Pulmonary Vascular Disease Flashcards

1
Q

what is the mortality of PE if left untreated

A

up to 30% die

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2
Q

what is the mortality of PE once treatment has started

A

2-8% die

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3
Q

what are the signs and symptoms of deep vein thrombosis (DVT)

A

leg swelling
leg redness
tenderness
oedema

(note, signs and symptoms are not always present)

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4
Q

what are investigations that may identify a deep vein thrombosis

A

D Dimer test
ultrasound
Venography

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5
Q

what is a D Dimer test

A

a test that measures protein degradation that breaks off from a clot

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6
Q

what is a venography

A

radiography of a vein after injection of radiopaque fluid

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7
Q

what are weaknesses of D dimer test to diagnose DVT

A

non-specific can go up in any inflammatory condition

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8
Q

if a D dimer test is negative does the patient have a DVT

A

no, if negative it effectively excludes PE/DVT

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9
Q

what is a pulmonary embolism

A

a blood clot lodged in the pulmonary ARTERIAL circulation

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10
Q

what are the signs and symptoms of pulmonary embolism

A
breathlessness 
pleuritic chest pain 
cough
haemoptysis
cyanosis 
tachypnoea
tachycardia
fever
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11
Q

what investigations could you do for a pulmonary embolism

A
arterial blood gas
troponin level
D dimer 
ECG
CXR
definitive radiology
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12
Q

what is a V/Q scan

A

ventilation/perfusion scan

inhaled radioactive gas
inject radiolabelled albumin

gamma camera compares them both looking for a ventilation perfusion mismatch

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13
Q

what imaging is gold standard for diagnosis of acute PE

A

pulmonary angiography

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14
Q

what are the signs and symptoms of a massive pulmonary embolism

A

sudden chest pain
SOB
collapse/loss of conciousness
hypotensive

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15
Q

what is the treatment for DVT

A

anticoagulation therapy -LMWH

warfarin started after INR is in normal range.

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16
Q

what is the treatment for an acute minor pulmonary embolism

A

hypoxic-give high flow O2
bed rest and analgesia
anticoagulation with LMWH for 7 days
then start on warfarin

17
Q

some patients will have a filter inserted into their vena cava why

A

if they have had an acute minor pulmonary embolism and are at high risk of a future emboli

18
Q

how would you treat a massive pulmonary embolism

A

oxygen
fluids
analgesia
iv heparin -stop when giving thrombolysis

thrombolysis or embolectomy

19
Q

what is mean pulmonary artery pressure at rest

A

25 mmHg

20
Q

what is mean pulmonary artery pressure on exercise

A

30mmHg

21
Q

what pressure is considered to be severe pulmonary hypertension

A

higher than 65mmHg

22
Q

what pressure is considered to be moderate pulmonary hypertension

A

46-65 mmHg

23
Q

Factor V Leiden is a mutated form of human factor V, what effect does it have

A

causes an increase in blood clotting

24
Q

what can be cardiac signs of pulmonary hypertension

A

R ventricular heave

tricuspid regurgitation

25
Q

what are the ways pulmonary hypertension can develop

A

hypoxic vasoconstriction - e.g COPD

decrease in the surface area of the pulmonary vascular bed- e.g PE

cardiac disease resulting in RV volume/pressure overload

26
Q

what is the treatment for pulmonary hypertension

A

warfarin, oxygen, diuretics

then a choice of vasodilator therapies (see slides)