Difference between revisions of "Pulmonary Hypertension"

Revision as of 16:14, 15 December 2010

Description:

Hypertension is defined as the pathological elevation of arterial blood pressure.

There are two main types of hypertension, systemic hypertension (affects the systemic circulation) and pulmonary hypertension (affects the pulmonary circulation).

Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.

Description:

Pulmonary hypertension=increase in pulmonary arterial pressure

There are two types of pulmonary hypertension:

1. Primary pulmonary hypertension=idiopathic pulmonary hypertension (Contributing factors: Drugs, Toxins, Genetic Predisposition and Infections)

2. Secondary pulmonary hypertension=pulmonary hypertension resulting from an identifiable underlying condition

cor pulmonale=right sided heart failure resulting from pulmonary hypertension

Pulmonary thromboembolism from neoplasia, heart worm disease, and other factors can cause cor pulmonale by blocking the pulmonary vessels with emboli leading to increased pulmonary arterial pressures and ultimately right sided heart failure.

The hypoxic conditions at high elevations or animals with chronic airway disease contribute to pulmonary hypertension through hypoxia-induced vasoconstriction.

Signalment

Some diseases predispose animals to secondary pulmonary hypertension.

Genetics & Breed Predisposition: Brachycephalic Dogs (chronic obstructive pulmonary disease); Small breeds (mitral endocardiosis); West Highland White Terriers (Pulmonary Fibrosis)

Diagnosis

History & Clinical Signs

Signs of right sided heart failure:

-Exercise Intolerance

-Dyspnoea

-Coughing

-Syncope

-Cyanosis

-Abdominal Distension

-Distended Jugular Veins

Physical Exam

Depends on underlying conditions

-Heart Murmur (Mitral or tricuspid regurgitation)

-Gallop Rhythm

-Increased Lung Sounds

-Splitting of S2 heart sounds

Laboratory Findings

-Arterial Blood Gases (Hypoxemia): If there are low oxygen conditions

-Complete Blood Count (Eosinophilia): If parasitic involvement; Serology or Fecal Baermann tests confirm parasitic involvement

-Biochemistry (Hyperglobulinemia): If Chronic Inflammation

-Urinalysis (Proteinuria): If Systemic Disease

Radiography

DV view

-Left atrial and ventricular enlargement

-Pulmonary arterial enlargement

-Congested pulmonary veins

-Signs of pulmonary disease

Electrocardiography

-Right ventricular hypertrophy (Deep S-waves)

-Signs of myocardial hypoxia (ST segment abnormalities)

Echocardiography

-Calculation of pulmonary arterial pressures

-Enlargement of right-side of heart

-Visualize mitral or tricuspid regurgitation

Treatment

Treat the underlying conditions:

