The 5 Groups of Pulmonary Hypertension Made Easy
The 5 Groups of Pulmonary Hypertension Made Easy
I learned this from a trainee at Johns Hopkins Hospital. Whoever created this is a genius! Thank you.
Content
0.08 -> i always found it difficult to remember
2 -> the five groups of pulmonary
3.679 -> hypertension
5.2 -> i learned a memory aid that i want to
7.52 -> share with you
8.72 -> while i was faculty at hopkins from one
10.719 -> of the residents i'm not sure who
12.4 -> created
13.2 -> this memory aid why is it important to
15.519 -> know the five groups
16.72 -> well remember when you diagnose someone
18.48 -> with pulmonary hypertension
20.4 -> that's not the end of the journey it's
22.64 -> the start of the diagnostic journey
24.96 -> similar to when you diagnose someone
26.56 -> with iron deficiency anemia or siadh
29.359 -> you need to understand why
31.41 -> [Music]
36 -> welcome back clinical problem solvers
38.16 -> it's prof res
39.28 -> i'm a clinician in chicago who loves
41.36 -> learning and teaching
43.04 -> and also i think my lighting skills are
45.36 -> improving i don't look like casper the
47.28 -> ghost anymore
48.399 -> comment below on how my lighting skills
50.16 -> are today we're going to talk about
51.68 -> pulmonary hypertension with a specific
53.6 -> focus on the five groups of pulmonary
55.52 -> hypertension
56.64 -> i'm going to teach you a mnemonic that
58.239 -> was taught to me by a student of mine
60.48 -> so that you never forget the five causes
63.359 -> before we dive into the five causes of
65.199 -> pulmonary hypertension
66.72 -> let's discuss how a patient with
68.32 -> pulmonary hypertension might present
70.56 -> clinically
71.84 -> this is important because twenty percent
73.76 -> of patients with pulmonary hypertension
75.52 -> it takes two years to get to a diagnosis
79.2 -> because the symptoms are non-specific
81.6 -> the initial symptoms may include fatigue
84.479 -> and exertional dyspnea why does this
86.96 -> happen well if you think about it
89.439 -> the function of the right side of the
90.88 -> heart is to take deoxygenated blood
94.32 -> push it to the lungs where it gets
95.6 -> oxygenated and then makes its way to the
97.439 -> left side of the heart
98.4 -> where the left side of the heart pumps
99.68 -> the blood to your tissues to deliver
101.84 -> oxygen and glucose
103.2 -> but if you have resistance in front of
105.6 -> the right side of the heart it's going
106.72 -> to be more difficult to get it to the
108.159 -> left side of the heart so when you're
109.52 -> moving around and you need that oxygen
111.52 -> and glucose
112.32 -> you're not going to get an adequate
113.52 -> supply which may manifest as fatigue or
116 -> shortness of breath
117.2 -> what happens as pulmonary hypertension
119.92 -> progresses well now
121.52 -> the right ventricle will get thick it
124.079 -> will dilate
125.439 -> you'll have right sided failure
128.64 -> and it's easy to know what might happen
131.2 -> so you might have volume overload
133.04 -> lower extremity edema ascites pleural
136.16 -> effusion
136.959 -> you might get an enlarged liver that's
139.36 -> tender and positive
141.04 -> because of this right-sided failure
143.2 -> additionally you may have
144.64 -> exertional syncope because
147.68 -> you're not getting enough blood into the
149.44 -> left side of the heart to pump blood to
151.2 -> the brain
151.84 -> so you pass out or you might have
154.08 -> exertional chest pain
156.48 -> pretty much the exertional chest pain is
158.8 -> because you have increased
160.8 -> wall tension due to the changes of the
162.959 -> right ventricle
164.56 -> and during exertion you just can't meet
167.68 -> the demand of the myocardial cells on
169.68 -> the right
170.08 -> side of the heart thereby you get
172.319 -> sub-endocardial ischemia
174.08 -> and angina so now that we know how
176.879 -> patients with pulmonary hypertension
178.4 -> might present clinically
180.159 -> let's talk about the five classes
181.84 -> because remember
183.2 -> once you frame someone with pulmonary
184.72 -> hypertension your diagnostic journey has
187.28 -> just
187.76 -> started so the way to do this and i'm
190.239 -> going to put this on the corner of the
191.76 -> screen
192.72 -> is think about the numbers one two three
195.04 -> four and five
196.159 -> and then put a mirror right in front of
198.56 -> these numbers so number one
200.72 -> if you put a mirror and you put another
202.64 -> one this looks like an artery so group
204.72 -> one is pulmonary arterial hypertension
208.4 -> these causes include idiopathic
210.48 -> pulmonary arterial hypertension
212.92 -> schistosomiasis hiv
215.92 -> drugs and toxins like tyrosine kinase
218.48 -> inhibitors
219.28 -> and connective tissue diseases or
220.879 -> autoimmune diseases like systemic
223.04 -> sclerosis group 2 draw a two out
226.799 -> put the mirror the other two will look
229.36 -> like this
230.319 -> this looks like a heart so group two is
232.959 -> due to
233.439 -> cardiac disease anything that causes
236.159 -> left sided failure
237.599 -> can lead to pulmonary hypertension group
240 -> three
241.28 -> imagine the three the mirror and you can
244.56 -> see it below two
245.84 -> looks like a line so group three
248.08 -> pulmonary hypertension is due to
249.76 -> lung disease so obstructive lung disease
251.76 -> like emphysema
253.12 -> restrictive lung disease like
254.56 -> interstitial lung disease
256.479 -> or even severe obesity can lead to
260.56 -> group three pulmonary hypertension group
263.199 -> four
263.68 -> draw out the four no mirror just draw it
266 -> out it looks like a chair
268.08 -> if someone is immobile it makes you
270.32 -> think of clots so group 4 is due to
272.24 -> chronic thromboembolic disease
274.4 -> but really anything that obstructs a
276.479 -> pulmonary arterial system
278.72 -> like parasites tumors can lead to group
282.72 -> 4
283.04 -> pulmonary hypertension group 5
286.08 -> is everything else and basically we
287.919 -> don't know how these causes
290.4 -> actually lead to pulmonary hypertension
293.04 -> but doesn't the
293.84 -> 5 look like an s so you can think of
296.479 -> sickle cell disease and
297.759 -> other hemolytic processes or sarcoidosis
302.96 -> in any case i hope this is a good start
305.52 -> or a foundation
306.8 -> to your understanding of pulmonary
308.32 -> hypertension as always
310.72 -> work hard today so you're better
313.12 -> tomorrow
314.08 -> than you were yesterday thanks
Source: https://www.youtube.com/watch?v=poXA0yBEyfY