Pulmonary Htn

Question 1

What is pul htn?

Answer 1

resting mPAP >25 mmHg measures with right heart catheterisation, often results in RHS HF, cor pulmonale

Question 2

Causes of pul HTN?

Answer 2

Pre capillary
Capillary and lung
post capillary
chronic hypoxemia

Question 3

Pre capillary causes?

Answer 3

Pul emboli, 1^ pul htn

Question 4

Capillary + lung causes?

Answer 4

COPD, asthma

Question 5

Post capillary causes?

Answer 5

LV failure

Question 6

Chronic hypoxemia causes?

Answer 6

COPD, altitude

Question 7

What is cor pulmonale and what does it cause?

Answer 7

Right circulation (pul htn) change directly causes right HF

Question 8

Pathology of Pul htn?

Answer 8

Reactive pul vasoconstriction when hypoxia (all above cause hypoxemia = low perfusion to tissue)

Increased pul vascular resistance + pressure therefore endothelial damage

RVH + Failure

Question 9

Sx of pul htn?

Answer 9

Initially exertion dyspnoea + fatigue then Right heart failure signs:
high JVP
Peripheral oedema
V waves prominent on JVP
Louder S2 than normal

Question 10

Dx of Pul htn?

Answer 10

Chest x ray = RVH, enlarged proximal pul artery

ECG = RA dilation (P.pulmonale, peaked p waves >2.5mm)

ECHO = RVH

DIagnostic (GS) = Right heart catheter

Question 11

Tx for Pul htn?

Answer 11

Phosphodiesterase - 5 inhibitor (sildenafil) - viagra
CCB (Amlodipine)
Endothelia 1 antagonists / prostaglandin analogues

Diuretics for oedema