Treat right sided heart failure

Treat pulmonary thromboembolism with heparin and then warfarin

Treat chronic obstructive pulmonary disease

Prognosis

-Depends on the disease condition and ability to control it

-Poor when pulmonary damage is irreversible

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+'''Description:'''
-== Introduction ==
-Hypertension is defined as the pathological elevation of arterial blood pressure.There are two main types of hypertension, [[Systemic Hypertension|systemic hypertension]] (affects the systemic circulation) and pulmonary hypertension (affects the pulmonary circulation). Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.
+*Hypertension is defined as the pathological elevation of arterial blood pressure.
-Pulmonary hypertension = increase in pulmonary arterial pressure.
-'''There are two types of pulmonary hypertension:'''
+*There are two main types of hypertension, systemic hypertension (affects the systemic circulation) and pulmonary hypertension (affects the pulmonary circulation).
-. '''Primary''' pulmonary hypertension = idiopathic pulmonary hypertension (contributing factors: drugs, toxins, genetic predisposition and infections)
-. '''Secondary''' pulmonary hypertension = pulmonary hypertension resulting from an identifiable underlying condition
+*Blood pressure in veterinary patients is not measured routinely; therefore hypertension is usually only diagnosed after clinical signs become apparent.
-[[Cor Pulmonale|'''Cor pulmonale''']] = [[Heart Failure, Right-Sided|right sided heart failure]] resulting from pulmonary hypertension.
-The hypoxic conditions at high elevations or animals with chronic airway disease contribute to pulmonary hypertension through hypoxia-induced vasoconstriction.
-==Signalment==
+'''Description:'''
-Some diseases predispose animals to secondary pulmonary hypertension. Predisposed breeds include brachycephalic dogs (chronic obstructive pulmonary disease); small breeds ([[Degenerative Mitral Valve Disease|mitral endocardiosis]]) and West Highland White Terriers (pulmonary fibrosis).
+*Pulmonary hypertension=increase in pulmonary arterial pressure
-== Clinical Signs ==
-Clinical signs may vary and also may be disguised by other signs of the underlying, causative disease. There is often signs of right sided heart failure, such as exercise intolerance, dyspnoea, coughing, syncope, cyanosis, abdominal distension and distended jugular veins.
+'''There are two types of pulmonary hypertension:'''
+. Primary pulmonary hypertension=idiopathic pulmonary hypertension (Contributing factors: Drugs, Toxins, Genetic Predisposition and Infections)
-== Diagnosis ==
+. Secondary pulmonary hypertension=pulmonary hypertension resulting from an identifiable underlying condition
-'''Physical examination''', depending on any underlying conditions, may show a [[Heart Murmurs|heart murmur]] (mitral or tricuspid regurgitation), presence of a gallop rhythm, increased lung sounds and splitting of S2 heart sounds (see [[:Category:Arrhythmia|arrhythmias]]).
-'''Blood tests''':
+*[[Cor Pulmonale|'''cor pulmonale''']]=right sided heart failure resulting from pulmonary hypertension
-:Arterial blood gases may show hypoxemia if there are low oxygen conditions.
-:Complete Blood Count will show an eosinophilia if ther is parasitic involvement. (Serology or Fecal Baermann tests would confirm parasitic involvement).
-:Biochemistry would show hyperglobulinemia in chronic inflammation.
-:A biomarker for a pulmonary hypertension is an elevated NT-proBNP.
-'''Urinalysis''' may show the presence of proteinuria if systemic disease is present.
-'''Radiography''' is best performed with a DV view. Signs will include right atrial and ventricular enlargement, pulmonary arteries enlargement, enlargement of the V. cava caudalis, congested pulmonary veins and signs of pulmonary disease.
+*Pulmonary thromboembolism from neoplasia, heart worm disease, and other factors can cause cor pulmonale by blocking the pulmonary vessels with emboli leading to increased pulmonary arterial pressures and ultimately right sided heart failure.
-'''Electrocardiography''' may show the presence of right ventricular hypertrophy (deep S-waves) and signs of myocardial hypoxia (ST segment abnormalities).
-'''Echocardiography''' may be used to calculate pulmonary arterial pressures. It may also show enlargement of the right-side of the heart and enable visualisation of mitral or tricuspid regurgitation.<gallery caption="[[File:Enlarged pulmonary artery.jpg|thumb|354x354px|Enlarged pulmonary artery]]">
+*The hypoxic conditions at high elevations or animals with chronic airway disease contribute to pulmonary hypertension through hypoxia-induced vasoconstriction.
-</gallery>
-<gallery caption="[[File:Diagnosis of Pulmonary Hypertension.jpg|thumb|340x340px|Enlarged right atrium and ventricle]]">
-</gallery>
-== Treatment ==
-'''Treat the underlying conditions:'''
+====Signalment====
+*Some diseases predispose animals to secondary pulmonary hypertension.
+Genetics & Breed Predisposition: Brachycephalic Dogs (chronic obstructive pulmonary disease); Small breeds (mitral endocardiosis); West Highland White Terriers (Pulmonary Fibrosis)
+====Diagnosis====
+=====History & Clinical Signs=====
+*Signs of right sided heart failure:
+-Exercise Intolerance
+-Dyspnoea
+-Coughing
+-Syncope
+-Cyanosis
+-Abdominal Distension
+-Distended Jugular Veins
+=====Physical Exam=====
+*Depends on underlying conditions
+-Heart Murmur (Mitral or tricuspid regurgitation)
+-Gallop Rhythm
+-Increased Lung Sounds
+-Splitting of S2 heart sounds
+=====Laboratory Findings=====
+-Arterial Blood Gases (Hypoxemia): If there are low oxygen conditions
+-Complete Blood Count (Eosinophilia): If parasitic involvement; Serology or Fecal Baermann tests confirm parasitic involvement
+-Biochemistry (Hyperglobulinemia): If Chronic Inflammation
+-Urinalysis (Proteinuria): If Systemic Disease
+=====Radiography=====
+ DV view
+-Left atrial and ventricular enlargement
+-Pulmonary arterial enlargement
+-Congested pulmonary veins
+-Signs of pulmonary disease
+=====Electrocardiography=====
+-Right ventricular hypertrophy (Deep S-waves)
+-Signs of myocardial hypoxia (ST segment abnormalities)
+=====Echocardiography=====
+-Calculation of pulmonary arterial pressures
+-Enlargement of right-side of heart
+-Visualize mitral or tricuspid regurgitation
+====Treatment====
+'''Treat the underlying conditions:
+'''
 *Treat right sided heart failure
@@ Line 55: / Line 121: @@
 *Treat pulmonary thromboembolism with heparin and then warfarin
 *Treat chronic obstructive pulmonary disease
-== Prognosis ==
-Depends on the disease condition causing pulmonary hypertension and the ability to control it. Prognosis is poor when pulmonary drainage is irreversible.
+====Prognosis====
-{{review}}
+-Depends on the disease condition and ability to control it
-{{OpenPages}}
+-Poor when pulmonary damage is irreversible
-[[Category:Lungs_-_Circulatory_Pathology]] [[Category:Vascular_Diseases_-_Dog]] [[Category:Vascular_Diseases_-_Cat]] [[Category:Arterial_Pathology]] [[Category:Expert_Review]]
+[[Category:Cardiovascular Pathology - Dog]][[Category:Arterial_Pathology]][[Category:To_Do_-_Cardiovascular]]
-[[Category:Cardiology Section]]