Learning Cardiology

Points to remember about pulmonary artery hypertension 1. Pulmonary arterial hypertension (PAH) - mean pulmonary arterial pressure > 20 mm Hg and a pulmonary vascular resistance > 3 WU, with a normal capillary wedge pressure of < 15 mm Hg 2. Increased pulmonary resistance results in right ventricular overload and right heart failure 3. Mortality of at least 50% in 7 years 4. Pregnancy in women with PAH is associated with high maternal and neonatal mortality rates 5. The only therapy with a direct survival benefit is intravenous epoprostenol, a prostanoid vasodilator 6. A positive acute vasodilator response is defined by a decrease in mean PAP ≥ 10 mm Hg to reach a mean PAP < 40 mm Hg with an improved or stable cardiac output. In these patients, high-dose calcium channel blockers significantly lower PAP and vascular resistance. 7. Most common cause of death- right sided heart failure 8. Agents within the same class (including PDE-5 inhibitors and guanylate cyclase stimulat

Q. Most common cause of pulmonary hypertension? A. Idiopathic pulmonary artery hypertension B. Left heart disease C. COPD D. CTEPH Answer: B. Left heart disease

Pulmonary hypertension Pulmonary arterial hypertension is restricted to those with a hemodynamic profile in which high pulmonary pressure is a  result of elevated precapillary pulmonary resistance and normal pulmonary venous pressure which is measured as a pulmonary wedge pressure of 15 mmHg or less. Definition: Resting mean pulmonary artery pressure of 25 mm Hg or more at catheterization of right heart. This is the hemodynamic feature which is shared by all types of pulmonary hypertension in Dana point classification system. CLASSIFICATION OF PULMONARY HYPERTENSION Pulmonary hypertension resulting from heart disease (group 2) implies an increase in pulmonary arterial pressure due to backward transmission of pressure elevation. Precapillary pulmonary hypertension such as that resulting from lung disease is group 3. Chronic thromboembolic pulmonary hypertension is group 4. Disease resulting from multifactorial mechanisms is group 5. Important point to no