Pulmonary Heart Disease

Front 1

In contrast to systemic blood pressure, which is measured as systolic/diastolic, what component of pulmonary blood pressure is used to diagnose hypertension?

Back 1

Mean pulmonary arterial pressure

Front 2

What does the Mean pulmonary arterial pressure need to be for a diagnosis of pulmonary HTN?

Back 2

>25 at rest

Front 3

Enlargement of the right ventricle due to disorders of the respiratory apparatus, NOT secondary to Left heart failure

Back 3

Cor pulmonale

Front 4

What always precedes cor pulmonale?

Back 4

pulmonary HTN

Front 5

T/F Increases in CO (as in exericse) cause large increases in pulmonary arterial pressure

Back 5

F. It is a high flow, low resistance circuit.

Front 6

T/F There is high sympathetic control of pulmonary vessels

Back 6

F. There is little CNS control

Front 7

How does the RAA system affect pulmonary pressure?

Back 7

It doenst have a significant effect.

Front 8

What is the major physiological control system for pulmonary vascular tone?

Back 8

Alveolar oxygen tension. More oxygen --> vasodilation

Front 9

What happens to pulmonary artery pressure during exerise?

Back 9

Exercise increases flow --> pulmonary vessels distend and more are used --> pulmonary vascular resistance DECREASES.

Front 10

As hypoxemia increases, pulmonary artery pressure _____

Back 10

increases

Front 11

How does pH affect pulmonary artery pressure?

Back 11

Increases it

Front 12

In COPD, ____ is the most important cause of pulmonary HTN and most treatable

Back 12

hypoxia

Front 13

Reducing the cross-sectional area of pulmonary tree as in emphysema or fibrosis results in a (decrease, increase) pulmonary arterial pressure

Back 13

increase

Front 14

Most common cause of pulmonary hypertension

Back 14

Elevated pulmonary venous pressure due to left sided heart failure

Front 15

Most important clinical rseult of increase pulmonary venous pressure?

Back 15

Pulmonary edema - NOT pulmonary hypertension, which doesn't happen in everyone with left sided heart failuire

Front 16

How does increased pulmonary flow, from L-> R shunts, affect pulmonary pressure?

Back 16

Over years, vessel walls thicken and resistance rises. This increases pulmonary pressure.

Eventually right-sided pressures may become so high that they exceed left-sided pressures.

Front 17

What is it called when there's a L to R shunt where right-sided pressures eventually become so high that they exceed left-sided pressures?

Back 17

Eisenmenger's syndrome

Front 18

What happens in idiopathic pulmonary hypertension?

Back 18

For an unknown reason, arterial and arteriolar wall thickening occurs

Front 19

What is the primary pathological changes in idiopathic pulmonary hypertension?

Back 19

Smooth muscle hypertrophy

Intimal hyperplasia/endothelial reduplication.

Front 20

T/F Sustained pulmonary HTN, regardless of the cause, causes muscular hypertrophy and remodeling of pulmonary arteries that becomes irreversible and causes even higher pressures.

Back 20

T

Front 21

What are the pathological changes accompanying pulmonary HTN remodeling?

Back 21

PLEXIFORM LESIONS ARE THE KEY.

1) Medial hypertrophy of small arteries and arterioles

2) Intimal hyperplasia

3) Partial or complete obliteration of lumen of small arteries

4) Thickening of wall of larger elastic pulmonary arteries.

5) RV hypertrophy

Front 22

Symptoms of idiopathic pulmonary HTN

Back 22

dyspnea, chest pain, fatigue, syncope, hemoptysis

Front 23

PE signs of Pulmonary Htn

Back 23

LOUD S2

palpable cardiac thrust along lower L heart border

Front 24

Dx testing of pulmonary htn

Back 24

Usually it's overlooked until patient has an episode of right heart failure.

Prior to that time, depends on clinicians considering dx in suspected/likely patients.

CXR; ECG; ECHO; PFTs; ABGs

But GOLD STANDARD is right heart catheterization of PA pressure and cardiac output

Front 25

Idiopathic pulmonary arterial HTN is most common in what group?

Back 25

Women aged 20-50

Front 26

Most common cause of cor pulmonale

Back 26

COPD - the blue bloaters (chronic obstructive bronchitis)

This is due to the hypoxemia and drop in pH.

Front 27

T/F Essential pulmonary hypertension is the most common kind.

Back 27

F. Essential/idiopathic pul HTN is rare. Most cases are secondary to heart failure

Front 28

T/F Systemic arterial hypertension is never caused by systemic venous hypertension.

Back 28

T. This is because there are valves separating the systems.

Front 29

T/F pulmonary arterial hypertension is never caused by pulmonary venous hypertension.

Back 29

F. Elevation of pulmonary venous pressure necessitates elevation of pulm art. pressure due to the lack of valves in pulmonary circulation.

Front 30

Which signs suggest pulmonary hypertension?

Back 30

Loud P2, elevated jugular venous perssure; edema; palpable RV "heave", TR murmur

Front 31

What test is necessary to confirm a suspected dx of pulmonary hypertension?

Back 31

Right heart catheterization

Front 32

Maintaining a normal (or near normal) PA pressure in the face of increasing PA blood flow (cardiac output) requires that what?

Back 32

pulmonary vascular resistance falls

Front 33

Two mechanisms are responsible for the decrease in pulmonary vascular resistance with increased blood flow (and therefore, maintaining normal or near PA pressure) during work/exercise.

What are they?

Back 33

1) Greater distension

2) Recruitment of more

Front 34

These 2 processes are the major mechanisms responsible for PH in most lung diseases.

Back 34

1) Vasoconstriction
2) Loss of pulmonary vessels

Front 35

Prostacyclin promotes what procses in pulmonary vessels? How does this relate to pulmonary HTN?

Back 35

Causes vasodilation.
Decreased in pulmonary HTN.

Front 36

Endothelin promotes what procses in pulmonary vessels? How does this relate to pulmonary HTN?

Back 36

Endothelins are proteins that constrict blood vessels and raise blood pressure. They are normally kept in balance by other mechanisms, but when they are over-expressed, they contribute to high blood pressure (hypertension) and heart disease.

Front 37

T/F The early stages of pulmonary HTN are thought to be reversible because they're vasoconstrictve, not due to vascular remodeling.

Back 37

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