Pulmonary Hypertension Flashcards
What is pulmonary hypertension?
Pulmonary arteries systolic BP >30mmHg or mean BP >20mmHg
Classification of pulmonary hypertension
- PAH - idiopathic, familial
- Left heart disease or PVH
- Lung diseases +/- hypoxaemia
- Chronic thromboembolic disease
- Miscellaneous - inflammation, extinsic compression of pulmonary vasculature, others
Signs of pulmonary hypertension
Left parasternal heave (LVH)
Loud palpable P2
Graham steel murmur of PR (in MS)
Functional TR
What is primary pulmonary hypertension?
Pulmonary hypertension in the absence of an obvious cause
Rare
Associated with connective tissue disease and vasculitis
Median survival is three years if untreated
How would you investigate a patient with pulmonary hypertension?
Confirm diagnosis and severity and look for underlying cause
ECG: right ventricular strain
ABG: type 1 or type 2 respiratory failure
CXR: prominent pulmonary arteries, oligaemic lung fields, signs of airways disease
Echo: signs of valve disease, assess right heart function, estimate pulmonary artery pressure
CTPA: chronic emboli
Lung function tests and high resolution lung CT
Right and left heart catheterisation
What are the treatments of secondary pulmonary hypertension?
Treat the cause
Diuretics
Long term oxygen therapy
Anticoagulation
Vasodilator therapy
Calcium channel blockers
Endothelin receptor antagonists (bosentan)
Phosphodiesterase 5 inhibitors (sildenafil)
Prostaglandins (epoprostenol, iloprost)
How do you treat primary pulmonary hypertension?
Diuretics
Anticoagulation
Vasodilator therapy
Atrial septostomy
Lung transplantation
Pulmonary hypertension in MS
Pathophysiology
Passive backward transmission of elevated LA pressure
Pulmonary arteriolar constriction
Interstitial oedema in small pulmonary vessels walls
Obliterative changes in pulmonary vascular bed
Consequent
RV enlargement
Secondary TR and PR
Right heart failure
