B4.067 - Pulmonary Vascular Disease

Question 1

3 major diseases of pulmonary vessels

Answer 1

Pulmonary embolism Pulmonary hypertension Pulmonary edema

Question 2

what is the swan ganz catheter

Answer 2

invasive hemodynamic measurement of pulmonary artery pressures

Question 3

which part of the heart has the lowest pressure

Answer 3

right atrium

Question 4

SVR calculation (systemic vascular resistance)

Answer 4

SVR = 80 x (MAP - RAP)/ (CO)

Question 5

calculation of pulmonary vascular resistance (PVR)

Answer 5

PVR = 80 x (MAP - LAP)/Pulmonary blood flow

Question 6

PAH classification

Answer 6

1. pulmonary artery HTN 2. Left heart disease 3. PH with respiratory disease or hypoxia 4. chronic thromboembolic disease 5. unclear/multifactorial

Question 7

what is PAH

Answer 7

one form of PH sustained elevation of mean pulmonary arterial pressure >25mmHg Mean pulmonary capillary wedge pressure (PCWP) and /or mean left ventricular end diastolic pressure <15 mmHg

Question 8

normal blood pressure in pulmonary artery

Answer 8

12-16

Question 9

multi hit hypothesis of pathogenesis of pulmonary arterial hypertension

Answer 9

primary genetic background modifier genes environmental trigger

Question 10

Answer 10

normal pulmonary artery and alveolus

Question 11

Answer 11

pulmonary artery remodeling

internal fibrosis

medial hypertrophy

adventitial proliferation

luminal obliteration

Question 12

signs of pulmonary HTN

Answer 12

JVD

Edema

chest pain

Question 13

what is prostacyclin

Answer 13

PGI2

activity through cAMP

Vasodilator

inhibits proliferation of vascular smooth muscle

Decreases platelet aggregation

decreased prostacyclin synthase in PAH

Question 14

goals of PAH therapy

Answer 14

fell better

live longer

breath

prevent blood clots

decrease scarring/blocked pipes

Question 15

supportive therapy for PAH

Answer 15

oxygen

coumadin

digoxin

diuretics

treatment of underlying/coexisting disease

Question 16

spectrum of treatments for PAH

Answer 16

nothing

oral medicines

nebulized medicines

continuously infused medicines

gene therapy

lung transplant

Question 17

classes of drugs for PAH

Answer 17

prostacycline

prostacycline analogues

Phosphodesterase inhibitors

endothelin receptor antagonists

Question 18

oral therapies for PAH

Answer 18

sildenafil

tadalafil

riociguat

bosentan

ambrisentan

macitentan

treprostinil

selexipag

Question 19

inhaled therapies for PAH

Answer 19

loloprost (6-9 inhalations daily)

Treprostinil (dosed QID up to 15 puffs)

Question 20

infusional therapies for PAH

Answer 20

Epoprostenol

Treprostinil

Question 21

how do thrombi form

Answer 21

blood stasis

hyper coagulable states

vessel wall abnormalities

Question 22

where do emboli originate

Answer 22

deep veins of lower extermities or pelvis

upper extremity veins

right heart chamber

SVC

Question 23

what happens when an embolus occur

Answer 23

decreased or total cessation of pulmonary blood flow to affected distal zone

physiologic dead space increased

bronchoconstriction

surfactnant production decreases (atelectasis)

arterial hypoxemia

Question 24

how does a PE cause increased PVR

Answer 24

50% occlusion necessary

dependant on amoutn of surface involved, underlying cardiopulmonary reserve and neurohormonal response

when mean PAP reaches >40 mmHg the RV will fail and collapse occurs

Question 25

what causes death in PE

Answer 25

from cardiovascular collapse rather than respiratory failure

Question 26

clinical symptoms of PE

Answer 26

pain or swelling of extremity is most common dyspnea pleuritic chest pain cough apprehension hemoptysis physical findings include tachycardia, tachypnea, hypoxia

Question 27

Answer 27

DVT

Question 28

Answer 28

PE

Question 29

Answer 29

PE

Question 30

how do you treat PE

Answer 30

prevent - DVT prophylaxis, anticoagulants, mechanical compression acute - anticoagulation

Question 31

anticoagulant drugs

Answer 31

subQ heparin, warfarin, low MW heparin

Question 32

supportive therapy for PE

Answer 32

oxygen, fluids and vasopressors for hypotension, thrombolytic therapy only with shock/cardiac arrest, embolectomy

Question 34

cardiogenic pulmonary edema

Answer 34

pressure related LV problesm, left sided valve problems, pulmonary vein obstruction

Question 35

non cardiogenic pulmonary edema

Answer 35

leaky capillaries ARDS, HAPE, neurogenic, opiate OD

Question 36

how do lungs protect themselves from excessive movement of fluid into interstitial spaces

Answer 36

lymphatic drainage aided by changes in intrathoracic pressure with normal respiration

Question 37

gel like matrix of hte lung is capabel of what

Answer 37

absorbing the additional fluid without affecting interstitial pressures

Question 38

Answer 38

pulmonary edema

Question 39

Answer 39

pulmonary edema

Question 40

pathophys of pulmonary edema

Answer 40

decreased lung compliance decreased lung volume increased airway resistance increased work of breathing V/Q mismatch increased A-a gradient hypoxemia

Question 41

clinical findings of mild pulmonary edema

Answer 41

dyspnea orthopnea few rales in bases variable amount of peripheral edema

Question 42

clinical findings of acute pulmonary edema

Answer 42

prod cough of frothy blood tinged sputum tachypnic apprehensive peripheral extremities cool, clammy, cyanotic rales and wheezing engorged neck veins tachycardia cardiac enlargement

Question 43

Answer 43

pulmonary edema

Question 44

managment of cardiogenic edema

Answer 44

improve cardiac function afterload reduction, inotropes eliminate excess fluid oxygen/ventilatory support advanced therapies - ECMO, LVAD, transplant

Question 45

managment of non cardiogenic edema

Answer 45

oxygen ICU advanced support treat underlying disease