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Year 1- Respiratory > Pulmonary Vascular Disease > Flashcards

Pulmonary Vascular Disease Flashcards

1
Q

How does a pulmonary embolism occur?

A
  • A thrombus (clot) forms in the venous system (usually in the deep veins of the leg)
  • It embolises through the veins through the heart and lodges in the pulmonary arteries
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2
Q

Whats the prognosis for a minor PE?

A

Very good if treated with anticoagulation

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3
Q

Whats the mortality rate for PE?

A

At 30 days mortality is between 0-25% (closer to 25% in a massive PE)

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4
Q

How do we determine the risk of mortality?

A

Using a PESI score based on:

  • Age
  • Sex
  • Comorbidity
  • Physiological Parameters
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5
Q

What are the Major Risk Factors for a Pulmonary Embolism?

A
  • Recent Major Trauma
  • Recent Surgery
  • Cancer
  • Significant cardiopulmonary disease e.g. MI
  • Pregnancy
  • Inherited Thrombophilia
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6
Q

What is a thrombophilila?

A

An inherited disorder with a predisposition to produce clotting factors (e.g. Factor V Leiden)

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7
Q

What happens if you get a small PE in a peripheral artery??

A

A section of the lung is infarcted.

This leads to local tissue inflammation, necosis and rubbing against the pleura

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8
Q

What are the signs and symptoms of a small Peripheral PE?

A

Symptoms:
Pleuritic Chest Pain (from rubbing)
Cough and Haemoptysis

Signs:
Pyrexia
Stony Dullness to percussion at base (due to pleural effusion)

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9
Q

What happens if there multiple small PEs?

A

Several areas are infarcted

This means perfusion of the lung in general becomes low

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10
Q

What are the signs and symptoms of multiple small PEs?

A

Symptoms:
pleuritic chest pain, cough, haemoptysis, isolated acute dyspnoea

Signs:
Tachycardia, Tachpnoea, Hypoxia

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11
Q

What happens during a massive PE?

A

A general lack of pulmonary blood flow leads to hypoxia and loss of blood pressure

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12
Q

What are the signs and symptoms of a massive PE?

A

The loss of blood pressure can lead to syncope or even cardiac arrest.

Signs:
Tachycardia, Hypotension, Tachypnoea, Hypoxia

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13
Q

How do we determine how likely someone is to get a PE?

A

By various scoring systems:

  • Wells Score
  • Revised Geneva Score
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14
Q

What early tests do we do when we suspect a PE?

A
  • A full blood count, blood gases & biochemistry.
  • A CXR (rules out other conditions)
  • ECG (shows tachycardia)
  • D-dimer (-ve indicates unlikely to have a PE)
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15
Q

What is the main test we use to determine a PE?

A

A CT pulmonary Angiogram (CTPA)

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16
Q

What test would we use to determine if the right ventricle is under strain?

A

An echocardiograph

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17
Q

What the use of a V/Q scan?

A

To show areas of ventilation and perfusion.

A PE would be indicated by normal ventilation but areas (or whole thing) of reduced perfusion

18
Q

Why would we consider doing abdomen CTs and mammography?

A

In the case of a PE in someone with little clinical risk we would use these tests to see if the cause is occult cancer.

19
Q

When would we do thrombophilia testing?

A

If the person had a PE without much clinical risk wed test for inherited disease

20
Q

What treatments do we use for someone with a minor PE?

A
  • Oxyegn
  • BloodThinners
  • Direct Oral Anticoagulatants (DOAC)
21
Q

What treatment would we add for a massive PE?

A

Thrombolysis

If contraindicated then a pulmonary embolectomy is performed

22
Q

Name some blood thinners?

A
  • Low Molecular Weight Heperarin (e.g. dalteparin)

- Warfarin

23
Q

Name some Direct Oral Anticoagulants (DOAC)?

A
  • Rivaroxaban

- Apixaban

24
Q

In what situation do we put someone on permanent anticoagulants?

A

IF they have a very high risk of future PE

25
Q

Name an agent of thrombolysis?

A

Alteplase (rt-PA)

26
Q

What is the level of pressure in pulmonary hypertension?

A

Pressure in pulmoary arterial tree >25mmHg

27
Q

What is the incidence of primary PH?

A

1-2/million (very rare)

28
Q

In what age group does secondary PH normally occur?

A

The elderly

29
Q

Name some causes for Pulmonary Hypertension?

A
  • Idiopathic (Primary)
  • Secondary to chronic respiratory disease
  • Secondary to left heart disease
  • Chronic Thromboembolic PH (CTEPH)
  • Miscellaneous
30
Q

How does a chronic respiratory disease lead to pulmonary hypertension?

A

The disease is bad enough it leads to hypoxia
That leads to pulmonary vasoconstriction
This leads to hypertension

31
Q

What are the miscelaneous causes of Pulmonary Hypertension?

A
  • Collagen Vascular Disease
  • Portal Hypertension
  • Congenital Heart Disease (L to R shunt)
  • HIV infection
32
Q

What are the symptoms of Pulmonary Hypertension?

A

Symptoms:

  • Exertional Dyspnoea
  • Chest Tightness
  • Exertional Presyncope or syncope (i.e. lightheaded or passing out on exercise)
33
Q

What are the signs of pulmonary hypertension?

A
  • Elevated Jugular Venous Pressure (JVP)
  • Right Ventricular Heave
  • Loud pulmonary second heart sound
  • Hepatomegaly
  • Angle Oedema
34
Q

What tests do we do in pulmonary hypertension to see if its secondary to pulmonary diseasE?

A
  • ECG
  • Lung Function Tests
  • CXR
35
Q

Whats the use of an echocardiograph in pulmonary hypertension?

A

The echocardiograph involves inducing a leak and measuring its velocity.
This way you can indirectly work out the arterial pressure to determine hypertension.

36
Q

What scans do we use testing for pulmonary hypertension?

A

A V/Q scan

A CTPA

37
Q

Why do we use a right heart catheterisation in pulmonary hypertension?

A
  • Allows direct measure of pulmonary artery pressure
  • Allows measurment of wedge pressure
  • Allows measurement of cardiac output.

All these rule out heart disease as the cause

38
Q

What is wedge pressure?

A

An indirect measure of pulmonary venous system pressure.

This tells us if theres a problem with the heart’s left side

39
Q

What are the general treatments for Pulmonary hypertension?

A
  • Treat underlying condition (if secondary)
  • Oxygen (if hypoxic)
  • Anticoagulation
  • Diuretics (if theres oedema)
40
Q

what are the specific treatments for PH?

A
  • Calcium channel antagonist
  • Prostacyclin (smooth muscle relaxant for vasodilation)
  • Endothelial Receptor Antagonists
  • Phosphodiesterase inhibitors
41
Q

What are the surgical treatments for PH?

A

Thromboendoarterectomy (For chronic thromboembolic PH)

Lung or heart transplant

Year 1- Respiratory (30 decks)

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