Causes
How many groups is Pulmonary HT categorised into?
5 groups
What is the main presenting symptom in PHT?
Shortness of Breath
What specific blood test is done for PHT, what is a positive finding?
Raised NT-pro BNP to check for RV failure
Prognosis for idiopathic PHT, what is the mean survival if untreated?
poor prognosis - mean survival of 2-3 years if untreated
What does Echo help with in diagnosing PHT?
can estimate pulmonary artery pressure
Which side of the heart does pulmonary HT put strain on?
Right side
Which Recreational drug increases the risk of PHT?
Methamphetamine
What 3 imaging techniques can be used in the diagnosis for PHT?
Chest X ray
Echocardiography
Cardiac MRI
How is 2ndry PHT treated?
treating underlying cause: PE/COPD/SLE
what type of granulomas are seen in sarcoidosis?
Non-caseating
Mean Arterial pressure is greater than ------ at rest and ----- upon exertion?
25mmHg - at rest
30mmHg upon exertion
Name 3 Risk factors for PHT
Female
Obesity
Pregnancy
High Altitudes
What 2 techniques are used for a PHT diagnoses?
Transthoracic echocardiogram and Right heart catheterisation
What are some supportive treatments offered to PHT patients?
O2 and diuretics - used in complications like respiratory failure and peripheral oedema
what criteria is used to rule out PE and what scoring system is used after this?
PERC, if post test probability >2% then do 2 level PE Wells Score
What is PHT caused by PE called?
Chronic thromboembolic pulmonary hypertension (CTEPH)
Name 3 symptoms of PHT other than SOB
What scans can be used to check for chronic thromboembolic disease?
V/Q scan, Ventilation/perfusion scan & CTPA
conservative management for PHT - 4 points
1. Exercise and rehab
2. Influenza and pneumococcal vax
3. Contraceptive advice
4. Psychosocial support
how often is the influenza and pneumococcal vaccine given to COPD patients?
influenza - yearly
pneumococcal - one off
Name the groups PHT is categorised into?
1 - idiopathic
2 - L heart Failure
3 - Chronic Lung Disease
4 - Pulmonary causes - Lung disease/hypoxia
5 - Pulmonary Vasc. Disease - PE
6 - Misc. - sarcoidosis, glycogen storage disease, haematological disorders
Describe how JVP is raised in pulmonary htn?
RH failure > RV dilated + inefficient > backing up of blood in RA, increased venous pressure, JV reflect RA pressure - become distended, raised JVP
What are some key ECG findings in patients with PHT?
What 4 drug types can be given to PHT patients?
CCB
IV prostaglandins
Endothelin receptor antagonists
PDE-5 inhibitors
What are RF for Left sided HF - group 2 PHT?
coronary artery disease, hypertension, diabetes and high cholesterol