Pulmonary Hypertension

Pathophysiology 1) increased arterial pressure in lungs 2) primary or idiopathic form occurs in absence of known precipitating causes 3) secondary form caused by – mitral stenosis, pulmonary venous occlusive disease, extreme obesity (Pickwickian syndrome), chronic hypoxemia, recurrent pulmonary embolism, kyphosis, infiltrative lung disease, chronic bronchitis, long periods at high altitude Signs and Symptoms 1) insidious onset of dyspnea idiopathic form 2) right heart failure with venous distention of neck 3) peripheral cyanosis late in disease 4) palpable right ventricular heave (owing to cor pulmonale) 5) fatigue 6) syncope 7) hepatomegaly 8) ankle edema 9) tachypnea 10) nonproductive cough 11) chest pain Characteristic Test Findings Radiology – 1) scattered infiltrates consistent with hemorrhage and hemosiderosis on chest radiograph 2) enlarged central pulmonary arteries EKG – 3) right axis deviation with right ventricular hypertrophy Echocardiography – 4) right ventricular enlargement with decreased left ventricular size Laboratory – hypoxemia Histology/Gross Pathology 1) early changes are reversible if underlying conditions are corrected (e.g., with heart surgery) 2) grade 1 – smooth muscle hypertrophy of arteries 3) grade 2 – intimal proliferation exists 4) grade 3 – intimal fibrosis has begun 5) grade 4 – dilation and thinning of pulmonary arteries with formation of nodular plexiform lesions 6) grade 5 – p...
Source: Inside Surgery - Category: Surgeons Authors: Tags: Pulmonology arterial pressure cyanosis dyspnea high altitude lungs obesity right heart failure Source Type: blogs