Clinical Aspect of PE and PH

Question 1

What is a PE?

Answer 1

Blockage of a pulmoanry ertery by a blood clot, fat, tumour or air. Slide 2

Question 2

What are the two types of a DVT and which is most likely to embolise?

Answer 2

Proximal (illeo-femoral) or distal (polpiteal).

Proximal DVTs are most likely to embolise. Slide 3

Question 3

How to diagnose a DVT?

Answer 3

Ultrasound Doppler leg scan (1st line) or a CT scan. Slide 5

Question 4

What are the clinical presentations of PE?

Answer 4

Large - Low BP, central cyanosis and sudden death.
Medium - Pleuritic pain, haemoptysis, breathless.
Small recurrent - progressive dysponoea, PH and right heart failure. Slide 6

Question 5

What are the risk factors for DVT and PE?

Answer 5

Thrombophilia
Contraceptive pill
Pregnancy
Trauma
Pelvic obstructions
Surgery
Immobility
Malignancy
Obesity. Slide 7+8

Question 6

What ways can a DVT be prevented?

Answer 6

Early post op mobilisation
TED compressions stockings
Calf muscle exercises
Direct oral anticoagulant medication. Slide 9

Question 7

What are the clinical features of a PE?

Answer 7

Tachycardia, tachypnoea, cyanosis, fever, low BP, crackles.
Type 1 resp failure.
Normal CXR unless the PE has been there for a while. Slide 11

Question 8

What investigations can be done for a PE?

Answer 8

PESI
ECG for right heart strain pattern
D-dimers raised
Isotope lung scan. Slide 13

Question 9

On an echo, what can be seen that is characteristic of a PE?

Answer 9

LV will be a D shape due to the RV being dilated and flattening the septum. Slide 18

Question 10

What are some underlying causes of PE?

Answer 10

Pregnancy, malignancy, autoantibodies, thrombophilia. Slide 19

Question 11

How do you treat DVT and PE?

Answer 11

Anticoagulants e.g. heparin, warfarin
Oral thrombin inhibitors e.g. dabigatran
Thrombolysis -ONLY severe PE
IVC filter. Slide 21-25

Question 12

What are causes for pulmonary venous hypertension?

Answer 12

LVSD ischaemia
Mitral regurgitation
Cardiomyopathy. Slide 30

Question 13

What are causes for pulmonary arterial hypertension?

Answer 13

Hypoxia
Multiple PE
Vasculitis
Drugs
Primary pulmonary hypertension. Slide 30

Question 14

What external factors can contribute to pulmonary hypertension?

Answer 14

Genetics
Obstructive sleep apnoea
ILD
Left heart disease
Obesity. Slide 32

Question 15

What are the clinical signs of PH and right heart failure?

Answer 15

Central cyanosis
Dependent oedema
Raised JVP with V waves
R ventricular heave
Enlarged liver. Slide 33

Question 16

What investigations can be done for pulmonary hypertension?

Answer 16

ECG
CXR
SaO2, arterial blood gases
Echocardiogram
D dimers 
VQ scan
CT pulmonary angiogram. Slide 34

Question 17

What is the treatment of primary pulmonary hypertension?

Answer 17

Prophylactic anticoagulation e.g. warfarin
Pulmonary vasodilators
Lung transplant. Slide 35

Question 18

What is chronic thromboembolic pulmonary hypertension?

Answer 18

A form of hypertension due to blood clots and scarring from trying to remove the blood clots, leading to blocking of the vessels. Slide 36

Question 19

What treatment can be given to someone with CTEPH?

Answer 19

Pulmonary arterial vasodilator e.g. Riociguat

Curative pulmonary endarterectomy. Slide 36