Pulmonary Hypertension Flashcards Preview

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Flashcards in Pulmonary Hypertension Deck (40):
1

what mean PAP on swan defines pulm HTN?

25mm Hg at rest

2

old definition of PAH on echo

systolic PAP > 40 (TR velocity 3-3.5m/s)

3

which drugs can cause PAH?

Fen-phen, amphetamines, cocaine, St. John's Wort, SSRIs

4

name the most important connective tissue dz that causes PAH

scleroderma

5

name the most important virus associated with PAH

HIV

6

name a common congenital heart dz associ. w/ PAH

eisenmenger's

7

what parasite can cause PAH?

schistosomiasis

8

what chemotherapy is associated with PAH due to pulmonary veno-occlusive dz?

bleomycin

9

are pleural effusions seen in IPAH?

no

10

what finding on right heart cath is suspicious for pulmonary veno-occlusive dz?

inconsistent PCWP tracings

11

if pt on cath table is given a PA vasodilator and they go into pulmonary edema, what should you think of?

pulmonary veno-occlusive dz

12

what to suspect when pt has severe PAH, pulm edema, high PCWP:LVEDP?

pulm veno-occlusive dz

13

Rx for pulmo veno-occlusive dz

diuretics, anticoagulant, O2, lung Tx

14

is bosentan recommended for pulmonary veno-occlusive dz?

no

15

WHO group classification for PAH

1- PAH
2- due to left heart dz
3- lung dz
4- chronic PE
5- multifactorial

16

***which of the WHO groups of PAH is often misdiagnosed as group 1 or idiopathic? How do you distinguish them?

WHO 4 (chronic PE)
V/Q scan

17

for CHRONIC thromboembolic pulmonary htn (CTEPH), which test is more sensitive: CT-pulmonary angiography or V/Q scan?

V/Q scan

18

currently, what WHO group for PAH is sarcoidosis in?

5

19

with RVH/RAE, which lead has an increased p wave on ekg?

II

20

how to calculate RVSP (which equals PASP) on echo?

4v2 + RAP where v = velocity of TR jet and RAP os estimated form IVC size.

21

describe the 4 functional classes of PAH according to WHO

I- PAH without sxs
II- sxs with ordinary activity, but mild
III- sxs with minimal activity, severe
IV- sxs at rest

22

is RHC required to diagnose PAH?

yes

23

Rx for WHO 4 PAH

anticoagulation, thromboendarterectomy

24

Rx for WHO 5 PAH

underlying cause

25

which WHO group classes of PAH should be anti coagulated?

1 (idiopathic) and 4 (embolic)

26

which WHO group PAH gets a vasoreactivity test on RHC?

1

27

name 3 agents that can be used to perform a vasoreactivity test in PAH

adenosine, epoprostenol, inhaled NO

28

what is a positive test during a invasive hemodynamic vasoreactivity assessment of PAH?

decrease in mean PAP of 10 to less than 40 with increased or unchanged C.O.

29

what drugs do you use to treat PAH with vasoreactivity on RHC?

CCBs (dihydropyridine or diltiazem)

30

which drug improves functional capacity and survival for PAH WHO group I (idiopathic)?

flolan=epoprostenol=prostacyclin

31

Bosentan MOA

endothelia receptor antagonist

32

sildenafil/tadalafil MOA

PDE 5 inhibitors

33

algorithm for treating NYHA IV PAH

epoprostenol, if doesn't work combo therapy then atrial septostomy or lung transplant

34

preferred treatment for NYHA II PAH

bosentan or sildenafil

35

components of PE severity index (PESI) [6] where even one point means 10% 30 d mortality

age >80, cancer, COPD, HR>110, BP< 90

36

for hemodynamically stable patients with PE, which is preferred: lovenox or UFH?

lovenox

37

for massive PE, which is preferred: UFH or lovenox?

UFH

38

what is associated with warfarin-induced skin necrosis?

Protein C deficiency

39

absolute contraindication to thrombolytics in massive PE (4)

h/o hemorrhagic stroke
active intracranial neoplasm
intracranial sx/trauma within 2 mo's
active internal bleeding within 2 mo's

40

when do you start CPAP for sOSA?

when apnea-hypopnea-index > 15 (AHI = apneic episodes + hypopneic episodes)