Pulmonary Hypertension (Pul HTN)

Exam Cram

• Pulmonary Hypertension is defined as raised pulmonary pressures and is associated with significant morbidity and mortality

• Presentation: reduced exercise tolerance, sob, peripheral oedema; BG systemic inflammatory condition

• Diagnosis: ECHO, right heart catheterisation or implantable sensor

• Management: endothelin receptor antagonists

 Types

1. Primary pulmonary hypertension

2. Due to LHF

3. Due to lung disease, e.g. COPD

4. Due to chronic venous thrombotic disease

5. Everything else: e.g. inflammatory, metabolic, blood and kidney disorders

Secondary pulmonary HTN: types 2-5. 

 Primary Pulmonary Hypertension

Presentation

• Syncope

• Progressive reduced exercise tolerance

• Tricuspid or pulmonary regurgitation (secondary to pulmonary HTN increased pressure

• Hepatomegaly

Investigations

• ECHO: RVH

• CXR: may be normal

• HRCT ?primary lung disease ?ILD

• ECHO: raised pulmonary pressures

Management

1. Endothelin A receptor antagonists: bosentan

Pregnancy

Pregnancy with pulmonary hypertension comes with a significant risk to the mother and baby. 

Management

• Prostacyclin analogues

• Anticoagulation considered

• Educated on worsening cardiac function and risk to mother & foetus

Core Pulmonale

Core Pulmonale is simply right sided heart failure from pulmonary hypertension. 

Signs

• Right sided heart failure: peripheral oedema- pretibial, sacral; ascites/ pleural effusions/ raised JVP

• Pulmonary hypertension: raised JVP, loud P2, right parasternal heave (RVH)

References

1. Pulmonary hypertension - victor chang cardiac research institute (no date) The Victor Chang Cardiac Research Institute. Available at: https://www.victorchang.edu.au/heart-disease/pulmonary-hypertension (Accessed: 07 October 2024).

Written in 2022