Core Conditions

Question 1

Signs of Pulmonary Hypertension vs Right Heart Failure

Answer 1

Pulmonary hypertension
Palpable RV heave and S2

LoudH2

S4 present

Pulmonary flow murmur

Right heart failure

ElevatedJVP

S3 present

Peripheral oedema, ascites, pleural effusions

Answer 2

Diagnostic Catheterization

• complications for diagnostic catheterization <1%
• inadequate diagnostic procedures occur in fewer than 1% of cases
• provocative pharmacological agents can be used to unmask pathology

ƒ fluid loading may unmask latent pericardial constriction afterload reduction or inotropic stimulation may be used to increase the outflow tract

gradient in HCM

ƒ coronary vasoreactive agents (e.g. methylergonovine, acetylcholine)

ƒ a variety of pulmonary vasoreactive agents in primary pulmonary HTN (e.g. oxygen,

calcium channel blockers, adenosine, nitric oxide, or prostacyclin)