- tricuspid valve pressure gradient - reflects the difference in pressure between RA and RV

Module 11 : Pulmonary Hypertension Flashcards by Adyson Strong

what is pulmonary hypertension characterized by

elevated pulmonary arterial pressures secondary to RV failure

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how are the categories of pulmonary hypertension characterized

based on which area of the circulatory system they affect which increased the pulmonary pressure

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what is pulmonary HTN

increased pressure in the pulmonary vasculature

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what is pulmonary HTN defined as

PCWP > 15mmHg
SPAP = RVSP if no RVOT obstruction 30-35
MPAP >/= 35mmHg
PVR >/= 3 wood units

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what will be the respiratory symptoms of PHTN

shortness of breath
cough
wheezing
hemoptysis
intercostal retraction

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what are the 4 signs of right heart failure

jugular venous congestion
peripheral edema
ascites
hepatosplenomegaly

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what are 5 associated cardiac symptoms with PHTN

palpitations/arrhtymias
chest pain
shortness of breath on exertion
othropnea
syncope

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what is normal RA and IVC pressure

0-4mmHg (average)

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what is normal right ventricle systolic and diastolic pressure

< 25 / < 10

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what is normal pulmonary artery systolic and diastolic pressure

< 25 / < 10

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how do we calculate RVSP with RAP and TV pg

RVSP = RAP + TVpg

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what is the RAP

RA pressure from IVC diameter

- 3,8,15

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what is the TV pg

tricuspid valve pressure gradient

- reflects the difference in pressure between RA and RV

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what RVSP would indicate mild moderate or severe PHTN

< 30 mmHg
30-35 mmHg
> 35 mmHg

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what is normal TR velocity

< 2.8-2.9 m/s

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what are the 6 cardiac causes of right sided heart failure

left sided heart failure is most common
pulmonic valve stenosis
right ventricular infarction
massive TR
congenital malformation
shunts

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what are the 2 categories of pulmonary causes of right heart failure

parenchymal

- vascular disease

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what are the 5 parenchymal causes of elevated right heart pressure

COPD asthma
interstitial lung disease
adult respiratory distress syndrome
chronic lung infection

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what are the 2 vascular causes of right heart pressure increase

pulmonary embolism

- primary pulmonary hypertension

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how does left sided heart failure increase right heart pressure

retrograde increased load/pressure

+ LV>LA>PLM VASC>RV>RA>IVC

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why does cor pulmonale occur

increased resistance in the pulmonary circulation

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what is the pathophysiology of cor pulmonale

progressively increasing chronic pressure overload of the right ventricle as it ejects into the high resistance vascular bed
+ if slow and gradual will first lead ti RV hypertrophy
+ if fast then RV dilation will happen first
+ then RV failure occurs

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what is an acute pulmonary embolism most often caused by

deep vein thrombosis

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how is PE and DVT treated

PE = treat DVT or lung resection

- DVT = IVC filter

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what is eisenmengers syndrome

- shunt reversal in patients with significant shunt that have developed PHTN from the shunt - shunt goes right to left

what 3 things does chronic elevation of RT heart pressures lead to

- dilated coronary sinus - reopening of PFO - dilated main PA

what are the 2 different categories of PHTN

- precapillary | - post capillary

what is the role of echo with PTHN

- identify cause of PHTN | + precapillary post capillary

what are the 3 most common post capillary causes of PHTN

- LV systolic function - LV diastolic function - left heart valvular disease

what are the right side 2D signs of of pulmonary artery hypertension

- enlarged RV (hypoinetic) - septal shifting (toward left) - RA enlarged - TV regurge - PA dilated - PV regurge - IVC dialted - SVC dilated

what are the 4 doppler right sided assessments of PAH

- TV regurge - PV insufficiency - IVC collapsible / reflux into hepatic veins - arrhythmia on ECG

what are the left side 2D signs oF pAH

- LV enlargement - LV hypo - LV, IAS, IVS aneurysmal - CMO - LA enlarged - MV abnormalities - AV sclerosis - prosthetic valves

what are the 5 left sided sided doppler features of PAH

- MV stenosis regurege - AV stenosis or regurge - systolic dysfunction - diastolic dysfunction - arrhythmia

what is the etiology of RVPO (RV pressure overload)

- any cause the increases pressure to the right heart + long standing regurge + primary pulmonary disease

what signs is seen with RVPO

- PSAX d sign seen in both systole and diastole

what does RVVO eventually become

- RVPO

what is the etiology of RVVO

- anything that causes increased volume to the right heart | + a left to right shunt such as significant ASD

what sign is seen with RVVO

- PSAX D sign in only diastole

what are the 3 spectra doppler methods of summarizing PAH

- SPAP (RVSP - MPAP - PAEDP

what 2 things does RVSP/SPAP use

- TR max velocity | - RAP

what does MPAP use

- using PR early diastolic velocity (PW or CW)

what does PAEDP use

- PR end diastolic velocity

what should we use to calculate the RVSP if it is present

- the VSD jet - more accurate - reflects the pressure difference between LV and RV

what is the equation for RVSP using VSD

-RVSP = SBP - (4 V^2)

what 5 technical factors need to be adjusted with RVSP

- peak velocity with CW is angle dependant - use color doppler to align - sweep speed 100cm/s - no feathering - do not measure unless peal clearly seen

what 4 windows are used to interrogate peak velocity of TR jet

- PLAX RVIT - PSAX - A4C - subcostal window

what is the equation for PAEDP

PAEDP = 4V ^2 + RAP

what velocity is used int he PAEDP equation

- PR CW trace at end diastole

what is normal PAEDP

< 10-12 mmHg

what is the real formula for MPAP

MPAP = 79 - (0.45 x PAT) PAT = pulmonary acceleration time

what is the rough estimate formula for MPAP

MPAP = 80 - ( 0.5 x PAT)

can PR jet velocity be used to asses MPAP and PAEDP

- yes | - should be done whenever RVSP is suspected to be elevated

how is the MPAP and PAEDP calculated with PR jet

- PG from early diastolic velocity tells us the MPAP (with RAP) - RVEDP is estimated from end diastolic velocity of the PR jet

what is normal SPAP (RVSP)

18-25 mmHg

what is mild elevated SPAP

30-40 mmHg

what is moderate elevated SPAP

40-70mmHg

what is severe elevated SPAP

> 70 mmHg

what is normal RVOT AT

>/= 120ms

what is mild decreased RVOT AT

80-110ms

what is moderate decreased RVOT AT

60-80 ms

what is severe decreased RVOT AT

< 60ms

what is normal MPAP

< 25 mmHg 9-18 average

what is mild elevated MPAP

30-40mmHg

what is moderate elevated MPAP

40-50mmHg

what is severe elevated MPAP

> 50 mmHg

what is normal PAEDP

4-12 mmHg

Module 11 : Pulmonary Hypertension Flashcards

(66 cards)