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34 Cards in this Set
- Front
- Back
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High blood pressure that only affects arteries in the lungs and right side of the heart?
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pulmonary HTN
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Pulmonary HTN that is not caused by other underlying dz?
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primary
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Causes of secondary pulm HTN?
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scleroderma, sarcoidosis, valvular heart dz, chronic thromboembolic dz, lung dz, liver dz, sleep apnea, lupus, rheumatoid arthritis, vasculitis, drugs
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Pulm HTN predominantly affects what gender at what age?
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women, age 40-50
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What are the group I classifications of pulm arterial HTN?
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idiopathic, familial, associated with other diseases, & associated w/ venous or capillary dz
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What are the group II classifications of pulm HTN associated w/ left heart dz?
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atrial or ventricular dz, valvular dz (mitral stenosis)
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The group III classifications of pulm HTN associated w/ lung dzs or hypoxemia?
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COPD, interstitual lung dz, sleep apnea, alveolar hypoventilation, chronic exposure to high altitude, developmental lung abnormalities
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The group IV classifications of pulm HTN 2/2 chronic thrombotic or embolic dz?
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PE, embolization of other matter, such as tumor cells or parsites
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The group V classifications, miscellaneous pulm HTN?
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compression of pulm vessels by adenopathy, sarcoidosis, tumors
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Normal pulm artery pressure (PAP)?
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25/8 mm Hg mean being 15mm Hg
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What systolic pressure or mean pulm artery pressure is considered pulm HTN?
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systolic >30 mm Hg or mean > 20 mm Hg
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What are contributing factors to pulm HTN?
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vasoconstriction, vascular smooth muscle and endothelial proliferation, thrombosis
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How does pulm HTN progress?
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proliferation & thickening of lung vessel walls, vascular stiffness w/ scarring and fibrosis, vessels become occluded, risk of thromboembolism, right heart hypertrophy and dilation to pump against increasing vascular resistance, right side heart failure
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What are the changes in pulmonary vasculature w/ pulm HTN?
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pulmonary arteries enlarge as the smaller vasculature narrows with scarring
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What are the changes to the lungs in pulm HTM?
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Scarring of lung vessel
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What are the cardiac changes w. pulm HTN?
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right ventricular hypertrophy and dilation, right atrial enlargement
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Sign and symptoms of pulm HTN?
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exertional dyspnea, easy fatigability, atypical chest discomfort, exertional lightheadedness, dizziness (b/c decrease cardiac output), hemoptysis (rare), hoarsness (rare, 2/2 compressed laryngeal nerve from enlarged pulm artery)
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Physical exam findings for pulm HTN?
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JVD, systolic murmur inc w/ inspiration (tricuspid valve regurgitation), pronounced 2nd heart sound at heart base 2/2 forceful pulmonic valve closure, diastolic pulm valve murmur along left sternal border, liver congestion, pitting edema
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Diagnostic studies used for pulm HTN?
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CxR, EKG, Echo, PFTs, V/Q scan or CT, HIV test, liver fct test, ANA, right sided cardiac catheterization to measure pulm artery pressure
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What is gold standard diagnostic study for pulm HTN?
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right-sided cardiac catherization to measure pulm artery pressure
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What findings are found in an EKG w/ pulm HTN?
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right axes deviation, right ventricular enlargement, right atrial enlargement
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What is the evidence of right ventricular enlargement on the EKG w/ pulm HTN?
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rS in lead I, Rs in lead V1, rS in lead V5 or V6
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What is the evidence of right atrial enlargement on the EKG w/ pulm HTN?
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p pulmonale
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What is measured in right-sided catherization?
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RA and RV pressure, pulm artery pressure, cardiac output, LV diastolic pressure, r-sided O2 sat to r/o atrial sepal defect
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What are preventive measures considered to TX pulm HTN?
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early diagnosis prevent significant damage to vasculature, genetic testing (20% risk w/ bmpr2 gene), avoid activities, smoking, high altitudes, vasoconstrictive drugs
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What categories of drugs are used to Tx pulm HTN?
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Ca channel blockers, prostacyclins, endothelin receptor antagonist, nitric oxide, digoxin, anticoags, diuretics, oxygen
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Which category of drugs used to Tx pulm HTN can cause hypotension?
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Ca channel blockers
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Which categories of drugs for pulm HTN have MOA of vascular dilation?
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prostacyclins, nitric oxide
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Which has MOA of blocking wall stiffening?
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endothelin receptor antagonists
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Which drug has liver side effects?
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bosentan (tracleer)
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Which strengthen cardiac contraction?
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digoxin
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What is not FDA approved for pulm HTN?
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viagra
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What are the different surgical interventions for pulm HTN?
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balloon angioplasty, pulm thrombo-endarterectomy, lung transplantation
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What are the complications with lung transplant?
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immune suppression w/ substantial risk of opportunistic infection
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