Pulmonary Hypertension

Question 1

what is pulmonary hypertension?

Answer 1

-sustained pulmonary arterial pressure greater than 25mmHg (normal approx 15mmHg)

Question 2

what is the normal arterial pressure in the pulmonary circuit?

Answer 2

-normal approx 15mmHg

Question 3

characteristics of the pulmonary circuit?

Answer 3

• has low pressure
• low resistance due to number of blood vessels
• physiologic: increase in cardiac output causes minimal increase in pulmonary pressure
• pathological increase, the pulmonary circuit is not very compliant, can become a major problem

Question 4

etiology of pulmonary hypertension?

Answer 4

• mostly secondary to cardiac & pulmonary problems
• increase pulmonary volume (eg. cardiac septal defects: aperture between RV&LV in fetal circulation if aperture does not completely close then blood pumped back to right ventricle not only to left ventricle)
• increase in pulmonary venous pressure (eg. Left ventricle dysfunction)
• Hypoxemia (hypoxia always causes compensatory vasodilation to systemic circulation. EXCEPT in lungs causes vasoconstriction if restrict than decrease CO2 spreading into blood)

Question 5

what is pulmonary hypertension mostly due to?

Answer 5

-mostly secondary to cardiac & pulmonary problems

Question 6

what is an example of increase in pulmonary volume that would lead to pulmonary hypertension?

Answer 6

cardiac septal defects: aperture between RV&LV in fetal circulation if aperture does not completely close then blood pumped back to right ventricle not only to left ventricle

Question 7

what is an example of an increase in pulmonary venous pressure that would lead to pulmonary hypertension?

Answer 7

left ventricle dysfunction

Question 8

manifestations of pulmonary hypertension?

Answer 8

• dyspnea (unable to deliver 02)
• syncope(deprive brain of 02 this will happen, fainting)
• chest pain on exertion
• fatigue (r/t hypoxia)
• mnfts of Right sided heart failure (pulmonary htn, right sided pumping against increased resistance than begins to fail

Question 9

manifestations of pulmonary hypertension?

Answer 9

• dyspnea (unable to deliver 02)
• syncope(deprive brain of 02 this will happen, fainting)
• chest pain on exertion
• fatigue (r/t hypoxia)
• mnfts of Right sided heart failure (pulmonary htn, right sided pumping against increased resistance than begins to fail)
• on chest x-ray: -RV hypertrophy (pumping against increased resistance) -distended pulm arteries(move blood in there become more distended)

Question 10

what are some of the manifestations that show up on a chest x-ray with pulmonary hypertension?

Answer 10

• RV hypertrophy(pumping against increased resistance)

- distended pulm arteries (move blood in there become more distended)

Question 11

Treatment of pulmonary hypertension

Answer 11

• managing is straight forward but addressing underlying problem is difficult
• cause (underlying)
• vasodilators (ex. calcium channel blockers)
• prostacyclin (not routinely used)

Question 12

what is the difficulties with the treatment of pulmonary hypertension?

Answer 12

-managing is straight forward but addressing underlying problem is difficult

Question 13

postacyclin drug sometimes used for treatment of pulmonary hypertension?

Answer 13

• several properties, not all properties applicable to case
• primary: vasodilation in pulmonary circuit, dilates RV & relives pressure that is increased acts to prevent regurgitation at Right atrioventricular valve.
• this drug acts on muscles (causing vasodilation)
• this drug has a problematic property: anti-thrombolytic