What is the definition of pulmonary HTN?
Pulmonary arterial pressure > 25 mmHg
How many grades are in the Heath and Edwards grading system? What is its purpose?
6; Determine if arterial changes of pulm. HTN could be reversed with cardiac surgery; 1 - 3 reversible, 4 - 6 not reversible
What causes cor pulmonale?
Increased pressure in the lesser circulation leads to hypertrophy of the RV
A muscular pulmonary artery shows occlusive intimal fibrosis. What is the Heath and Edwards grade?
Plexiform lesions consisting of irregular interlacing blood channels, dilation and thinning of pulmonary arteries is shown. What is the Heath and Edward Grade?
What is found in Heath and Edward Grade 6?
Fibirinoid Necrosis of arteries and arterioles
What are the conditions that fall under precapillary HTN?
- L-R cardiac shunt
- Primary Pulmonary HTN
- Thromboembolic pulmonary HTN
- HTN due to fibrotic lung disease and hypoxia
What are the conditions that fall under postcapillary HTN?
- Pulmonary veno-occlusive disease
- HTN secondary to left-sided cardiac disorders (ie mitral stenosis, aortic coarctation)
What causes primary pulmonary HTN? In this case, what do patients normally die from?
Increased pulmonary arterial tone; Cor pulmonale
What is Pickwickian Syndrome?
Severe obesity that impedes breathing
How can Pickwickian Syndrome and Kyphoscoliosis cause pulmonary HTN?
Both conditions -> Hypoventilation -> Hypoxemia -> Vasoconstriction of Small Pulm. Arteries -> Pulm HTN
How does mitral insufficiency lead to pulm HTN?
Mitral stenosis/insufficiency -> LA regurgitation -> Pulm Venous congestion -> Pulm Artery congestion -> HTN
A patient presents with progressive dyspnea and CXR reveals scattered lung infiltrates. The biopsy of a pulmonary vein is shown below. What is the Dx? What is the cause of this disease?
Veno-occlusive disease of the lung; Uncertain etiology but possibly viral infection, toxic agents, and chemoTx