pulmonary hypertension

Question 1

a map >__ is needed to maintin good adequate perfusion

Answer 1

60

Question 2

how do we calculate map

Answer 2

(systolic+ (2* diastolic)/3

Question 3

map <60 means what

Answer 3

inadequate perfusion is likely

Question 4

what is the MAP of a bp that is 120/80

Answer 4

MAP

120+ (2*80)/3

first do 2*80= 160
then add 160+120
280/3

93.3= good adequate perfusion to the organs

Question 5

normal mean pulmonary arterial pressure (mPAP) is between _______

Answer 5

8-20 mmhg

Question 6

what is the definitive way to test pulmonary arterial pressure

Answer 6

pulmonary artery catheterization is the definitive way to determine the diagnosis of pulmonary hypertension

Question 7

how is pulmonary artery catheterization done

Answer 7

the pulmonary artery catheter

inserted in the right atrium from venous access usually through the right internal jugular vein

Question 8

pulmonary hypertension is diagnosed if mPAP is >__ mmhm

Answer 8

20

Question 9

if pulmonary hypertension is greater then __ indicates severe pulmonary HTN

Answer 9

35

Question 10

what disorders fall under group 1 pulmonary HTN

Answer 10

idiopathic PH

HIV
LUPUS
CT disorders

congenital heart disease

Question 11

what disorder falls under group 2 pulmonary HTN

Answer 11

left heart diseases

aortic stenosis

left ventricular systolic/diastolic dysfunction

Question 12

what disorders fall under group 3 pulmonary HTN

Answer 12

COPD

obstructive sleep apnea

interstitial lung disease

pulmonary fibrosis

Question 13

what disorders fall under group 4 pulmonary HTN

Answer 13

thromboembolic disorders PE

Question 14

what disprders fall under group 5 pulmonary HTN

Answer 14

all other diseases
kidney
sarcoid

Question 15

most common group that causes pulmonary HTN

Answer 15

left heart disease
- aortic stenosis
left ventricular hypertrophy

Question 16

if pulmonary arterial wedge pressure is greater than (>15) then this signifies _______

Answer 16

left heart disease
group 2

Question 17

pulmonary arterial wedge pressure estimates pressure of _____

Answer 17

left atrium

Question 18

if pulmonary wedge pressure is <15 then this means pulmonary HTN could be due to what?

Answer 18

thromboembolic disorder (4)

copd/lung (3)

arterial resistance (1)

Question 19

pulmonary HTN signs

Answer 19

early on= shortness of breath and dyspnea

advancing disease it will lead more to exertional dyspnea

other
- jvd
ascites

Question 20

pulmonary htn ekg findings

Answer 20

right ventricular hyprtrophy
—–> tall R wave, in V1

right ventricular strain——> ST depression with T wave inversion, v1-v3

right axis deviation
1 is down, avf is up

Question 21

gold standard test for pulmonary HTN (most precise)

Answer 21

right heart catheterization
>20 mpap is diagnostic

Question 22

other lab work to check in pulmonsry HTN

Answer 22

check for HIV

check LFTs
- for chronic liver disease

check anti nuclear antibody to screen for rheumatoid factor

Question 23

chest x ray for pulmonary HTN shows ______

Answer 23

loss of AP window

Question 24

group 4 class i lowest prevalence but those with hisotry of a PE require rule out using __ scan

Answer 24

VQ

Question 25

if suspect group 4 thromboembolic disease, what scan will you perform ?

Answer 25

V/Q scan

Question 26

a positive vasodilater response is what? drop in mean pulmonary pressure greather than __ mmHg to less than __ mmHg

Answer 26

used to classify if group 1 is treated with ccb , if positive then YES 10 40

Question 27

is vasodilator challenge positive then u will use what med

Answer 27

ccb specially non- dihydropyridine, (diltiazem, verapamil) drop greater than 10

Question 28

if vasodilation is negative how will you treat? group 1 tx, (negative vasodilator challenge) functional class 1 (no symptoms) (functional class 2 and 3) class 4, all symptoms

Answer 28

class 1 (MONOTHERAPY) treat using nitric oxide pathway - phosphodiesterase inhibior, sildenafil, tadalafil (1st) class 2 , no symotoms at rest, but with exertion combination, phosphodiesterase inhibitor, (sildenafil, tadalafil) and endothelia (bosentan) clas 4, prostaglandin pump, epoprostenol oral ccb, non dihydro - diltiazem

Question 29

group 2 tx (ALL classes)

Answer 29

tx left side HF with diuretics if reduced ef use digoxin

Question 30

group 3 tx (ALL classes)

Answer 30

tx underlying lung condition BUT additional treprostinil is approved for interstitial lung disease

Question 31

group 4 tx (all classes)

Answer 31

life long anticoagulation

Question 32

last resort tx for pulmonary htn

Answer 32

lung transplant

Question 33

class 1 symoptoms

Answer 33

no dyspnea, chest pain, no limit on activity

Question 34

class 2 symptoms

Answer 34

slight limit on activity no symptom at rest, bt with activity, such as exercise, cause chest pain,

Question 35

class 3 symptoms

Answer 35

significant limit on activity symptoms even with activitys like brushing teeth, cause chest pain, and dyspnea

Question 36

class 4 symptoms

Answer 36

canot perform any physical activity without symptoms

Question 37

if echo using doppler is >50 then PH is ______

Answer 37

likely