Cardiology>>>>>Pulmonary Hypertension And Pericardium
Question 2#

You are asked by one of the echocardiography technicians to review an echocardiogram for an elderly patient who presents with breathlessness. Estimated RV systolic pressure, as judged by the velocity of the tricuspid regurgitant jet, is moderately elevated.

In terms of an aetiology of the pulmonary hypertension, which one of the following is true?

a. The presence of normal atrial size in the setting of diabetes and hypertension, in particular, point to a left heart cause
b. Lung disease is an uncommon cause
c. Thrombus seen in the proximal pulmonary arteries means that chronic thromboembolic disease has to be the explanation for the pulmonary hypertension
d. The fact that the referral has come from a rheumatologist helps shed light on the cause
e. Echocardiographic evidence of an old myocardial infarction is unlikely to be related

Correct Answer is D


The echocardiogram in PH can be instructive as to the underlying aetiology. Left heart disease and lung disease/hypoxia are common causes. Left atrial dilatation is a red flag for left heart disease. Be mindful of systemic disease processes such as connective tissue disease which can underlie pulmonary arterial hypertension. Proximal pulmonary artery thrombus can form in situ due to sluggish flow when the pulmonary arteries are dilated, especially in patients with Eisenmenger syndrome.