pulmonary circulation

Question 1

COr pulmonale - what is it, causes, syx, mx

Answer 1

• RSHF causes by chronic pulmonary HTN. This leads to back pressure of blood in right atrium, superior vena cava, systemic venous system
• Causes: chronic lung disease (COPD, ILD, cystic fibrosis), pulmonary vascular disorders, neuromuscular disorders

Presentation

• Asyx
• Sob +/- exertion
• Peripheral oedema
• Syncope
• CP

Signs

• Hypoxia
• Cyanosis
• Raised JVP
• Peripheral oedema
• Hepatomegaly

Management

• Rx underlying cause
• Consider LTOT

Question 2

Pulmonary HTN: causes. presentation, Ix, Mx

Answer 2

Increase in mean pulmonary arterial pressure

CAsues:

(1. ) Lung disease: COPD, Asthma, ILD, bronchiectasis, cystic fibrosis
(2. ) Pulmonary vascular disease: Idiopathic pulmonary HTN (primary pulmonary HTN), pulmonary vasculitis, PE, portal hypertension
(3. ) Hypoventilation: OSA, kyphosis/scoliosis, neuromuscular conditions (e.g. myasthenia gravis)
(4. ) Left Heart Disease: Mitral stenosis, mitral regurgitation, left ventricular failure

Presentation

• Sob
• Syncope
• Fatigue
• Signs: Raised JVP, parasternal heave, loud P2, presence of an S3 sound, pansystolic murmur (tricuspid regurgitation) and an end-diastolic murmur (pulmonary regurgitation).

Ix

• ECG: p pulmonale, RVH, right axis deviation
• ECHO
• Right heart catheterisation (GOLD)

Mx

• Rx underlying cause
• Reduction of pulmonary vascular resistance: LTOT, Nifedipine, Sildenafil, Prostacycline analogues, Bosentan (endothelin receptor antagonist)
• Manage HF
• Heart-lung transplant