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48 Cards in this Set
- Front
- Back
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Define pulmonary hypertension
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Pulmonary hypertension is excessive pressure exerted on the walls of the pulmonary arteries by the blood. Vasoconstriction of the arteries can be due to increased blood flow caused by a shunt
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What is the main etiology of Pul HTN
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1) Primary - unknown cause
2) Secondary -COPD -Abnormal chest walls - left side heart failure - Shunt - Thrombosus (deep vein) |
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What diseases predominantely cause COPD
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Emphysema and chronic bronchitis
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What is the clinical signs and symptoms for Pul HTN
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Secondary - Dyspnea cyanosis
Primary - no symptoms unless untreated and then right heart failure |
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What are the symptoms associated with right heart failure?
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Dissented jugular vein
Bilateral leg edema ascites hepatomegally |
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When there is a left to right shut is cyanosis present?
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No, cyanosis is only present in shunts from right to left
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What are the cardiac ausculatation findings in patients with pul HTN
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- P2 increase (PV closing) heard @ 2nd intercostal space left upper sternal border
- Pulmonary ejection soun (systolic murmur) - Heart murmur @ TV during systole - heard @ lower sternal border - PR or PI = pulmonary insufficiency |
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What are the important M mode findings with pul HTN
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-Paradoxical septal motion
- No A wave in PSAX-Aov - Mid systolic notching of pulmonic valve (Flying W) |
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What are the best views to check for PFO?
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Subcostal 4
Psax Aov AP4 RVIT |
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What are the best views to check for TR?
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RVIT
Psax Aov AP4 Subcostal 4 |
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What are the important 2d findings with pul HTN?
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RV concentric hypertrophy
RVE RAE RV forming the apex Pancake septum D shaped LV Pul Artery dilatation Reverse shunt (eisenmenger) Dilated IVC Dilated hepatic vein Pressure overload PFO |
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What are the important doppler findings with Pul HTN
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TR
PR PV flow acceleration Flying W MPAP PAEDP PASP RVOT |
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What is cor pulmonale
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Right heart failure due to COPD Pul HTN and RV hypertrophy
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What is the normal range of PASP and how do you measure it
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Normall = <30 mmHg
Mild = 30-40 Moderate = 40-70 Severe = >70 Eisenmenger = >120 PASP = 4(TR)* +RAP |
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What are the severity scales of Pul HTN
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Mild = 30-40
Moderate = 40-70 Severe = >70 Eisenmengers = >120 |
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What is the normal range for MPAP and how do you measure it
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Normal 9-18
MPAP = 4(peak PR)* |
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What is the normal range for PAEDP and how do you measure it?
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Normal = 4 to 12
PAEDP = 4(end PR) + RAP |
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Define systemic hypertension
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Excessive pressure exerted on the walls of the systemic arteries by blood.
>140 Systole >80 Diastole |
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What is the main etiology of Sys HTN
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1.Primary - unknown cause
Chemicals in body cause vasoconstriction Age = artherosclerosis (hardening of vessels) 2. Secondary Renal disease Aortic coarctaton Endocrine disease Side effect of medications |
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What is the clinical signs and symptoms for Sys HTN
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Asymptomatic
Headache dizzyness palpitation Tinnitus Dyspnea blurred vision |
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What are risk factors for systemic HTN
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Obesity
smoking alcohol family history history of heart failure race age |
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What are the complications of systemic HTN
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Stroke
CAD Renal failure aneurysn retinopathy dissetion |
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What are the important ECG findings in patients with systemic HTN
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LVH - Increased R wave in V5 and V6
Deep S wave in V1 and V2 Ischemia - ST segment depression Enlarged atrium - notched P wave Atrial fibrillation Ventricular arrythmia |
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What are the important M Mode findings in patients with systemic HTN
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Concentric LVH
LA Enlargement Aortic Root Dilated Thickening of AOV (sclerosis with no stenosis) |
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What is normal LA measurements
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Normal 2.7 to 4.0
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What is normal aortic root measurements
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2 to 3.7
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What are the important 2D findings with Systemic HTN
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Concentric LVH
Speckled groound glass appearance of myocardium MAC AoV sclerosis (no Stenosis) LA Enlargement Aortic root dilatation Pressure overload on LV Increased afterload LV dilatation in LATE STAGE |
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What are the important doppler findings with Sys HTN
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Grade I diastolic dysfunction
E to A Reversal Increased IVRT Increased deceleration Time E' to A' reversal AR - seen with aortic root dilatation MR - MAC and Diastolic dysfunction |
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What are the medical treatments for Sys HTN
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**reduce risk factors/healthier lifestyle**
Diuretics Vasodilators Beta blockers Calcium blockers ACE Inhibitors |
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Right ventricular systolic pressure overload can be caused by...
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Pulmonary HTN
Afterload increase |
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What heart disease causes the left ventricular walls to appear thick on an echo?
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Systemic HTN
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What are common Echo findings associated with Systemic hypertension?
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Concentric LVH
Dilated LV Speckled ground glass myocardium MAC Aortic root dilatation AoV sclerosis Diastolic dysfunction (grade I) MR AR LA dilatation |
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In the abscence of an A wave and mid systolic notching of the pulmonic valve on M mode is consistent with?
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Known as flying W
Consistent with Pulmonary HTN |
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The RVOT is also known as
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Infundibulum
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The moderator band is located within what structure
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Right Ventricle
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The RVSP can be measured by
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RVSP = 4(TR)* + RAP
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What is the main cause of hepatomegally and peripheral edema in patients with pulmonary HTN
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Right heart failure
Increased pressure --> IVC/SVC congestion ---> Right heart failure |
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In PSAX PM if the left ventricle has a D shape appearance what is it an indication of?
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RT ventricle pressure overload
Pulmonary HTN |
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Describe Cor pulmonale
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COPD
RV Hypertrophy Pul HTN all 3 causing RT HEART FAILURE |
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What is the effect of long standing systemic HTN on the Heart and LV function?
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Increased grade of diastolic dysfunction
Decreased systolic function LV Dilatation |
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How do we measure systolic function?
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Cardiac Output
Stroke Volume Ejection fraction Cardiac Index |
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What is the effect of Pul HTN on the heart
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Concentric RVH
Dilation of RA Diastolic dysfunction Volume overload PR/TR Right Heart failure IVC Dilation Hepatic vein dilation Pressure overload Pul Artery dilateion D shaped LV Pancake Septum |
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What is blood pressure
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The pressure of blood against the heart walls
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What is diastolic blood pressure
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The minimum pressure exerted on heart walls
Normal = 80 |
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What is systolic blood pressure?
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The maximum pressure exerted on heart walls
Normal = 120 |
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What are the Echo doppler findings in Pul HTN
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TR
PR PV flow - Flying W (mid systolic notching of PV) |
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Systemic HTN is considered _____ heart ____ overload/afterload
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Systemic HTN is considered LEFT heart PRESSURE overload/afterload
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How do you determine RAP
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IVC measurement & Sniff
IVC < 1.7 and >50% = 5 IVC < 1.7 and < 50% = 10 IVC > 1.7 and > 50% = 10 IVC > 1.7 and < 50% = 15 IVC > 1.7 and no = 20 |
