The topic now is Pulmonary Hypertension.
As simple as it may seem, it's the fact that
you have to dive into quite a bit of detail
and the reason for that is because there has
been so much research on this over the years
because of sequelae of right-sided heart failure,
cor pulmonale and death, that now, at this
point, we know how to, first, identify normal,
completely analyze the pathology through WHO
classifications and every single class you
will have to know, there's four of
them and then management.
To begin with, Pulmonary Hypertension, defined
As of 2019.
The definition has been updated
to a mean pulmonary arterial pressure
or mPAP of greater
than 20 millimeters mercury at rest
measured by right heart catheterization.
would you go about, perhaps, measuring this?
How about a right heart catheterization?
So, here, when you catheterize the right side
and you get from the right ventricle and moved
up to you pulmonary artery. Alright, can you
picture that? Good. Right ventricle, you have
a pressure of approximately 2, very passive,
but then you start getting to pulmonary artery,
the pressure increases to approximately 10,
but at rest, if you find that the pulmonary
arterial pressure is greater than 20, guaranteed,
your patient has Pulmonary Hypertension.
But what caused this? Well, let's continue.
The Pulmonary Hypertension may result in arteriosclerosis.
What does that mean? Imagine when there is
an increase in tension, then what's going
to happen? Is this arteriolar is this
an arteriole? That is your first question,
isn't it? Always. Whenever you deal with blood
vessels, you want to try to break it up into
the arteries and arterioles and then that
will then give you the respected diagnosis.
Here, it is arteriosclerosis, most likely,
hyaline type. Then you have medial hypertrophy,
intima fibrosis of pulmonary arteries and
by that we mean that, here is my intima, there
is my media and so, those are two major layers
of the blood vessels that are being affected.
There will be medial hypertrophy and intimal
fibrosis, causing what, please? Increased
narrowing of the pulmonary arteries. Now,
the clinical course includes severe respiratory
distress. Whenever there is problem with the
pulmonary artery and there is increased resistance
or pressure you are then going to feel this
in the right ventricle resulting in right
ventricle hypertrophy (RVH) and unfortunately,
getting into severe failure, cor pulmonale.