FN: Pulmonary Hyptertension Flashcards Preview

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Flashcards in FN: Pulmonary Hyptertension Deck (10):
1

Definition

PA pressure >25 mmHg

2

Causes

Left Heart disease
Lung parenchymal disease
Pulmonary Vascular disease
Hypoventiliation

3

Left Heart disease leading to pulmonary hypertension

􏰀 Mitral stenosis
􏰀 Mitral regurgitation
􏰀 Left ventricular failure
􏰀 L→Rshunt

4

Lung parenchymal disease


Lung Parenchymal Disease
􏰀 Mechanism
􏰁 Chronic hypoxia → hypoxic vasoconstriction 􏰁 Perivascular parenchymal changes
􏰀 COPD
􏰀 Asthma: severe, chronic
􏰀 Interstitial lung disease
􏰀 CF, bronchiectasis

5

Pulmonary Vascular disease

􏰀 Idiopathic pulmonary hypertension
􏰀 Pulmonary vasculitis: scleroderma, SLE, Wegener’s
􏰀 Sickle cell
􏰀 Pulmonary embolism: acute or chronic
􏰀 Portal HTN: portopulmonary HTN

6

Hypoventilaition

􏰀 􏰀 􏰀 􏰀
Ix
􏰀 􏰀
􏰀
OSA
Morbid obesity (Pickwickian syn.)
Thoracic cage abnormality: kyphosis, scoliosis Neuromuscular: MND, MG, polio

7

Investigations

ECG
ECHO
Right heart catheterisation: gold standard

8

ECG shows

􏰁 P pulmonale 􏰁 RVH
􏰁 RAD

9

Echo

􏰁 Velocity of tricuspid regurgitation jet
􏰁 Right atrial or ventricular enlargement 􏰁 Ventricular dysfunction
􏰁 Valve disease

10

Right heart catheterisation: gold standard

􏰁 Mean pulmonary artery pressure 􏰁 Pulmonary vascular resistance
􏰁 CO
􏰁 Vasoreactivity testing to guide Rx

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