16. Pulmonary Vascular Disease Flashcards
(22 cards)
What is a Pulmonary Embolism(PE)?
The formation of a thrombus (blood clot) in the venous system
Where is a PE usually found?
In the deep veins of the legs
Where does a PE embolise to?
The pulmonary arteries
What percentage of all hospital admissions are PEs?
1%
Can a PE be fatal?
Yes, a massive PE can be
Can minor PEs be treated?
Yes, with anticoagulation. It has a very good prognosis
What are the major risk factors for Venous Thromboembolism?
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease (e.g. MI or COPD)
Pregnancy
Inherited thrombophilia (e.g. Factor V Leiden)
What are the symptoms of a PE?
- Pleuritic Chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (Massive PE)
What are the signs of a PE?
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachypnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
What are the Pre-test Probabilities?
Wells Score
Revised Geneva Score
What are the PE investigations?
Full blood count, biochemistry, blood gases Chest X-Ray ECG D-dimer CT Pulmonary Angiogram (CTPA) V/Q scan Echocardiography Consider CT abdomen and mammography Consider thrombophilia testing
What is the prognosis for PE?
Mortality at 30 days varies from 0 to 25%
PESI Score
- Based on age, sex, comorbidity and physiological parameters
How is PE treated?
Oxygen Low molecular weight heparin e.g. dalteparin Warfarin Direct Oral Anticoagulants (DOAC) - rivaroxaban, apixaban Thrombolysis - Alteplase (rt-PA) Pulmonary Embolectomy
What is Pulmonary Hypertension(PH)?
Elevated blood pressure in the pulmonary arterial tree, Defined as a mean pulmonary artery pressure of > 25 mmHg
Which type of hypertension is more common?
Secondary pulmonary (occurring in older age group)
What are the causes of PH?
Idiopathic Secondary to chronic respiratory disease Secondary to left heart disease Chronic Thromboembolic PH (CTEPH) Miscellaneous - collagen vascular disease - portal hypertension - congenital heart disease (L to R shunt) - HIV infection
What are the symptoms of PH?
Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope
What are the signs of PH?
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
What are PH investigations?
ECG Lung function tests Chest X-Ray Echocariography V/Q scan CTPA Right heart catheterisation - allows direct measure of pulmonary artery pressure - measurement of wedge pressure - measurement of cardiac output
What are the general treatments for PH?
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
What are the specific treatments for PH?
Calcium channel antagonist e.g. amlodipine Prostacyclin Endothelin receptor antagonists - bosentan - ambrisentan Phosphodiesterase inhibitors - sildenafil - tadalafil
What are the other treatments for PH?
Thromboendarterectomy (CTEPH)
Lung or heart lung transplant
