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CC May 2018 Pulmonary HTN

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echoecho's version from 2018-05-02 03:51

Section

Question Answer
Is pulmonary vasculature typically a low or high pressure circuit?Low
List the two things that pulmonary vasculature does?1) delivers deoxygenated blood to the lungs 2) returns oxygenated blood to the left atrium
What is the normal pulmonary pressure?12-16 mmHg (when measured at rest during right catherization)
Pulmonary HTN is defined as a pressure of > ____ mmHg?25
A variety of conditions can result in elevated pulmonary pressures, list 5 categories with examples?1) Pulmonary arterial HTN (idiopathic, heritable, HIV-associated, systemic sclerosis, connective tissue disease, congenital heart disease, schistosomiasis, drug-induced). 2) Left heart disease (systolic dysfunction, diastolic dysfunction and valvular disease) 3) Lung disease and/or hypoxia (COPD, sleep disordered breathing and interstitial lung disease) 4) chronic thromboembolic disease 5) Multifactorial causes (metabolic conditions, systemic conditions and sickle cell disease)
Pulmonary HTN is often seen in primary care practices among patients with what?1) COPD 2) heart failure OR 3) thromboembolic disease
*** The most common condition that produces pulmonary HTN is what?left heart failure (either systolic or diastolic)
Pulmonary HTN may be progressive and severely debilitating and is associated with increased ______ and _____?morbidity and mortality
The most common cause of death from pulmonary HTN is what?right sided heart failure
What are the common presenting symptoms of right-sided heart failure?1) worsening dyspnea on exertion 2) fatigue that may be out of proportion to the underlying disease
What are the physical findings of right-sided heart failure?1) hypoxia on pulse oximetry 2) elevated jugular venous pressure 3) as cites 4) lower extremity edema 5) right ventricular heave or 6) tricuspid murmur
*** There is no high quality evidence to support routine screening of ASYMPTOMATIC patients at increased risk for pulmonary HTN, true or false?true
Experts recommend screening which patients?1) systemic sclerosis 2) related connective tissue disorders 3) sickle cell disease 4) familial pulmonary HTN due to the BMPR2 mutation, usually with transthoracic echo
What is the initial work-up in patients with symptoms suggestive of pulmonary HTN?1) CXR. 2) echo 3) CBC 4) CMP 5) B-type natriuretic peptide (BNP)
What are the EKG findings consistent with pulmonary HTN?1) right ventricular enlargement 2) RBBB 3) right ventricular strain pattern and/or 4) S1Q3T3 pattern
*** If no alternative dx is clearly supported, what should be performed?echo
What are the echo features suggesting pulmonary HTN?1) flattening of the intraventricular septum 2) increased right ventricular mass 3) dilation of the pulmonary artery 4) dilation of the right atrium
Pulmonary artery pressure may be estimated from continuous wave Doppler measurements; pressures > ___ to ____ mmHg are suggestive of pulmonary HTN?35; 40
It is estimated that the sensitivity of echo is___% and the specificity is ____% for diagnosing pulmonary HTN?83; 72
If elevated pulmonary pressures are noted, patient should be assessed for the underlying causes that may be amenable to targeted therapies, true or false?true
*** Referral to subspecialists with experience in treating pulmonary HTN is recommended. An optimal team approach includes what people?1) primary care 2) cardiac specialists 3) pulmonary specialists 4) rehabilitation 5) patient/family education and support 6) mental health/counseling 7) dietitians
*** Patients with pulmonary HTN should receive which vaccinations?1) influenza 2) pneumococcal
*** Patients with pulmonary HTN should undergo what supervised exercise training?pulmonary rehabilitation
*** Patients with pulmonary HTN should avoid what two things?1) high altitudes 2) anesthesia
*** Patients with pulmonary HTN should have diuretic therapy if what is present?if fluid retention due to right heart failure is present
*** Patients with pulmonary HTN should receive continuous oxygen therapy if what is present?if pulse ox is consistently < 91%
*** Patients with pulmonary HTN should receive what if there is anemia?correction of underlying causes of anemia
What type of oxygen therapy should be considered for prophylaxis during airline travel?continuous oxygen therapy
Treatment of pulmonary HTN is based upon the underlying _______?etiology
What medications are the first line therapy for pulmonary HTN?Calcium channel blockers such as 1) Nifedipine (Procardia) 2) Diltiazem (Cardiazem) 3) Amlodipine (Norvasc)
The above medications should not be used as empirical treatment without evaluation for acute _________?vasoreactivity
List additional medication therapy?1) Endothelin receptor antagonist 2) phosphodiesterase type 5 inhibitors 3) Soluble guanylate cyclase stimulators 4) Prostacyclin agents
Patients w/ left heart disease may benefit from what?1) BP control 2) correction of significant valvular disease
Patients with OSA may benefit from treatment with?CPAP
A minority of patients with chronic thromboembolic disease improved with pulmonary __________ (best performed at a center of excellence)?endarterectomy
All patients with chronic thromboembolic disease require lifelong ________?anticoagulation
What transplantations are options for select patients?1) lung transplant 2) heart-lung transplants
*** SUMMARY = Define pulmonary HTN?pulmonary artery pressure > 25 mmHg (a complex disorder that can be caused by a variety of underlying conditions)
*** SUMMARY = Symptoms can be non-specific. List the 3 diseases that primary care most often sees related to pulmonary HTN?1) left heart failure 2) COPD 3) thromboembolic disease
*** SUMMARY = A stepwise approach to dx includes what tests?1) echo 2) CXR 3) CBC 4) BNP (B-type natriuretic peptide) 5) echo
*** SUMMARY = Tratment of the ______ comorbidites conditions is required for optimal care. A multidisciplinary tears approach is recommended?underlying
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