Vascular Disease

Question 1

What are the normal resting pressures in the chambers of the heart, pulmonary artery and aorta?

Answer 1

The normal resting cardiac pressures are the following:

Right Atrium: <5 mm Hg
Right Ventricle 25/<5 mm Hg
Pulmonary Artery: 25/8 mm Hg
PCWP: 10 (4-12) mm Hg
Left Atrium: 120/<12
Aorta: 120/80 mm Hg

Question 2

What is the definition of pulmonary hypertension, pre-capillary pulmonary hypertension, isolated post-capillary pulmonary hypertension, and combine pre- and post-capillary hypertension?

Answer 2

Pulmonary hypertension (PH) is defined as having an elevated mean pulmonary artery pressure (<20 mm Hg) at rest.

Pre-capillary hypertension is defined by the following characteristics: mPAP > 20 mm Hg , PAWP < 15 mm Hg , PVR > 3 WU.

Isolated post-capillary PH (IpcPH) is defined by the following characteristics: mPAP >20 mm Hg, PAWP > 15 mm Hg, PVR <3 WU.

Combined pre- and post-capillary PH (CPcPH) is defined by the following characteristics: mPAP > 20 mm Hg, PAWP > 15 mm Hg, PVR > 3 WU.

Question 3

What is the WHO classification of pulmonary hypertension (PH)?

Answer 3

The WHO’s classification of pulmonary hypertension (PH) is the following:

Group I - Pulmonary Arterial Hypertension

Group II - Pulmonary Hypertension due to Left Heart Disease

Group III - Pulmonary Hypertension associated with Chronic Lung Disease or Hypoxia

Group IV - Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Artery Obstructions

Group V - Pulmonary Hypertension with Multi-Factorial Mechanisms

Question 4

What is the WHO Functional Assessment of Pulmonary Hypertension (modified after NTYA functional classification?)

Answer 4

The WHO Functional Assessment for Pulmonary Hypertension is the following:

Class I - Patients with pulmonary hypertension (PH) but without resulting limitation of physical activity. Ordinary physical activity does not cause undue displeasure or fatigue, chest pain or near syncope.

Class II - Patients with PH resulting in a slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnea or fatigue, cheat pain or near syncope.

Class III - Patient with PH resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity caused undue dyspnea or fatigue, chest pain or near syncope..

Class IV - Patients with PH with inability to carry out any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may even be present at rest. Discomfort is increased by an physical activity.