Pulmonary and Systemic Hypertension- CardioRush

Pressures
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Pressures
What is the main difference between the right and left heart?
25mmHg
What is the pressure cut off for the pulmonary artery above which is considered pulmonary hypertension (PHT)?
0-4
What are the normal pressures in the RA?
25/4
What are the normal pressures in the RV?
25/10
What are the normal pressures in the PA?
8-10
What are the normal pressures in the LA?
120/10
What are the normal pressures in the LV?
Dyspnea, fatigue, syncope esp during exercise from impaired pulmonary and systemic blood flow
What are the clinical signs associated with pulmonary hypertension?
High pressure/afterload for the RV causes failure, death
What is the result of pulmonary hypertension on the right heart?
False (R and L heart structurally linked, changes in right affect the left)
True or false: pulmonary hypertension mainly affects the right heart, there is little effect on the left heart
Increased volumeWhich is the RV better at adapting to tolerate: increased pressure or increased volume?Eccentric hypertrophy causes dilation and tricuspid regurg, RV wall thickens with concentric hypertrophy, RV pushes into LV, causes LV dysfunction, eventual RCHFWhat is the response of the RV to pressure overload from pulmonary hypertension?5How many groups are there in classifying pulmonary hypertension?PA remodeling, LCHF, lung disease, PTEGenerally, what are the 4 causes of pulmonary hypertension as seen by groups 1-4 in vet patients?Precapillary, pulmonary arterial hypertensionWhat is group 1 pulmonary hypertension?Post capillary, secondary to L heart diseaseWhat is group 2 pulmonary hypertension?Secondary to lung diseases or hypoxiaWhat is group 3 pulmonary hypertension?Secondary to chronic PTEWhat is group 4 pulmonary hypertension?Poorly understood causesWhat is group 5 pulmonary hypertension?Idiopathic, heritable, drug/toxin induced, congenital disease with L to R shunt, portal hypertension, HW infection, connective tissue diseaseWhat are some causes of group 1 pulmonary hypertension?Any heart disease that leads to LCHFWhat are some causes of group 2 pulmonary hypertension?Interstitial lung disease, COPD, chronic exposure to high altitude, sleep apneaWhat are some causes of group 3 pulmonary hypertension?HW infection, PTE, neoplasiaWhat are some causes of group 4 pulmonary hypertension?Pulmonary artery with deoxygenated bloodWhat vessels are affected in group 1 pulmonary hypertension?Pulmonary veins with oxygenated bloodWhat vessels are affected in group 2 pulmonary hypertension?Pulmonary arterial system alone affected, disorders that cause arterial remodelingWhat generally causes group 1 pulmonary hypertension?TrueTrue or false: in all groups of pulmonary hypertension, there is an imbalance between vasodilation and vasoconstriction, with vasoconstriction winning out in many causesPDA, VSD, ASDWhat are examples of congenital heart disease that result in group 1 pulmonary hypertension?L to RWhat direction is shunting initially in congenital heart disease that leads to pulmonary hypertension?Volume overload through PA, arterial remodeling, proliferative changed, increase in pulmonary vascular resistance, RV increases pressure, pressure eventually larger than L heart, reverse shuntingWhat is the pathophysiology of congenital heart disease with L to R shunting causing pulmonary hypertension?Eisenmenger syndromeWhat is the term for left to right shunting reversing and flowing right to left due to increase pulmonary artery pressure?False (Causes murmur to disappear because pressure gradient is lost, no high velocity flow like in L to R shunting, no noise)True or false: Eisenmengers syndrome (reverse shunting) causes the murmur associated with the original defect to become louderFalse (Becomes contraindicated because the pressure is so high that the shunt is now a pop off valve and closing it causes pressure build up)True or false: It is safe to surgically close a shunt once it has changed from R to LThomboxane, endothelin, serotoninWhat signaling molecules cause vasoconstriction?Prostacyclin, NOWhat signaling molecules cause vasodilation?Endothelial dysfunctionWhat is the term for imbalance between the vasodilators and vasoconstrictors causing hypertension?False (much of the time, endothelial dysfunction is permanent, even after the underlying cause is fixed)True or false: endothelial dysfunction is often a transient phenomenon and will resolve when the inciting factor is fixedLCHF causes pressure increase in LA, transmitted backwards to pulmonary veins, capillaries, and