Pulmonary vascular disease Flashcards
Describe where a thrombus can form and embolise? (define)
Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.
State the major risk factors of venous thromboembolism?
Recent major trauma Recent surgery Cancer Significant cardiopulmonary disease e.g. MI Pregnancy Inherited thrombophilia
What are the 3 broad symptoms of pulmonary embolism?
Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (massive PE)
What are the signs of pulmonary embolism?
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachypnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
What does the wells score involve?
Includes symptoms and signs of VTE, previous VTE and risk factors
Describe a few of investigations involved for those with PE
FBC, CXR, ECG, D-dimer, CT for specifically the angiogram, V/Q scan, Echocardiography,
Which score can be used after the diagnosis has been made?
PESI score
Based on age, sex, comorbidity and physiological parameters
Describe treatment for PE
Oxygen Low molecular weight heparin e.g. dalteparin Warfarin Direct Oral Anticoagulants (DOAC) rivaroxaban, apixaban Thrombolysis Alteplase (rt-PA) Pulmonary Embolectomy
Define pulmonary hypertension
Elevated blood pressure in the pulmonary arterial tree.
Defined as a mean pulmonary artery pressure of > 25 mmHg.
Describe the epidemiology of idiopathy pulmonary hypertension
Rare, rapid progressive condition that can cause premature death
Secondary is more common and occurs in odler age
What are causes of pulmonary hypertension?
Idiopathic (group 1)
- Collagen vascular disease
- portal hypertension
Secondary to left heart disease (2)
Secondary to chronic respiratory disease (3)
Chronic Thromboembolic PH (CTEPH) (4)
Sarcoidosis ( group 5)
State some symptoms of pulmonary hypertension
Extertional dysponoea
chest tightness
exertional presyncope or syncope
State some signs of pulmonary hypertension
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
Describe some investigations for pulmonary hypertension
ECG Lung function tests Chest X-Ray Echocardiography V/Q scan CTPA
Right heart catherterisation to directly measure the pulmonary artery pressure
State the specific treatment for pulmonary hypertension
Calcium channel antagonist e.g. amlodipine
Prostacyclin
Endothelin receptor antagonists
Riociguat
Phosphodiesterase inhibitors
