Flashcards in Lecture 6 Pulmonary Vascular Disease Deck (30):
1
A swan catheter measures what?
LA pressure aka pulmonary capillary wedge pressure
2
Pulmonary arterial hypertension:
elevation of pulm arterial pressure to more than ____ at rest and with a pulmonary capillary wedge pressure less than ____ mm hg
25, 15
3
what generally causes pulmonary arterial hypertension? Who is the classic patient? (according to pathoma)
generally idiopathic (IPAH);
young women
4
IPAH is heritable, due to a inactivating mutation in ____ gene, which normally inhibits ____ proliferation. Other gene mentioned in notes is ____
BMPR2;
vascular smooth muscle;
ALK1
5
what connective tissue disease is associated with PAH?
systemic sclerosis (Associated with poor prognosis)
6
_____ may be the most prevalent cause of PAH worldwide
shistosomiasis
7
clinical findings in PAH:
increased ___ (heart sound). ____ lift. ____ regurg. late ____.
P2 (closing of pulmonic);
parasternal; tricuspid, cyanosis
8
2 drugs associated with pulm HTN (mentioned in notes/FA)
cocaine, anorexigens (also meth)
9
Give one particularly common example of Pulm HTN due to left heart disease
mitral stenosis (or regurg);
ie LV dysfunction, Aortic stenosis
10
Pulm HTN due to hypoxemia:
disease such as ____ cause hypoxemic _____ of blood vessels, leading to general vaso____ of pulmonary vessels
COPD (or sleep apnea, high altitdue);
vasoconstriction, constriction
11
Recurrent pulmonary _____ can cause pulm HTN due to ____ and decreased cross sectional area of the vascular bed
emboli; reorganization (of emboli)
12
Pulm Aterial HTN pathological changes:
medial ____ due to increased ___ ____;
____ fibrosis;
_____ arteriopathy (High Yield as per pathoma)
hypertrophy, smooth muscle;
intimal;
plexiform
13
what does scleroderma look like on CT (mentioned a few times in class)
honeycomb
14
Path of HTN:
name 2 vasodilators that are decreased;
name a vasoconstrictor that is increased
prostacyclin, NO;
endothelin
15
What should be given first to a patient with PAH?
Oxygen
16
______ syndrome can cause pulmonary HTN secondary to congenital heart defect
Eisenmenger's
17
single classic symptom of Pulm HTN mentioned in pathoma
exertional dyspnea;
other symptoms = fatigue, syncope, cough
18
gold standard of diagnosing PAH:
right heart catheterization (Swan)
19
heart changes in pulm HTN:
initially _____, then death from decompensated ___ ___
RVH; cor pulmonale
20
With RVH, large ___ waves are seen in leads V1 and V2
R
21
2 biomarkers of PAH (Associated with survival)
BNP; hyponatremia
22
treatment of PAH:
endothelin receptor agonists such as ____.
PDE-5 inhibitors such as ____.
Prostacyclin analogs such as ____
bosentan;
sildenafil;
epoprostenol (or iloprost)
23
3 side effects of epoprostenol mentioned in FA:
flushing, jaw pain, hypotension
24
Virchow triad associated with developing DVT
SHE:
Stasis; hypercoaguability, endothelial damage
25
Pulmonary embolus presents as sudden-onset ____, chest pain, ______, and _____.
dyspnea; tachycarida, tachypnea (according to FA)
26
How would you treat a pulmonary embolus causing hemoptysis?
blood thinners (mentioned in lecture)
27
What happens to the V/Q ratio in PE?
obstruction-->moves ratio towards affinity (because very low Q)
28
prophylaxis/acute management of PE (according to FA)
LMWH or unfractionated heparin
29
long term prevention of PE (According to FA)
oral anticoagulants such as warfarin
30