What are the test findings of precapillary pulmonary HTN disorders?
- abnormally low DLCO with normal lung function otherwise
- no PE or evidence of disease on CXR
What is the pulmonary capillary wedge pressure approximately equal to?
the left atrial pressure and the left ventricle end-diastolic pressure
Since pre-capillary causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), ______ does not develop.
When standing upright at rest, most of the cardiac output goes to ______ due to _____.
the bases of the lung; gravity
In chronic pulmonary inflammatory states (like chronic bronchitis and bronchiectasis), the bronchial arteries _______.
enlarge and provide increased blood flow
What is a normal RA pressure?
Mean pulmonary arterial pressure can be elevated by what three mechanisms?
- PLA (such as in heart failure or mitral stenosis)
- cardiac output (not usually causative)
The lung has two arterial blood supplies: _____ and the ______.
the bronchial circulation; pulmonary circulation
What do the bronchial arteries supply?
- the trachea
- the airways down to the terminal bronchioles
- parts of the esophagus
- the vaso-vasorum of the aorta
What gene mutation is associated with idiopathic pulmonary arterial HTN (IPAH)?
bone morphogenic protein receptor type 2 (BMPR2)
The hydrostatic pressure gradient is opposed by _____.
the oncotic pressure gradient
What is a normal PAOP pressure?
This measurement is approximately equal to the left atrial pressure and the left ventricle end-diastolic pressure.
pulmonary capillary wedge pressure
How is idiopathic pulmonary arterial hypertension (IPAH) treated?
- vasodilators such as calcium channel blockers
- endothelin-1 blockers
- phosphodiesterase-5 inhibitors
A difference of more than 5 mmHg between the PA diastolic pressure and the PCWP suggests ______.
pulmonary vascular disease
The source of most bleeding in the lung (hemoptysis) is ______.
the bronchial circulation
Use of ______ is contraindicated in post-capillary pulmonary hypertension.
pulmonary arterial vasodilators
The presence of a wedge pressure less than 15 mmHg with coexistent pulmonary edema is consistent with ______ pulmonary edema.
What are the main subcategories of Group 1 PAH? (5)
- connective tissue disease
- portal hypertension
Use of pulmonary arterial vasodilators is contraindicated in ______.
post-capillary pulmonary hypertension
Since ______ causes of pulmonary hypertension do not increase pressure in the microcirculation (i.e. pulmonary capillary bed), pulmonary edema does not develop.
What is the tx for hydrostatic pulmonary edema?
diuretics inotropic drugs (increase C.O.)
With exercise, cardiac output increases and the increased flow goes to the _____ in the lung.
upper lobe vessels
What is the tx for non-cardiogenic pulmonary edema?
- mainly supportive care
- supplemental O2
The bronchial circulation is important in ______ and also protects the lung against _____.
fetal lung development; the infarcting effects of pulmonary emboli
The hydrostatic pressure gradient (Pmv-Pi) drives fluid from the pulmonary microcirculation into the _____.
What is a normal PA pressure?
What is a normal RV pressure?