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Pulmonary Medicine > Pulmonary Circulation > Flashcards

Pulmonary Circulation Flashcards

1
Q

how much blood volume flows through the lung per minute on average?

A

5L/min

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2
Q

What is the average blood pressure in the pulmonary circulation?

A

15mmHg

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3
Q

What is the average pressure in your right atrium?

A

2mmHg

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4
Q

What is the average pressure in your right ventricle?

A

25/0mmHg

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5
Q

What is the average pressure in your left atrium?

A

5mmHg

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6
Q

What is the average pressure in your left ventricle?

A

120/0mmHg

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7
Q

What is it called when the pressure in your left atrium becomes greater than the pressure in your pulmonary vein?

A

Heart failure

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8
Q

How does cardiac cath measure the pressure in the left atrium?

A

By inserting a cath through the right heart and into the pulmonary artery. Balloon seals all pressure generated from right heart off from the lungs and left heart, allowing us to detect distal pressure. This is called the wedge pressure

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9
Q

How is total resistance preasured?

A

it is the sum of alveolar and extra-alveolar resistances

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10
Q

What happens during hypoxia?

A

hypoxic vasoconstriction drives blood away from areas without good gas exchange to areas of that are receiving oxygen

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11
Q

What are the passive controls of pulmonary vascular resistance?

A

Lung volume and blood pressure. (Gravity is a passive factor that effects both)

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12
Q

what are some potential causes of pulmonary edema?

A 
High capillary pressure (common presentation of left heart failure)
Inflammation, 
Impaired lymphatic drainage 
High altitude, 
Drowning
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13
Q

Why doesn’t pulmonary edema begin right away when lungs begin to experience stressors that cause edema?

A

The ability of the pulmonary lymphatics to increase the rate of lymph flow provides a large reserve before pulmonary edema starts to occur. Once the lymphatics are “overwhelmed”, fluid accumulation starts to occur – first in the interstitial space and may eventually flood the alveoli.

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14
Q

what is a pleural effusion

A

Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing

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15
Q

How often does a DVT progress to a PE?

A

10% of the time. 5,000,000 DVT and 500,000PE/year in US

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16
Q

What are the 3 major factors that contribute to genesis of venous thrombosis?

A

1) Damage of endothelium of vessel wall
2) Hypercoagulability
3) Stasis

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17
Q

What are some risk factors for epithelial damage?

A 
Inflammation
Age > 60 years
Malignancy
 Stress
Smoke
Obesity
Pollutions
18
Q

What are the most common risk factors for hypercoaguability?

A 
Protein C Deficiency**
Protein S Deficiency**
Antithrombin III Deficiency**
Factor V Leiden: 3-5 times higher risk 
Prothrombin G20210A
Hyperhomocysteinuria
Dysfibrinogenemia
Familial plasminogen
pregnancy
19
Q

What are some additional risk factors for PE?

A

major trauma, recent surgery

20
Q

slide 18

A

lk

21
Q

What are some things you’d expect to see in the clinical presentation of PE?

A 
Leg pain, swelling, erythema, warmth
Dyspnea, chest pain and hemoptysis, shock
Sudden
Tachypnea, fever, tachycardia
Hypotension
Crackles, S4, loud P2, JVD, cyanosis
22
Q

whats do you most commonly see on a CXR when looking at a PE?

A

nothing, looks normal

23
Q

What are the most useful tests to diagnose PE?

A

duplex US, VQ scan, CT, sometimes pulmonary angiography

24
Q

What are the treatments for PE?

A

Oxygen
Heparin (APTT 1.5 to 2.5 times normal within 24 hours, Heparin level 0.3 to 0.7)
Warfarin
Massive PE: give thrombolysis therapy via catheter.

25
Q

how often do you see chronic PE?

A

4% of survivors have a clot that doesn’t go away or respond to therapy. It can lead to fibrotic changes in vessel wall, treated surgically

26
Q

What are other types of embolism?

A

air, fat, amniotic fluid

27
Q

You can make the diagnosis of pulmonary hypertension when the mean pulmonary artery pressure is greater than _______mmHG.

A

25mmHg

28
Q

What is the first part of the body to suffer in a patient with pulm htn?

A

the right ventricle

29
Q

what is the criteria to diagnose pulmonary arterial hypertension?

A

a mean pulmonary arterial pressure >25mmHg AND a pulmonary capillary wedge pressure/left ventricular end-diastolic pressure <15mmHg. So basically the pressure in the pulm artery is elevated, but not in the pulm vein.

30
Q

What are 5 major categories for patients with pulmonary artery htn?

A

lung disease/hypoxemia, left heart dz, chronic PE, miscellaneous

31
Q

what are some common signs/symptoms of patients with PE?

A

dyspnea, pain on inspiration, tachypnea, chest pain, tachycardia, hypotension, cracles, JVD, cyanosis

32
Q

what does the ABG usually reveal for a PE patient?

A

acute respiratory alkalosis due to hyperventilation

33
Q

What is a lab test you can run to check for DVT or PE?

A

d-dimer, will be elevated in presence of thrombus

34
Q

what kinds of preventative options do patients with h/o DVT/PE

A

typically anticoagulation like Coumadin, vena cava filters (greenfield)

35
Q

if you see PCWP, what does that mean?

A

pulmonary capillary wedge pressure

36
Q

what disease is characterized by right ventricular hypertrophy and eventrual failure resulting from pulmonary dz and associated hypoxia. (Most frequently caused by COPD)

A

Cor Pulmonale

37
Q

“Pulmonary hypertension” has several classifications, what are they?

A

1) Pulmonary arterial htn (PAH)
2) Pulmonary htn owing to left heart dz
3) Pulm htn owing to lung dz and hypoxia
4) chronic thromboembolic pulm htn (CTEPH)
5) pulm htn with unclear unlifactorial mechanism

38
Q

what is the clinical presentation of pulm htn?

A

dyspnea, cough, cp, syncope, hemoptysis, pedal edema, “Velcro” crackles, JVD, hepatomegaly, pulsatile liver, ascites, loud P2 (pulmonary valve closing)

39
Q

Stew has had uncontrolled htn for years. His doctor recently told him that now his left ventricle is enlarged and causing the pressure in his lungs to be high. Would you tell him he had primary or secondary PH?

A

Secondary, resulting from left heart dz. (Primary PH develops without known cause)

40
Q

What are some general symptomatic treatment options for pulmonary htn?

A 
General sysmptomatic therapy:
Oxygen
Diuretics (reduce rt heart edema)
Digoxin 
Coumadin
Respiratory Rehab
41
Q

what are some more aggressive treatments of pulmonary htn?

A

Vasodilator therapy: ERA, PDE-5 inhibitors and prostacyclin therapy
Surgical treatment:
atrial septestomy
Lung transplant

42
Q

What is the most important aim of treatment for cor pulmonale?

A

correction of alveolar hypoxia by administrating O2. Other forms of treatment target underlying disease

Pulmonary Medicine (14 decks)

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