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Echo 2 > C13: Pulmonary hypertension > Flashcards

C13: Pulmonary hypertension Flashcards

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1
Q

define PHT

A

characterized by evaluated pulmonary arterial pressure secondary to RV failure

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2
Q

can both pulmonary disease and disease of the RV muscle cause PHT

A

yes

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3
Q

w/ PHT, what changes are seen to systolic and diastolic function of the RV

A

reduced FAC, TAPSE and S prime

diastolic usually abnormal

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4
Q

2 categories of causes of PHT

describe them

A

pre-capillary:
before the lungs….
-congenital heart disease - shunts
-respiratory diseases - PE, PPS

post-capillary:
after the lungs...
-MV disease, AV disease
-myoxoma
-cor triartiatum
-PV compression
-myocardial disease
-systemic HTN
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5
Q

are most causes of PHT pre or post capillary causes

A

post

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6
Q

PHT values for:
PCWP
SPAP
MPAP

A

PCWP - > 18mmHg ( > 15 mmHg is abnormal)

SPAP = RVSP if no obstruction - >35 mmHg (30-35 is borderline)

MPAP - >/= 25 mmHg

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7
Q

respiratory symptoms for PHT

A

SOB
cough
wheezing
hemoptysis - press is so high, blood is getting into the air passageways
intercostal retraction - increased muscle mass due to difficulty breathing

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8
Q

associated cardiac symptoms w/ PHT

A 
palpitations/arrhythmias
chest pain
SOB
orthopnea
syncope

signs of RHF

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9
Q

norm mean pressure in the RA and IVC

A

0-4 mmHg

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10
Q

norm pressure in the RV and PA

A

< 25 / < 10 (systolic and diastolic)

same for both

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11
Q

is TV pg the same as 4(v)^2

A

yes

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12
Q

cardiac causes of RHF

A 
LHF
pulmonary valve stenosis
RV infarction
massive TR
congenital malformations
shunts
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13
Q

when the R heart fails, what always happens to the pulmonary pressures

A

they always go up

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14
Q

2 pulmonary/lung causes of elevated R heart pressures

A

parenchymal

vascular

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15
Q

parenchymal, pulmonary causes of elevated R heart pressures

A

COPD
interstitial lung disease
adult respiratory distress syndrome
chronic lun infection

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16
Q

vascular, pulmonary causes of elevated R heart pressures

A

PE

primary pulmonary HTN

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17
Q

describe the pathophysiology of cor pulmonale

A

progressively increasing chronic pressure overload of the RV as it ejects into the high resistance vascular bed

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18
Q

how does cor pulmonale initially affect the RV?

how does it progress

A

initially: RVH…

…then RV dilation and TR from annular dilation…. then RV failure

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19
Q

common cause of PE

A

DVT that became an emboli

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20
Q

what is a saddle emboli

A

clot that lodges @ the bifurcation of the PA

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21
Q

in patients w/ a shunt (ASD/VSD/PFO) who have developed P HTN, what can happen to the direction of the shunt

What is it called when thIs happens?

A

it can be reversed (going from right to left) due to very high pulmonary pressures… or could be biphasic depending on which press is higher

Eisenmengers syndrome

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22
Q

how does chronic volume overload of the RV affect the lungs

A

permanent lung damage which raises pulmonary pressures and RVSP

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23
Q

anything that causes pressure or volume overload of the RV will also cause what

A

RVH and RV and TV annular dilation (TR)

