Pulmonary Hypertension
Definition
Increased pulmonary arterial pressure due to (1) reduction in the caliber of the pulmonary vasculature or (2) an increase in pulmonary blood flow
Types
- Primary
- Secondary
Etiology
- Primary Pulmonary Hypertension
- Unknown
- Proposed etiologies include Raynaud's phenomenon, oral contraceptives, and/or thickening or fibrosis of the intima of the small pulmonary arteries and arterioles
- Secondary Pulmonary Hypertension
- Parenchymal disease of the lung, (COPD, cor pulmonale)
- Mitral stenosis
- Mitral regurgitation
- Left ventricular failure
- Reduced left ventricular compliance
- Left atrial myxoma
- Pulmonary embolism
- Restrictive lung disease
Signs and Symptoms
- Decreased exercise tolerance
- Weakness
- Fatigue
- Syncope on effort
- Occasional angina
- Progressive dyspnea
- Cyanosis due to congestive heart failure late in the disease
Pulmonary Hypertension Severity Scales
Systolic pulmonary artery pressure
- Normal : 18 to 25 mm Hg
- Mild : 30 to 40 mmHg
- Moderate : 40 to 70 mm Hg
- Severe : >70 mmHg
Acceleration time
- Normal :≥120 msec
- Mild : 80 to 100 msec
- Moderate : 60 to 80 msec
- Severe : < 60 msec
Pulmonary artery end-diastolic pressure
- Normal : 4 to 12mm Hg
M-Mode
- Absent or decreased "a" dip (< 2 mm) of the posterior pulmonary valve cusp
- Mid-systolic notching (flying W) of the posterior pulmonary valve cusp
2-D
- D-shaped left ventricle in systole or diastole or both ("pancaking" of the interventricular septum), best seen on the parasternal short-axis view of the left ventricle
- Right ventricular hypertrophy/dilatation
- Dilatation of the inferior vena cava/ hepatic veins with failure of the inferior vena cava to collapse at least 50% upon inspiration
Doppler
- Pulmonary regurgitation
- Tricuspid regurgitation
- Determine the pulmonary artery pressures (SPAP, MPAP, PAEDP)