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Differentiate Pulmonary arterial hypertension from pulmonary venous congestion

Differentiate Pulmonary arterial hypertension from pulmonary venous congestion. Pulmonary Arterial Hypertension. Causes Primary/ Idiopathic Genetic Secondary Cardiac Pulmonary hypoxic vasoconstriction decreased area of the pulmonary vascular bed volume/pressure overload.

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Differentiate Pulmonary arterial hypertension from pulmonary venous congestion

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  1. Differentiate Pulmonary arterial hypertension from pulmonary venous congestion

  2. Pulmonary Arterial Hypertension • Causes • Primary/ Idiopathic • Genetic • Secondary • Cardiac • Pulmonary • hypoxic vasoconstriction • decreased area of the pulmonary vascular bed • volume/pressure overload

  3. Secondary Pulmonary Arterial Hypertension • Hypoxic Vasoconstriction • COPD and obstructive sleep apnea • Due to down regulation of endothelial nitric oxide synthetase • Decreased Area of Pulmonary Bed • Occurs when loss of vessels exceed 60% of the total pulmonary vasculature • Occurs in patients with collagen vascular disease like CREST and scleroderma. And those with chronic emboli

  4. Volume/ Pressure Overload • Seen in patients with left to right intracardiac shunts • May passively occur in patients with left atrial hypertension and left ventricular dysfunction, mitral valve disease and hose with aortic stenosis

  5. Pulmonary Arterial Hypertension • Chest radiograph • Classic finding is enlargement of central of pulmonary arteries, attenuation of peripheral vessels and oligemic lung fields • Findings of RV and RA dilatation are possible

  6. Pulmonary Venous Hypertension • Secondary to increased resistance to pulmonary venous drainage • Associated with diastolic dysfunction of the LV and valvular dysfunction • Features • Capillary congestion • Focal alveolar edema • Dilatation of interstitial lymphatics

  7. mild cardiomegaly • normal pulmonary arterial markings • pulmonary venous congestion • fluid within the horizontal fissure • prominent Kerley B lines (indicative of lymphatic engorgement) Lateral chest film show marked venous congestion with fluid visible in both the horizontal and oblique fissures

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