Cardio - Pulmonary Hypertension

Question 1

What is the normal PA pressure?

Answer 1

25 mmHg (systole)

Question 2

What is considered PHT?

Answer 2

>30 mmHg (systole)

Question 3

What is mild PHT?

Answer 3

30-50 mmHg

Question 4

What is moderate PHT?

Answer 4

50-75 mmHg

Question 5

What is severe PHT?

Answer 5

>75 mmHg

Question 6

The lungs are _____ pressure, _____ resistance, _____ capacitance.

Answer 6

low, low, high

Question 7

Which side of the heart is at a lower pressure than the other?

Answer 7

R side is much lower pressure than the L

Question 8

What are the 4 causes of PHT?

Answer 8

1. Idiopathic/primary
2. L-sided heart disease (MVDz, DCM)
3. Chronic pulmonary disease (bronchitis, pulm fibrosis)
4. Pulmonary thromboembolic disease

Question 9

What causes idiopathic/primary PHT?

Answer 9

Retention of fetal PVR

Question 10

What does L-sided heart disease lead to in terms of PHT?

Answer 10

pulm venous hypertension

Question 11

What does chronic pulmonary disease lead to in terms of PHT?

Answer 11

Hypoxemia and vasoconstriction

Question 12

What are some pulmonary thromboembolic diseases?

Answer 12

HWD, PLN, PLE, Cushings

Question 13

What side of the heart has precapillary PHT?

Answer 13

R side

Question 14

What side of the heart has post-capillary PHT?

Answer 14

Left

Question 15

What is pre-capillary PHT?

Answer 15

Disease before the blood reaches the capillaries

Question 16

What is post-capillary PHT?

Answer 16

High pressure after the capillaries that backed up across the capillary bed

Question 17

All PHT causes are ____-capillary EXCEPT _____.

Answer 17

pre, L-sided heart disease

Question 18

What happens to the pulmonary arteries/arterioles in PHT?

Answer 18

Medial hypertrophy of tunica media, intimal proliferation and fibrosis, plexiform lesions

Question 19

What happens to the heart in PHT?

Answer 19

High RV afterload –> RV hypertrophy/dilation –> MPA enlargement –> tricuspid regurg –> pulmonic regurg –> IVS flattening/small LV

Question 20

PHT occurs due to too much _____.

Answer 20

afterload

Question 21

What are the CS associated with PHT?

Answer 21

Syncope, dyspnea, exercise intolerance cough (from underlying lung disease)

Question 22

PHT is often misdiagnosed as _____ secondary to _____.

Answer 22

L-CHF, MVDz

Question 23

How can PHT be differentiated from L-CHF secondary to MVDz?

Answer 23

PHT primarily presents with syncope and exercise intolerance (MVDz is dyspnea and cough)

There is none or a SOFT murmur, R > L (LOUD murmur in MVDz)

Sinus arrhythmia or bradycardia (tachycardia in MVDz)

RV enlargement (vs. LA), pulm artery distention (vs. pulm veins)

Question 24

What are some lateral radiographic findings that can point to PHT?

Answer 24

Lack of LA enlargement, apex of heart not touching sternum (due to RV enlargement pushing it up), enlargement of cranial lobar pulm artery

Question 25

What are some VD radiographic findings that can point to PHT?

Answer 25

Bulge on MPA, generalized interstitial pattern (can be due to heartworm pneumonitis)

Question 26

Doppler echo measures _____ of blood flow.

Answer 26

velocity

Question 27

Velocity of blood flow is determined by _____ \_\_\_\_\_.

Answer 27

pressure gradient

Question 28

What is the modifed bernoulli equation?

Answer 28

PG = 4v²

Question 29

We can estimate PA pressure using velocity of what two things?

Answer 29

Tricuspid regurg (systolic) or pulmonic regurg (diastolic)

Question 30

How is PHT estimated echocardiographically?

Answer 30

High velocity of tricuspid regurg --\> high RV systolic P --\> high PA systolic P

Question 31

What test is used to determine if PHT is due to L-sided heart disease?

Answer 31

Echo

Question 32

What test is used to determine if PHT is due to chronic bronchopulmonary disease?

Answer 32

TXR, fluoroscopy, bronchoscopy, airway sampling, thoracic CT

Question 33

What test is used to determine if PHT is due to pulmonary thromboembolic disease?

Answer 33

D-dimers, thoracic CT angiography, screen for PLE/PLN, screen for Cushing's

Question 34

What test is used to determine if PHT is due to HWD?

Answer 34

HW antigen test

Question 35

What meds are indicated for PHT when there is also **R-CHF**?

Answer 35

Furosemide, Pimobendan, Enalapril/benazepril

Question 36

What meds are indicated for PHT when that is the **only problem**?

Answer 36

Sildenafil

Question 37

What treatments are considered if PHT is due to L-sided heart disease?

Answer 37

Enalapril, Pimobendan, Furosemide, Spironolactone (likely stage C)

Question 38

What treatments are considered if PHT is due to chronic bronchopulmonary disease?

Answer 38

Bronchodilators (theophylline), cough suppressants (hydrocodone), abx (doxycycline), steroids (pred)

Question 39

What treatments are considered if PHT is due to pulmonary thromboembolic disease?

Answer 39

Clopidogral, Aspirin, tx of PLE/PLN, Cushing's

Question 40

What treatments are considered if PHT is due to HWD?

Answer 40

HW preventative, doxycycline, melarsomine protocol

Question 41

Generally, prognosis for PHT is _____ unless \_\_\_\_\_.

Answer 41

guarded, cause is reversible