Pulmonary HTN

Question 1

What are the 2022 ESC/ERS guidelines for definitions of
PH
Pre capillary PH
Isolated post capillary PH
Combined pre and post capillary PH
Exercise PH

Answer 1

PH mPAP>20mmHg

Pre capillary PH mPAP >20,
PAWP <15, PVR >2

Isolated post capillary mPAP >20
PH PAWP >15, PVR <2

Combined pre and mPAP >20
post capillary PH PAWP >15, PVR >2

Exercise PH mPAP/CO slope between rest and exercise >3mmHg/L/min

Question 2

Outline the pulmonary HTN classes

Answer 2

1. Pulmonary arterial HTN: includes idiopathic, inheritable, 2 drugs/toxins, ass CTD, HIV, portal HTN, Congenital heart disease, schistosomiasis
   2.PH in ass with left heart disease
2. PH in ass with lung disease or hypoxia
3. PH ass with pulmonary artery obstruction - CTEPH, other pulmonary artery obstructions
   5.Unclear mechanism - haeamtological, metabolic, chronic renal failure, fibrosing mediastinitis

Question 3

Give examples of endothelin antagonists

Answer 3

Bosentan, Ambrisentan, Macitentan

Question 4

Give examples of PDE5 inhibitors

Answer 4

Sildenafil, Tadalafil,cGMP stimulator, Riociguat

Question 5

Give examples of prostanoids (cAMP)

Answer 5

Prostacyclinn/epoprostenol IV, iloprost Iv or neb, trepostinil Iv neb sc, selexipag oral

Question 6

What is the mechanism of sotatercept?

Answer 6

Ligand trap for TGF-beta superfamily membranes

Question 7

What are the treatment options for group 1 PAH?

Answer 7

Low risk - Combination ERA + PDE5i
High risk - combination PPA, ERA, PDE51

Question 8

Which of the following medical conditions has the highest prevalence of pulmonary arterial hypertension?
COPD
Portal HTN
Sarcoidosis
SLE
Systemic sclerosis

Answer 8

Systemic sclerosis

Question 9

What are the causes of pre-capillary PH?

Answer 9

PAH
CTEPH
PH-Respiratory

Question 10

What are the causes of post-capillary PH?

Answer 10

LHD