAH WHO group I (idiopathic)?

Answer 30

flolan=epoprostenol=prostacyclin

Question 31

Bosentan MOA

Answer 31

endothelia receptor antagonist

Question 32

sildenafil/tadalafil MOA

Answer 32

PDE 5 inhibitors

Question 33

algorithm for treating NYHA IV PAH

Answer 33

epoprostenol, if doesn’t work combo therapy then atrial septostomy or lung transplant

Question 34

preferred treatment for NYHA II PAH

Answer 34

bosentan or sildenafil

Question 35

components of PE severity index (PESI) [6] where even one point means 10% 30 d mortality

Answer 35

age >80, cancer, COPD, HR>110, BP< 90

Question 36

for hemodynamically stable patients with PE, which is preferred: lovenox or UFH?

Answer 36

lovenox

Question 37

for massive PE, which is preferred: UFH or lovenox?

Answer 37

UFH

Question 38

what is associated with warfarin-induced skin necrosis?

Answer 38

Protein C deficiency

Question 39

absolute contraindication to thrombolytics in massive PE (4)

Answer 39

h/o hemorrhagic stroke
active intracranial neoplasm
intracranial sx/trauma within 2 mo’s
active internal bleeding within 2 mo’s

Question 40

when do you start CPAP for sOSA?

Answer 40

when apnea-hypopnea-index > 15 (AHI = apneic episodes + hypopneic episodes)