Pulm HTN

An elevation in pulm vasculr presur dat can b causd by an isolatd increas in pulm arterial presur / by increas in both pulm arterial & pulm venous presur

In practice, pulm HTN is usd for pulm arterial HTN & is dfined as a resting mean pulm artery presur greatr dan 25mm of Hg / a resting sytolic pulm artery presur greater dan 40mm Hg

##Etio & Clasn
1)Pulm arterial HTN
-related 2 colagen vasclr diseas, livr cirhsis, HIV infn, congenital systemic to pulm shunts
-asso wid significnt venous / capilary invo
-pulm venooclusive diseas

2)Pulm venous HTN
-left sided atrial / ventriculr heart diseas
-left sided valvulr heart diseas

3)Pulm HTN asso wid hypoxaemia
-interstitial lung diseas
-obstructiv sleep apnoea

4)Pulm HTN due 2 chronic thrombotic / embolic diseas
-thromboembolism 2 proximl pulm arteries
-obstrctn of distl pulm arteries in pulm embolism, sickl cel disease

-sarcoidosis, histiocytosis X

-norml pulm artery systolic presur at rest is 18-25mm of Hg, wid a mean of 12-16mm of Hg. Dis low presur is due 2 large cross sectionl area of pulm circulation, whch results in low resistenc
-increas in pulm vasculr resistenc
-increas in pulm bld flow

1)symptoms of pulm HTN & its consequencs
-fatigue, dyspnea, syncop, angina due 2 reducd cardiac output
-haemoptysis uncomon & ocurs due 2 ruptur of distended pulm vessels
-peripheral edma, tender hepatomgaly, raised jugulr venous presur due 2 rt ventr failur

2)signs of pulm HTN
peripherl cyno due 2 reducd cardiac output & skin bld flow

-pulse is low volum due 2 reducd cardiac output & left ventr strok volum

prominent a wavs, JVP elevtd wid rt ventr failur, prominent v wavs & rapid y descent wid functional TR

-inspection & palpn
apicl impuls may b shiftd indicating rt ventr hypertrophy & dilatation
visibl & palpabl left parasternal heav & epigastrc pulsations indicating rt ventri hypertrophy
palpabl P2

pulmo ejectn sound
abno S2
rt atrial 4th heart sound S4
rt ventr 3rd heart sound S3
pulm ejection systo murmur
pulm early diastolic murmur
tricuspid pansyst murmur

rt axis deviation
rt atrial enlargmnt
rt ventr hypertrophy

2)Chest Xray
enlargment of pulm trunk & its main branches
peripherl pruning of vasculr shadows
enlargd rt atrium
enlargd rt ventr


autoantibodies if colagn vasc diseas
arterial bld gas 2 exclud hypoxia / acidosis
sleep studies
helical CT
high resolution chest CT
cardiac catheterisation

-directed @ early recognition & Rx of undrlying caus
-pulm enarterectomy is curent mainstay of chronic thrombemblc pulm HTN
-Rx of hypoxaemia by low flow O2
-excesiv diuretics avoided
-drugs lik ilioprost, bosentan, sildenafil
-oral anticoagulants can b

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