Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
13 Cards in this Set
- Front
- Back
|
pulmonary pressures
|
Normal: systolic 15-25, diastolic 5-10, mean ~15
Pul HTN: PA mean >25; systolic >30 |
|
|
Causes for PH
|
1. inflow (too much)
2. not enough outflow 3. decreased pulmonary vasculay capacity related to flow -destruction or blockage -endothelial dysfunction 4. alveolar P related to flow |
|
|
conseqeunces of PH
|
-dilatation of RV, dec RCA flow
-rt heart failure -inadequate oxygenation |
|
|
classification of pulmonary HTN
|
1. Idiopathic PH: no other cardio-pulmonary disease as casue, normal PAWP
2. Secondary PH (SPH): seen in many cardiac and pul disorders -COPD (most common cause of PH in adults) - CHF |
|
|
Pulmonary arterial HTN
|
->6% of all cases are familial in nature and come from a specific genetic abnormality
|
|
|
SPH mechanisms
|
1. chronic hypoxia with secondary vasoconstriction
2. pul venous HTN (lt heart failure) 3. pulmonary artery obstruction 4. left-to-right shunts |
|
|
Eisenmenger's syndrome
|
-fixed, irreversible PH in pts with bidirectional or right-to-left shinting of blood
|
|
|
Idiopathic PH presumed mechanisms
|
1. endothelial dysfunction
2. K+ channel defect --> vasoconstriction 3. Thrombosis in situ (wals of vessels) |
|
|
History
|
Early: fatigue, vague chest discomfort
Advanced: dyspnea on exertion, cyanosis, angina (RV), edema, syncope, palpitations, hemoptysis |
|
|
Risk factors and associated conditions for PH
|
1. Drugs and toxins: aminorex, fenfluramine, dexfenfluramine, toxic rapeseed oil
2. gender 3. HIV infx 4. Liver disease |
|
|
PE
|
-ssx assoc with underlying disease (COPD)
-signs of RVH.failure: inc P2, right vent S3,S4 -JVD, edema, pleural effusions -hepatosplenomegaly, ascites, pulsatile liver |
|
|
Initial tests
|
1.EKG: RAD, R>S V1, RAE, RBBB, ST/T change
2. Chest Xray: large rt vent, dilated hilar arteries, dec peripheral pulmonary vessels 3. PFTs, ABGs, serologic testing 4. f/u: Enchocardiography |
|
|
Treatment
|
1. avoid precipitating circumstances, substances, high altitude, pregnancy
2. Treat underlying conditions 3. Phelbotomy if polycythenic 4. Low-flow O2 if chronic parenchyml dz., desaturation w/activity, or RHF w/low CO 5. anticoagulants |
