Pulmonary Hypertension

Question 1

What is pulmonary hypertension?

Answer 1

Elevated mean pulmonary artery pressure over 25mmHg at rest causing back pressure into systemic venous system

Question 2

Causes of pulmonary hypertension?

Answer 2

4 groups:

Group 1: Idiopathic pulmonary hypertension, connective tissue disease

Group 2: Left HF

Group 3: Chronic lung disease

Group 4: Pulmonary embolism

Group 5: others +

Question 3

Signs of pulmonary hypertension?

Answer 3

SOB
Syncope
Tachycardia

Right HF signs…
Raised JVP
Hepatomegaly
Peripheral oedema

Question 4

Investigations for pulmonary hypertension?

Answer 4

ECG
Chest x ray
NT pro BNP
Echocardiogram

Question 5

What ECG changes would you expect to see in someone with pulmonary hypertension?

Answer 5

Signs of right sided heart strain:
- Peaked p waves (p pulmonale)
- tall R waves V1-V2 and deep S waves in V5-V6 (RV hypertrophy)
- Right axis deviation
- right bundle branch block

Question 6

What findings would you get on CXR in pulmonary hypertension?

Answer 6

Dilated pulmonary arteries
RV hypertrophy

Question 7

Management of idiopathic pulmonary hypertension?

Answer 7

CCBs

IV prostaglandin, e.g. epoprostenol

Endothelin receptor antagonist e.g. macitentan

Phosphodiesterase 5 inhibitor e.g. sildenafil

Question 8

Management of secondary pulmonary hypertension?

Answer 8

Treating underlying cause