Pulmonary hypertension

Question 1

What is the resting Mean Peripheral Arterial Pressure (mPAP) in pulmonary hypertension?

Answer 1

Over 25mmHg

Question 2

How is the resting mPAP measured?

Answer 2

Right heart catheterisation

Question 3

What does pulmonary hypertension often result in?

Answer 3

Right side heart failure
Cor pulmonale

Question 4

What are pre-capillary causes of pulmonary hypertension?

Answer 4

PE
Primary pulmonary hypertension (idiopathic, small pulmonary arteries constrict)

Question 5

What are capillary and lung causes of pulmonary hypertension?

Answer 5

COPD
Asthma (hypoxia triggers vasoconstriction)

Question 6

What is a post-capillary cause of pulmonary hypertension?

Answer 6

Left ventricle failure

Question 7

What are conditions causing chronic hypoxemia leading to pulmonary hypertension via vasoconstriction?

Answer 7

Asthma
Altitude

Question 8

In response to hypoxia from various conditions, reactive pulmonary vasoconstriction occurs leading to increased pulmonary vascular r_____ and pressure leading to ______ damage

Answer 8

resistance
endothelial

Question 9

The increased pulmonary pressure leads to r___ v___ h______ and failure

Answer 9

right ventricle hypertrophy

Question 10

What are symptoms of pulmonary hypertension?

Answer 10

Exertional dyspnoea and fatigue
Later right heart failure signs

Question 11

What are some right heart failure signs?

Answer 11

Increased JVP (backlog of blood flow from right atrium back up jugular veins)

Peripheral oedema (congestion from right side of heart and increased hydrostatic pressure)

V waves prominent on JVP (correspond to venous filling phase of cardiac cycle)

Louder S2 than normal

Question 12

What is S2?

Answer 12

The second heart sound occurs during ventricular diastole (relaxation, closure of aortic and pulmonary valves after ejection, dub sound of lub dub)

Question 13

How is pulmonary hypertension diagnosed?

Answer 13

Chest XR: RVH and enlarged proximal pulmonary artery

ECG: RA dilation (p pulmonale characterised by tall and peaked P waves greater than 2.5mm in II, III and aVF)

Echo: RVH

Gold standard = Right heart catheter (over 25 mmHg)

Question 14

What is treatment for pulmonary hypertension?

Answer 14

Phosphodiesterase inhibitors like sildenafil (Viagra, prevents breakdown of cGMP promoting vasodilation)

CCB eg amlodipine (block calcium in vascular smooth muscle cells leading to relaxation and vasodilation)

Endothelin-1-antagonists (endothelin-1 is a potent vasoconstrictor produced by endothelial cells) or prostaglandin analogues (mimic affects of naturally occurring vasodilators)

For oedema use diuretics