Cardiology>>>>>Pulmonary Hypertension And Pericardium
Question 7#

You are invited by your consultant to study data recorded from right heart catheterization.

Which one of the following is true? 

a. The transpulmonary gradient is the difference between mean pulmonary artery pressure (mPAP) and mean pulmonary wedge pressure (mPWP)
b. The pulmonary vascular resistance is the transpulmonary gradient (TPG) multiplied by the cardiac output (CO)
c. Left atrial hypertension is reflected by a pulmonary wedge pressure >20 mmHg
d. A positive pulmonary vasodilator test is indicative of a patient who will always respond to calcium-channel blockade
e. Adenosine is used to assess vasodilatation response

Correct Answer is A

Comment:

Transpulmonary gradient (TPG) is given by mPAP – mPWP and is normally <12 mmHg. Pulmonary vascular resistance is given by TPG divided by CO. A PWP >15 mmHg indicates left atrial hypertension. A vasodilator challenge is performed with inhaled nitric oxide to identify the small subset of patients with pulmonary arterial hypertension who will benefit from long-term calcium-channel blockade. A portion of those with an initially positive response (dmPAP ≥10 mmHg to ≤40 mmHg with d/normal CO) will become refractory to vasodilator provocation (and therefore calcium-channel blockade) in the future.