Circulation Flashcards
Surgical embolectomy is only for massive PE.
If AC is CI, get IVC filter.
CTEPH treatment
surgical or percutaneous pulmonary endarterectomy. If high surgical risk, balloon angioplasty and/or medical therapy with pulmonary vasodilators (Riociguat). Should be on AC.
Bone morphogenetic protein receptor type II (BMP2) gene
familial pulmonary htn
Intermediate or High Wells score.
Start AC before imaging
If suspecting pulmonary hypertension due to CTEPH
V/Q scan before RHC
Poor PE prognosis
RV:LV diameter > 0.9, new RBBB, S1Q3T3
Most common hypercoag cause of CTEPH
antiphospholipid antibodies. Can also see anticardiolipin antibodies, and lupus anticoagulant. Splenectomy increases risk. All CTEPH patients should undergo hypercoag workup.
PH TR jet
> 3.4. Also early diastolic pulmonary regurgitation velocity of >2.2 m/sec, an IVC diameter >2.1 cm with <50% inspiratory collapse, or a pulmonary artery diameter >25 mm
RHC for PH timing
After it is diagnosed on echo. IF pcwp tracing is unreliable, directly measure LVEDP.
Pulmonary arterial htn treatment
Test for vasoreactivity: ≥10 mm Hg reduction in mPAP to a value of <40 mm Hg and without a reduction in CO. If positive-> CCBs. If negative, Pulmonary vasodilators such as PDE-5i.
Massive PE.
hypotension, cardiogenic shock, or cardiac arrest.
Systemic thrombolytics if acceptable bleeding risk. CI in structural intracranial disease, previous intracranial hemorrhage, ischemic stroke within 3 months, active bleeding, recent brain or spinal surgery, recent head trauma with fracture or brain injury, and bleeding diathesis
Precapillary pulmonary htn without evidence of lung disease on PFTs/CT chest, consider
CTEPH
CTPA kidney CI
AKI or chronic kidney disease with GFR <30
Undifferentiated shock
Consider adrenal crisis (hyperkalemia, hyponatremia). central obesity, abdominal striae, and bruises= cushing.
angiotensin-converting enzyme (ACE) inhibitor–induced angioedema diagnosis
no lab testing, clinical diagnosis, due to the inhibition of bradykinin degradation.
if there were family history of angioedema, personal history of malignancy, or prior angioedema event-> suspect rare angioedema disorder and get complement protein 4 level.
