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Pulmonary Hypertension (Types (Group 2: PH due to left heart disease…

- - - - Definition
        
        Pulmonary artery wedge pressure (PAWP) <=15 mmHg
        
        Pulmonary Vascular resistance (PVR) >3 wood units)
        
        Note: In the absence of....other causes of Pre-capillary PH, ex:
        
        PH due to lung disease
        
        CTEPH
        
        Other rare diseases
      - A.K.A pre-capillary PH
    - - Characteristic
        
        Septal veins
        
        Pre-septal venules with occlusive fibrotic lesions
        
        Venous muscularization
        
        Patchy capillary proliferation with pulmonary capillary hemangiomatosis
        
        Pulmonary edema
        
        Occult alveolar hemorrhage
        
        Lymphatic dilation
        
        Lymph node enlargement
        
        Inflammatory infiltrates
    - - Changes in vasoreactivity
      - Changes in wall structure
      - Decreases in pulmonary vascular density
      - Reduced alveolarisation
  - - - CTEPH
        
        Organized thrombi tightly attached to the medial layer
        
        Replacing noral intima
- - - - Crossectional pressure
      - Pulmonary Artery Wedge Pressure (PAWP)
      - Pulmonary wedge pressure
      - Pulmonary artery occlusion pressure
    - - Pressure measured
        
        By: Wedging pulmonary catheter with inflated balloon into small pulmonary arterial branch
        
        To: Estimates left atrial pressure
      - Clinical significance
        
        Provides indirect measure of left atrial pressure
        
        How?
        
        Due to large compliance of pulmonary circulation
        
        What For?
        
        Gold standard: determining the cause of pulmonary edema
        
        Clinical application?
        
        20 mmHg : severity of left ventricular failure and mitral stenosis