pulmonary hypertension
- related: Pulmonary Diseases, Cardiology and Hemodynamics
- tags: #literature #cardiology #pulmonology
- in mixed pre and post capillary pHTN, need to find whether it’s more heart issues vs pulmonary issues. HFpEF with borderline PCWP, for example, would have less group 2 PHTN. Use both echo and RHC to determine
- Can start tadalafil 20 for group 3 PH and go up to 40 mg if tolerated
- Tyvaso: used for ILD-PH. Not effective in CPFE subgroup
- ERA, Winrevair: not recommended in group 3 PH
Cause
- COPD patients have proportional pulmonary hypertension
- genetic mutations in pulmonary hypertension
- HIV associated PAH
Symptoms
- Fixed splitting S2 and loud P2 heart sound is suggestive of pulmonary hypertension
Lab Findings
- pulmonary hypertension initial labs include BNP, CBC, TSH, LFT, ANA
- presence of RVH and P pulmonale can suggest pulmonary hypertension
- echo findings in pulmonary hypertension includes, high RVSP, TR, and RV dysfunction
- large PA size on CT can suggest pulmonary hypertension but does not tell severity
Work up
- normal right heart catheterization pressures
- pulmonary hypertension pre and post capillary pressures
- hemodynamics in portopulmonary hypertension
- pulmonary hypertension by groups and workup
- right heart cath RHC can evaluate for shunt and cardiac output for pulmonary hypertension
- right heat cath RHC can be used for vasoreactivity testing during pulmonary hypertension workup
- PVOD pulmonary venoocclusive disease and PCH pulmonary hemangiomatosis
Other pathophysiology
- High PCWP in pulmonary hypertension can be beneficial
- ESRD patients with AV fistula can cause high cardiac output heart failure and pulmonary hypertension
- TAPSE shows how RV is adapting to pulmonary hypertension. Lower TAPSE is associated with higher mortality
- cor pulmonale is right heart failure from pulmonary hypertension
- sickle cell disease and pulmonary hypertension
- drugs associated with pulmonary hypertension
Treatment
- use endothelin antagonist to treat pulmonary hypertension in sickle cell patients
- pulmonary hypertension treatment overview
- pulmonary vasodilators can worsen group 2 PH
Lecture Notes
- pulmonary hypertension 1 31 2023 lecture
- Apex LV or RV dominant on POCUS?
- septal motion towards/away from LV?
- RVEDP = surrogate for RAP?
- PCWP: pick before inspiration?
- TP pressure / CO = PVR?
- group 2 pts: diurese, wait then RHC
- (DPG) PAP diastolic - PCWP > 7 = precapillary
- sotatercept: stellar trial
- redox trial for o2
Links to this note
-
drugs associated with pulmonary hypertension
- related: pulmonary hypertension
-
echo findings in pulmonary hypertension includes, high RVSP, TR, and RV dysfunction
- related: pulmonary hypertension
-
genetic mutations in pulmonary hypertension
- related: pulmonary hypertension
-
hemodynamics in portopulmonary hypertension
- related: pulmonary hypertension
-
large PA size on CT can suggest pulmonary hypertension but does not tell severity
- related: pulmonary hypertension
-
pulmonary hypertension by groups and workup
- related: pulmonary hypertension
-
pulmonary hypertension pre and post capillary pressures
- related: pulmonary hypertension
-
pulmonary hypertension treatment overview
- related: pulmonary hypertension
-
pulmonary vasodilators can worsen group 2 PH
- related: pulmonary hypertension
-
PVOD pulmonary venoocclusive disease and PCH pulmonary hemangiomatosis
- related: pulmonary hypertension
-
right heart cath RHC can evaluate for shunt and cardiac output for pulmonary hypertension
- related: pulmonary hypertension
-
right heat cath RHC can be used for vasoreactivity testing during pulmonary hypertension workup
- related: pulmonary hypertension
-
sickle cell disease and pulmonary hypertension
- related: pulmonary hypertension
-
use endothelin antagonist to treat pulmonary hypertension in sickle cell patients
- related: pulmonary hypertension