Pulmonary Hypertension

• What does pulmonary hypertension refer to?

  Increased resistance and pressure in the pulmonary arteries
• What effect does pulmonary hypertension have on the heart?

  It causes strain on the right side of the heart as it pumps blood through the lungs
• What is the consequence of back pressure in pulmonary hypertension?

  It leads to back pressure through the right side of the heart and into the systemic venous system
• How is pulmonary hypertension defined?

  As a mean pulmonary arterial pressure of more than 20 mmHg
• What are the five groups of causes of pulmonary hypertension?

  1. Group 1: Idiopathic pulmonary hypertension or connective tissue disease (e.g., systemic lupus erythematosus)
  2. Group 2: Left heart failure (e.g., myocardial infarction or systemic hypertension)
  3. Group 3: Chronic lung disease (e.g., COPD or pulmonary fibrosis)
  4. Group 4: Pulmonary vascular disease (e.g., pulmonary embolism)
  5. Group 5: Miscellaneous causes (e.g., sarcoidosis, glycogen storage disease, haematological disorders)
• What is the main presenting symptom of pulmonary hypertension?

  Shortness of breath
• What are some other signs and symptoms of pulmonary hypertension?

  Syncope, tachycardia, raised jugular venous pressure, hepatomegaly, and peripheral oedema
• What ECG changes indicate right-sided heart strain in pulmonary hypertension?

  • P pulmonale (peaked P waves)
  • Right ventricular hypertrophy (tall R waves in V1 and V2, deep S waves in V5 and V6)
  • Right axis deviation
  • Right bundle branch block
• What chest x-ray changes are associated with pulmonary hypertension?

  • Dilated pulmonary arteries
  • Right ventricular hypertrophy
• What does a raised NT-proBNP blood test result indicate?

  It indicates right ventricular failure
• How can an echocardiogram be used in the context of pulmonary hypertension?

  It can be used to estimate the pulmonary artery pressure
• What is the prognosis for untreated idiopathic pulmonary hypertension?

  • Poor prognosis
  • Mean survival of 2-3 years after diagnosis if untreated
• What are the treatment options for idiopathic pulmonary hypertension?

  • Calcium channel blockers
  • Intravenous prostaglandins (e.g., epoprostenol)
  • Endothelin receptor antagonists (e.g., macitentan)
  • Phosphodiesterase-5 inhibitors (e.g., sildenafil)
• How is secondary pulmonary hypertension managed?

  By treating the underlying cause, such as pulmonary embolism, COPD, or systemic lupus erythematosus
• What supportive treatments are used for complications of pulmonary hypertension?

  • Oxygen therapy
  • Diuretics for oedema
  • Management of arrhythmias
• When was the last update made to the pulmonary hypertension notes?

  June 2023
• What resources are available for testing knowledge on pulmonary hypertension?

  Members can access digital flashcards, Anki-like fact trainers, and various question types