Cardio E2: Pulm HTN

What is Pulmonary HTN?

What is Pulmonary HTN?

syndrome of dyspnea-related symptoms in the presence of a mean pulmonary arterial pressure of >25mmHg, regardless of mechanism

Pulmonary HTN is a syndrome of dyspnea-related symptoms in the present of mean pulmonary arterial pressure of _______

>25 mmHG

Is pulmonary HTN more common in men or women?

Women

Pulmonary HTN is a highly complex is what type of disorder?

Progressive

Which WHO Pulm HTN Classification group:
Pulmonary artery hypertension (PAH)

Group 1

Which WHO Pulm HTN Classification group:
PH due to left heart disease (venous)

Group 2

Which WHO Pulm HTN Classification group:
PH due to lung disease (hypoxic)

Group 3

Which WHO Pulm HTN Classification group:
PH due to chronic PE (clots)

Group 4

Which WHO Pulm HTN Classification group:
Due to unknown cause/miscellaneous

Group 5

Which WHO Pulm HTN Classification group:
Arteries in the lungs become narrow, thickened, or stiff, causing the right heart o work harder

Group 1

Which WHO Pulm HTN Classification group:
Can lead to RV failure & cor pulmonale

Group 1

Which WHO Pulm HTN Classification group:
Usually due to valvular disease or LV failure

Group 2

Which WHO Pulm HTN Classification group:

Usually due to chronic hypoxia- COPD, pulm fibrosis, OSA, long-term high altitude

Group 3

Which WHO Pulm HTN Classification group:

Can benefit from surgery to remove clots

Group 4

Which WHO Pulm HTN Classification groups can benefit from treatment of underlying conditions?

Groups 2 & 3

Which WHO Pulm HTN Classification group:
Can be due to sarcoidosis, sickle cell, chronic hemolytic anemia, splenectomy, mechanical compression (tumors), metabolic disorders

Group 5

Which WHO functional class:

Symptom-free when physically active or resting

Class I

Which WHO functional class:

No symptoms at rest, but normal activities can cause some discomfort & SOB

Class II

Which WHO functional class:

Resting may be symptom-free, but normal chores are greatly limited due to SOB or fatigue

Class III

Which WHO functional class:

Symptoms at rest and severe symptoms w/ activity

Class IV

In pulmonary HTN, vascular homeostatic imbalances can lead to a triad of symptoms:

Vascular constriction, Cellular proliferation, Prothrombotic state

Patients with pulmonary HTN can initially present with __________ edema, which eventually progresses to _______________

Ankle, then abdominal/ascites

Symptoms of pulmonary HTN are similar to the symptoms of _______________

R heart failure

What can be heard upon auscultation in a patient with pulmonary HTN?

Loud P2, S3 or S4 present, Holosystolic TR murmur, Possible crackles (if ILD)

What murmur can be associated with pulmonary HTN?

Holosystolic tricuspid regurgitation

What will Pulmonary HTN show on a CXR?

"Pruning" of peripheral pulmonary vessels

What may be seen on CXR in patients with pulmonary HTN?

Enlarged cardiac apex, "Pruning" of peripheral pulmonary vessels

Pulmonary HTN may show ________ axis deviation on EKG

Right

What may be seen in the RV leads on EKG in a patient with pulmonary HTN?

ST depression & T wave inversion

What can indirectly diagnose pulmonary HTN by estimating the PA pressure?

Echo

What can directly diagnose pulmonary HTN, and is the most accurate/useful?

Right heart catheterization

What is the normal pulmonary artery pressure at rest?

8-20 mmHg

Mean pulmonary artery pressure in pulmonary HTN is _____ at rest or _____ during exercise

>25 mmHg @ rest
>30 mmHg during exercise

What does treatment of pulmonary HTN focus on?

Improving symptoms- disease is progressive and incurable

Group ____ is the only form of pulmonary HTN where PAH-specific therapies are proven beneficial

1

Group ____ is the only group that can have definitive & curative results

4

CCB that can be used for treatment of PAH:

Amlodipine

Endothelin receptor antagonists that can be used for treatment of PAH:

Bosentan (can cause hepatic toxicity)