arteries, leads to pulmonary arterial remodeling, endothelial dysfunctionWhat is the pathophysiology of group 2 pulmonary hypertension?Interstitial fibrosis, sleep apnea, chronic hypoxiaWhat are some examples of lung diseases in dogs that can lead to group 3 pulmonary hypertension?Vasoconstriction to shunt blood to more O2 rich areas for gas exchange, opposite of systemic response (vasodilation)What is the reaction of pulmonary capillaries to hypoxia in the lung tissue and how does this compare to systemic capillaries?Hypoxia causes vasoconstriction, increase vascular resistance in lung, subsequent endothelial dysfunction, permanent remodeling of vesselsHow does chronic hypoxia lead to pulmonary hypertension with group 3 PHT?Stress from hyperinflation, inflammationHow can the vascular bed be directly damaged in lung disease?Neoplasia, hypercoagulable states, trauma, surgery, HWWhat are causes of PTE in dogs and cats?TrueTrue or false: group 5 is a catch all group for causes of pulmonary hypertension that don't fit into the other categories and is uncommon in vet medTreat underlying cause of PHT, try to dilate pulmonary vessels to decrease pressureWhat are the treatment options for pulmonary hypertension?Endothelin Receptor Antagonists, NO, inhibit cGMP breakdownWhat are the 3 categories of drugs used to treat pulmonary hypertension?Targets endothelial dysfunction present in all groups, blocks endothelin binding, vascular smooth muscle dilatesWhat is the MOA of endothelin receptor antagonists?VasoconstrictionWhat is the result of endothelin-1 produced by endothelial cells binding to endothelin receptors in the vascular smooth muscle?Bosentan, ambrisentan, macitentanWhat are 3 examples of drugs that are endothelin receptor antagonists?Very expensive, significant side effects in humans, poorly understood in animalsWhat are the issues with endothelin receptor antagonists that causes them not to be used often to control pulmonary hypertension?Shearing force on endothelial cells induces NO production from L arginine, diffuses into smooth muscle, increase cGMP, cause vasodilationWhat is the normal function of nitric oxide in the vessels?Nitroprusside IV, nitroglycerine pasteWhat are the formulations of NO that can be given in pulmonary hypertension?Can be applied topically in unstable patientsWhat is the benefit of using nitroglycerine paste?Phosphodiesterase 5 (PDE 5)What enzyme breaks down cGMP in smooth muscle cells?Sildenafil, Tadalafil, VardenafilWhat are 3 examples of phosphodiesterase 5 inhibitors for use in pulmonary hypertension?TrueTrue or false: the use of PDE5 inhibitors has hugely improved the survival time of patient with pulmonary hypertension from 3 days to 3 monthsRight heart catheterization for direct measurement of wedge pressureWhat is the gold standard for documenting the presence of pulmonary hypertension?Pressure in PA almost same as RV as long as no pulmonic stenosis, use doppler in tricuspid regurgHow can we use echo as an indirect measurement of pulmonary pressures?Pressure gradient = 4V^2What is the modified Bernoulli Equation?>160mmHgWhat is the pressure cutoff above which we can call it systemic hypertension?Pressure/COWhat is the equation for resistance?CO x TPRWhat is the equation for blood pressure?Change in pressure, radius^4, blood viscosity, length of vesselWhat factors affect the calculation of flow of blood?TrueTrue or false: due to the relationship of radius and flow, a small change in diameter of vessel causes an exponentially greater change in flowSNSWhat neural signal causes vasoconstriction systemically?PSNSWhat neural signal causes vasodilation systemically?Catecholamines, endothelin, ADH/vasopressin, RAASWhat humoral signals cause vasoconstriction?NO, histamine, prostacyclinWhat humoral signals cause vasodilation?Drop in BP, renal perfusion, or Na concentrationsWhat activates RAAS?Vasoconstriction, Na and water retentionWhat is the overall effect of RAAS?ACE inhibitor, Ca channel blockers, hydralazineWhat are some of the drugs we can use to treat systemic hypertension?Enalapril, BenazeprilWhat are examples of ACE inhibitors that could be used to stop RAAS to control systemic hypertension?Amlodipine (targets vasculature, Diltiazem is heart specific)What is an example of Ca channel blockers to control systemic hypertension?Affects Ca metabolism in smooth muscleWhat is the effect of hydralazine to control systemic hypertension?False (PDE5 is only in pulmonary vessels, not systemic vessels, so it is only used to control pulmonary hypertension)True or false: PDE5 inhibitors like sildenafil can be used to control systemic hypertension