Difference between revisions of "Pulmonary Hypertension"

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'''Description:'''
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{{OpenPagesTop}}
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== Introduction ==
  
*Hypertension is defined as the pathological elevation of arterial blood pressure.
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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.  
*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:'''
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Pulmonary hypertension = increase in pulmonary arterial pressure.
*Pulmonary hypertension=increase in pulmonary arterial pressure
 
  
'''There are two types of pulmonary hypertension:'''
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'''There are two types of pulmonary hypertension:'''  
  
1. Primary pulmonary hypertension=idiopathic pulmonary hypertension (Contributing factors: Drugs, Toxins, Genetic Predisposition and Infections)
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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
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2. '''Secondary''' pulmonary hypertension = pulmonary hypertension resulting from an identifiable underlying condition  
  
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[[Cor Pulmonale|'''Cor pulmonale''']] = [[Heart Failure, Right-Sided|right sided heart failure]] resulting from pulmonary hypertension.
  
*[[Cor Pulmonale|'''cor pulmonale''']]=right sided heart failure resulting from pulmonary hypertension
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The hypoxic conditions at high elevations or animals with chronic airway disease contribute to pulmonary hypertension through hypoxia-induced vasoconstriction.  
*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.
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==Signalment==
  
Genetics & Breed Predisposition: Brachycephalic Dogs (chronic obstructive pulmonary disease); Small breeds (mitral endocardiosis); West Highland White Terriers (Pulmonary Fibrosis)
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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).
  
====Diagnosis====
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== Clinical Signs ==
  
=====History & Clinical Signs=====
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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.
  
*Signs of right sided heart failure:
 
  
-Exercise Intolerance
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== Diagnosis ==
  
-Dyspnoea
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'''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]]).
  
-Coughing
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'''Blood tests''':
 +
:Arterial blood gases may show hypoxemia if there are low oxygen conditions.
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: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.
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:A biomarker for a pulmonary hypertension is an elevated NT-proBNP.
  
-Syncope
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'''Urinalysis''' may show the presence of proteinuria if systemic disease is present.
  
-Cyanosis
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'''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.
  
-Abdominal Distension
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'''Electrocardiography''' may show the presence of right ventricular hypertrophy (deep S-waves) and signs of myocardial hypoxia (ST segment abnormalities).
  
-Distended Jugular Veins
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'''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]]">
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</gallery>
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<gallery caption="[[File:Diagnosis of Pulmonary Hypertension.jpg|thumb|340x340px|Enlarged right atrium and ventricle]]">
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</gallery>
  
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== Treatment ==
  
=====Physical Exam=====
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'''Treat the underlying conditions:'''  
 
 
*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 right sided heart failure
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*Treat pulmonary thromboembolism with heparin and then warfarin
 
*Treat pulmonary thromboembolism with heparin and then warfarin
  
*Treat chronic obstructive pulmonary disease  
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*Treat chronic obstructive pulmonary disease
 
 
 
 
====Prognosis====
 
  
-Depends on the disease condition and ability to control it
 
  
-Poor when pulmonary damage is irreversible
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== Prognosis ==
  
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Depends on the disease condition causing pulmonary hypertension and the ability to control it. Prognosis is poor when pulmonary drainage is irreversible.
  
  
*Caused by '''left-to-right vascular shunts''' or increased resistance of the pulmonary vascular system
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{{review}}
  
*In animals, it is most commonly a sequel of '''widespread fibrosis in the lung''' or [[Bronchitis#Chronic bronchitis|chronic bronchitis or bronchiolitis]] which stimulates hypertrophy in the walls of small arteries
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{{OpenPages}}
*Severe prolonged pulmonary hypertension leads to [[Cor Pulmonale|'''cor pulmonale''']], right-sided heart failure secondary to primary lung disease
 
  
[[Category:Lungs - Circulatory Pathology]]
 
  
[[Category:Vascular Diseases - Dog]][[Category:Vascular Diseases - Cat]][[Category:Arterial_Pathology]][[Category:To_Do_-_Cardiovascular]]
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[[Category:Lungs_-_Circulatory_Pathology]] [[Category:Vascular_Diseases_-_Dog]] [[Category:Vascular_Diseases_-_Cat]] [[Category:Arterial_Pathology]] [[Category:Expert_Review]]
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[[Category:Cardiology Section]]

Latest revision as of 13:45, 23 June 2021


Introduction

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.

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.

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. Predisposed breeds include brachycephalic dogs (chronic obstructive pulmonary disease); small breeds (mitral endocardiosis) and West Highland White Terriers (pulmonary fibrosis).

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.


Diagnosis

Physical examination, depending on any underlying conditions, may show a heart murmur (mitral or tricuspid regurgitation), presence of a gallop rhythm, increased lung sounds and splitting of S2 heart sounds (see arrhythmias).

Blood tests:

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.

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.

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 causing pulmonary hypertension and the ability to control it. Prognosis is poor when pulmonary drainage is irreversible.




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