Pulmonary HTN and Cor Pulmonale

Question 1

Pulmonary HTN def

Answer 1

elevated pressures in the pulmonary vasculature system

• arterial from right ventricle
• venous side coming back into the atrium

Question 2

Cor Pulmonale def

Answer 2

elevated pressures in pulmonary vascular system leading to enlargement of the right side of the heart, usually the right ventricle

Question 3

Right atrium pressure

Answer 3

5 mmHg

nickel

Question 4

Left atrium pressure

Answer 4

10 mmHG

dime

Question 5

Right ventricle pressure

Answer 5

25 mmHG quarter

Question 6

left ventricle pressure

Answer 6

124 mmHG $1.25

Question 7

what is normal pulmonary artery pressure

Answer 7

20/10

Question 8

what is normal resting pulmonary artery pressure

Answer 8

around 15 mmHg

Question 9

What pressure defines pulmonary hypertension

Answer 9

pulmonary artery pressure of =>25 mmHg

Question 10

List of things that cause pulmonary hypertension

Answer 10

1. Pulmonary arterial HTN (primary and secondary)
2. Pulmonary venous HTN due to left sided heart disease
3. Pulmonary hypertension associated with disorders of respiratory system
4. Chronic thrombotic and/or embolic disease
5. Disorders affecting pulmonary vasculature

Question 11

Primary arterial PH

Answer 11

• sporatic
• familial
• pathophys is in small pulmonary arteries and arterioles
• increased contraction and decreased relaxation which elevates pressure

Question 12

secondary arterial PH

Answer 12

• collagen vascular disease (RA, lupus, etc.)
• congenital: pulmonary left to right shunts, overload right side of heart
• portal HTN - back pressure to right side of heart
• HIV
• drugs/toxins

Question 13

Pulmonary venous HTN

Answer 13

left sided heart disease

• ventricular heart disease
• valvular heart disease
• pulmonary veno-occlusive disease

Question 14

what is pulmonary veno-occlusive disease?

Answer 14

veins returning to LA are clotted

Question 15

PH associated with disorders of the respiratory system

Answer 15

• COPD
• Interstitial lung dz
• sleep disordered breathing
• alveolar hypoventilation disorders (central sleep disorder due to brain problem)

Question 16

PH due to chronic thrombotic and embolic dz

Answer 16

• thromboembolic obstruction of proximal pulmonary arteries (chronic emboli)
• obstruction of distal pulmonary arteries (PE or sickle cell dz)

Question 17

PH due to disorders affecting pulmonary vasculature

Answer 17

• sarcoidosis (fibrosis interferes with circulation, similar to COPD)
• scleroderma (collagen vascular dz)

Question 18

Two classifications of pathophysiology

Answer 18

1. pre-capillary - problem is in pulmonary artery or arteriole
2. passive - pressure is on left side of the pulmonary capillary, pulmonary venous side or “back pressure” usually due to left sided heart disease

Question 19

Mild clinical manifestations

Answer 19

fate and vague chest discomfort

Question 20

severe clinical manifestations

Answer 20

wide range

• dyspnea (most common)
• SOB
• syncope
• atypical chest pain

Question 21

true or false, PH is the most common cause of dyspnea when pt has PH

Answer 21

FALSE

• would never jump to PAH if pt has dyspnea, would suspect many other things first

Question 22

PE findings with mild PH

Answer 22

no discernable physical findings

Question 23

what are two major heart sounds heard on every healthy heart

Answer 23

S1 and S2

Question 24

What is S1

Answer 24

closer of the AV valves

Question 25

What is S2

Answer 25

A2 and P2 which are aortic and pulmonary valves

Question 26

Which closes first, A2 or P2? Why?

Answer 26

A2 - pressure on the left side > right side so aortic pressure is higher which causes the aortic valve to close slightly faster than the pulmonic valve

Question 27

Which heart sound is louder when listen at the base of the hearT? why?

Answer 27

S2, because you're physically closer to the aortic and pulmonary valves

Question 28

What happens on inspiration to heart sounds?

Answer 28

separation between A2 and P2

Question 29

Why is there separation between A2 and P2 on inspiration

Answer 29

when inspire, pressure in chest drops, causes blood to flow faster and longer into the lungs - Increase in blood volume across pulmonary valve causes it to close slower

Question 30

what are two abnormal heart sounds

Answer 30

S3 and S4

Question 31

What are S3 & S4

Answer 31

soccer analogy: - sound of blood falling from atria to ventricles and "bouncing" bc ventricles are stiff and don't give to cushion falling blood. - S3 early diastole - S4 late diastole

Question 32

what are common high frequency sounds

Answer 32

S1 S2 murmurs *listen with diaphragm

Question 33

What are common low frequency sounds

Answer 33

gallops *use bell

Question 34

which type of valve insufficiency is common

Answer 34

tricuspid insufficiency

Question 35

What are PE sx of PH

Answer 35

1. increased intensity of P2 2. murmurs of pulmonary and tricuspid insufficiency 3. increased JVD

Question 36

Why is S2 louder in PH

Answer 36

loudness is determined by amt of blood coursing back towards right ventricle after ventricular contraction and how sudden the motion is arrested when the valve closes.

Question 37

why does PH have splitting of A2 and P2

Answer 37

- takes longer to get blood into pulmonary circulation, takes longer for pulmonary valve to close. - "fixed splitting" - split on inspiration AND expiration

Question 38

where should S2 be loudest?

Answer 38

base | higher on chest

Question 39

5 dx tests

Answer 39

``` Not useful: - Hx and PE - CXR - EKG More useful - echo-cardiogram Diagnostic - Right heart cath ```

Question 40

Treatment of PH

Answer 40

pulmonologist or cardiologist :) | Except PE which is treated by generalist