What are the 5 groups of pulmonary hypertension (from WHO)
Group 1: pulmonary arterial hypertension (idiopathic, heritable, connective tissue disease related etc) Group 2: pulmonary hypertension owing to left heart disease Group 3: pulmonary hypertension owing to lung disease and/or hypoxia Group 4: chronic thromboembolic pulmonary hypertension (CTEPH) Group 5: pulmonary hypertension with unclear multifactorial mechanisms
How high does the pulmonary arterial pressure have to be to meet criteria for pulmonary arterial hypertension?
What are the causes of group 1 pulmonary hypertension?
What do you see on examination of a pt with pulmonary hypertension?
Signs of R heart failure Pulmonic component of 2nd heart sound has increased intensity and is widely split Graham Steell murmur: pulmonic regurgitation murmur Signs of R ventricular strain: R sided S3 gallop, tricuspid regurgitation murmur
How high does the estimate of pulmonary artery systolic pressure have to be on echocardiography to qualify for pulmonary hypertension?
How high would the capillary wedge pressure be in a pt with pulmonary hypertension due to L heart disease?
What's the gold standard investigation for pulmonary hypertension?
R heart catheterization
Which therapies should be considered in all pts with pulmonary hypertension, regardless of the group?
Diuretics Oxygen Anticoagulation Digoxin Exercise training
What are the advanced therapies that might be useful (particularly in group 1)?