Fouty- Pulmonary HTN

Question 1

mean pressure for PCWP (LA pressure)

Answer 1

5-15 mmHg

Question 2

how to measure PA pressure

Answer 2

R heart cath

Question 3

mean PA pressure > ______mmHg to diagnose pulmonary HTN

Answer 3

20 mmHg

Question 4

sx’s of this include:
dyspnea on exertion/sob
fainting
chest pain/pressure
swelling of abd and legs

Answer 4

pulmonary HTN

Question 5

JVD
ascites
edema
(signs of what)

Answer 5

RV failure

Question 6

presence of loud 2nd heart sound indicates what

Answer 6

extra hard closure of aortic or pulmonic valve closing against higher pressure

Question 7

increased 2nd heart sound
RV heave
murmurs
(can indicate what)

Answer 7

pulmonary arterial HTN (precapillary)

Question 8

gold standard for determining if someone has pulmonary HTN

Answer 8

R heart cath

Question 9

artery that supplies upper lobe of lung

Answer 9

R upper pulmonary artery

Question 10

artery that supplies middle and lower R lung lobes

Answer 10

R lobar artery

Question 11

arteries or veins seen here

Answer 11

veins

Question 12

arteries or veins seen here

Answer 12

arteries

Question 13

blood pressure=

Answer 13

CO x vascular resistance

Question 14

mean pulmonary artery pressure=

Answer 14

(CO x PVR)+ LA pressure

Question 15

3 main causes of increased mean pulmonary artery pressure

Answer 15

1. increased CO
2. increased PVR
3. increased LA pressure

Question 16

clinically relevant causes of pulmonary HTN

Answer 16

increase in L atrial pressure
increase in pulm. vascular resistance

Question 17

increase in L atrial pressure (PCWP) is associated with what HTN

Answer 17

post-capillary (pulmonary venous HTN)

Question 18

increase in pulmonary vascular resistance is associated with what HTN

Answer 18

pre-capillary (pulmonary arterial HTN)

Question 19

increase in _____ pressure ultimately causes increase in pressure in capillaries and mean pulmonary arterial pressure

Answer 19

LA

Question 20

mean PAP>20 mmHg and increased PCWP

Answer 20

pulmonary HTN due to pulmonary venous HTN

Question 21

most common causes of pulmonary HTN due to pulmonary venous HTN

Answer 21

cardiac causes (LA hypertrophy or dilation, mitral stenosis)

Question 22

Answer 22

hydrostatic pulmonary edema due to aortic stenosis

Question 23

mean PAP>20 mmHg with a NORMAL PCWP

Answer 23

pulmonary HTN due to pulmonary arterial HTN

Question 24

primary vascular disorder can cause what pulm. HTN

Answer 24

pulmonary arterial HTN

Question 25

pleural/pulmonary causes such as emphysema or interstitial lung disease can cause what pulm. HTN

Answer 25

pulmonary arterial HTN

Question 26

chronic alveola hypoventilation can cause chronic hypoxia leading to remodeling that causes what pulm. HTN

Answer 26

pulmonary arterial HTN

Question 27

HTN due to what

Answer 27

idiopathic pulmonary arterial HTN (see R and L hilum enlarged)

Question 28

this person has a VSD, what kind of HTN?

Answer 28

pulmonary arterial HTN

Question 29

untreated congenital heart defect causing pulmonary arterial HTN later in life

Answer 29

Eisenmenger's syndrome

Question 30

person with congenital heart defect that was never resolved; what HTN?

Answer 30

pulmonary arterial HTN

Question 31

idiopathic genetic scleroderma VSD (what kind of diseases and what can they cause)

Answer 31

pulmonary vascular disease causing pulmonary arterial HTN

Question 32

what obstructive pulmonary disease can cause pulmonary arterial HTN

Answer 32

emphysema

Question 33

pathophys of how emphysema can cause pulmonary arterial HTN

Answer 33

chronic hypoxia (due to decreased surface area of alveoli/capillary and decreased DLCO) which causes vasoconstriction and pulm/ HTN ALSO destruction of pulmonary vessels

Question 34

restrictive lung disease that can cause pulmonary arterial HTN

Answer 34

interstitial lung disease

Question 35

pathophys of how interstitial lung disease can cause pulmonary arterial HTN

Answer 35

chronic hypoxia and destruction of pulmonary vessels

Question 36

pathophys of scoliosis causing pulmonary arterial HTN

Answer 36

chronic hypoventilation of alveoli and respiratory failure

Question 37

obesity can cause what HTN and why

Answer 37

pulmonary arterial HTN; due to chronic hypoxia and chronic vasoconstriction of pulmonary circulation

Question 38

remodeling of vessels due to chronic hypoxia (steps and it can ultimately lead to what)

Answer 38

vasoconstriction increased vascular resistance pulmonary HTN RV failure

Question 39

Answer 39

pulmonary arterial medial hypertrophy (from severe PAH)

Question 40

Answer 40

pulmonary arterial intimal thickening

Question 41

Answer 41

normal; no CO decline

Question 42

Answer 42

reversible; CO starts to decline

Question 43

Answer 43

irreversible; PAP and CO decrease and PVR continues to increase

Question 44

severe pulmonary arterial HTN causes

Answer 44

RV hypertrophy RV dilatation RV failure

Question 45

Answer 45

normal

Question 46

Answer 46

RV failure

Question 47

4 main risk factors for pulmonary arterial HTN due to pulmonary vascular disease

Answer 47

genetics drugs (diet pills) systemic disease (scleroderma) infection (schistosomiasis)

Question 48

drug for PAH that decreases endothelin effects

Answer 48

endothelin receptor antagonists

Question 49

drugs for PAH that increase impact of NO in pathway

Answer 49

phosphodiesterase inhibitors

Question 50

drugs for PAH that prevent vasoconstriction by increasing cAMP (decrease in Ca2+)

Answer 50

Prostacyclin derivatives