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24
Q

chronic evaluation of the RT heart pressure often lea to what 3 things

A

dilated coronary sinus
reopening of a PFO (acquired PFO)
dilated main PA

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25
how does the reopening of a PFO due to high Rt heart pressures occur
the atria are stretched so the foramen oval is no longer covered
26
post capillary causes of P HTN usually involve what type of dysfunction of the LV
systolic, diastolic dysfunction or L heart valvular disease
27
R heart US features w/ P HTN IVC/SVC? PA?
``` RV and RA dilated decreased systolic function IVS and IAS bowing to the LV TR/ TV annular dilation PA dilated w/ PR IVC and SVC dilated ```
28
why might a patient w/ P HTN have tachycardia
to compensate for low output
29
L heart US features w/ P HTN
``` LV and LA dilated decreased systolic function LVH or cardiomyopathy MR/ MV abnormalities Av sclerosis LV, IAS, IVS aneurysmal ```
30
how can the LV often appear w/ P HTN
can appear compressed b/c the RV can become severely enlarged
31
how will the motion of the IVS often appear the P HTN
paradoxical, will move towards the RV during systole instead of the LV will also appear flattened in PSAX and created the "D" bounce
32
size of the RV free wall with P HTN in which view do we measure
> 5 mm subcostal 4CH b/c we are using axial res
33
in how many view must you see and ASD/PFO to diagnose it
2 views
34
which pathology of the pericardium often goes with pulmonary disease
pericardial disease
35
what causes RV pressure overload (RVPO) when would the "D" sign be seen during the cardiac cycle w/ press overload
- longstanding regurg - primary pulmonary disease both systole and diastole
36
can RVPO and RVVO coexist
yes
37
over time, what does RVVO lead to
RVPO
38
what causes RV volume overload (RVVO) when would the "D" sign be seen during the cardiac cycle w/ press overload
any etiology that causes increased volume... e.g. - severe TR - left to right shunt like an ASD only in diastole
39
norm measurements for RVOT distal and prox MPA
RVOT distal PV: <33mm | prox MPA: < 27mm
40
does the RV contract well with high afterload
no... TAPSE, S prime and FAC will be reduced, RV cant handle high afterload
41
how do you get the SPAP (systolic pulmonary artery pressures) aka RVSP
using TR max velocity + RAP OR using VSD peak velocity
42
how do you get the MPAP
MPAP = 4v^2 + RAP using PR early diastolic velocity of the CW tracing (PSAX preferred for better alignment) OR MPAP = 80 - (0.5 x PAT) using PW
43
how do you get the PA-EDP
PA-EDP = 4v^2 + RAP using the PR end-diastolic velocity of the CW tracing (PSAX preferred for better alignment)
44
is the RVSP valid w/ severe TR
no
45
w/ a VSD, do we still use the TR jet to estimate the RVSP
no, use the VSP jet, it will be more accurate
46
how to calculate RVSP w/ VSD jet
take the blood pressure minus the press gradient from the VSD jet (4v^2) to get the RVSP RVSP = SBP - 4(peak velocity of VSD)^2
47
what does the velocity of the VSD jet reflect
the press gradient b/w the Lv and RV during systole
48
what should sweep speed be set to for TR jet for RVSP
100 cm/s
49
in which views do we assess the TR jet velocity
RVIT PSAX A4CH (on and off axis) Sub4CH
50
which view is best to asses an eccentric TR jet
Sub4CH... especially if jet is medially directed
51
how can you make the measurement of the IVC more accurate
get perpendicular to the IVC
52
normal PAEDP
4-12 mmHg
53
how does increased PA pressure affect PAT
it will shorten... press in the RV has to rise above that of the PV in order for the PV to open, when it finally does, its open for a shorter amount of time and the RV hard hardly push any blood into the PA due to resistance.... making the PAT short
54
how should sweep speed be set to measure PAT
100 cm/s or more, b/c we're measuring a short period of time
55
when should you use PR jet velocities to assess the mPAP and RV-EDP
whenever RVSP is suspected to be elevated
56
value for mild SPAP/RVSP elevation severe
mild 35-40 mmHg severe > 70 mmHg
57
normal RVOT AT / PAT
>/= 120
58
value for mild PAT severe
mild 80-110 ms severe < 60 ms
59
value for mild mPAP elevation severe
mild 30-40 mmHg severe > 50 mmHg
60
normal mPAP
< 25 mmHg

Echo 2 (15 decks)

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