Pathoma - Pulmonary HTN and RDS Flashcards Preview

CPR Week 6 > Pathoma - Pulmonary HTN and RDS > Flashcards

Flashcards in Pathoma - Pulmonary HTN and RDS Deck (21)
Loading flashcards...

Normal pressure in the pulmonary circuit compared to what is considered high pressure

Normal is about 10mmHg
High pressure is > 25mmHg


pulmonary HTN is characterized by what?

Atherosclerosis of the pulmonary trunk

Smooth muscle hypertrophy of pulmonary arteries

Intimal fibrosis

Plexiform lesions


Pulmonary HTN leads to ______

Right ventricular hypertrophy/right sided heart failure


Presentation of pulmonary HTN

Exertional dyspnea, especially in younger women


Primary pulmonary HTN

Seen in young adult females unknown etiology


Genetic correlation with primary pulmonary HTN

Familial forms are related to inactivating mutations of BMPR2, which leads to proliferation of vascular smooth muscle


Secondary Pulmonary HTN is caused by what

Arises from hypoxemia (like in COPD and ILD) or increased volume in the pulmonary circuit (like in congenital heart disease)

May also arise with recurrent pulmonary embolism


Acute Respiratory Distress Syndrome (ARDS)

Damage to alveolar capillary interface in the alveolar sacs leads to leaking of protein rich fluid that builds up a hyaline membrane diffusely in the lung.


Histology of ARDS

Alveolar sacks with hyaline rings around the inside


Problems with ARDS

1. Exchange barrier in alveolar sacs leads to cyanosis

2. Membranes are sticky, causing pressure on the sacs to collapse.

Overall: Hypoxemia and cyanosis with respiratory Distress



White out diffusely


Cause of ARDS


Sepsis, infection, shock, car accident, pancreatitis, etc.

Activation of neutrophils induces protease mediated and FR damage of Type I and type II pneumocytes


Treatment of ARDS

Addressss underlying cause...

Ventilation with positive and expiratory pressure (PEEP)

Recovery may be complicated by insterstitial fibrosis


Why do we get fibrosis?

Problem with pneumocyte type II, which is the regeneration stem cell of the lung. Without this, you have to do repair instead of regeneration, leading to the interstitial fibrosis


Neonatal respiratory distress syndrome

Respiratory distress due to inadequate surfactant levels


____ pneumocytes produce surfactant which _____

Type II pneumocyte

Reduces surface tension of the lungs so the alveolar sacs don't collapse


Clinical features of neonatal respiratory distress syndrome

1. Increasing respiratory effort after birth, tachypnea with use of accessory muscles, and grunting

2. Hypoxemia with cyanosis

3. Diffuse granularity ofl ung on CXR


Neonatal respiratory distress syndrome is associated with what 3 things?

1. Prematurity which we can screen with L:S (>2) ratio to screen for surfactant levels (Lethicin (AKA phosphatidylcholine) and sphingomyelin make surfactant)

2. C-section delivery

3. Maternal diabetes


How is maternal diabetes related to neonatal respiratory distress syndrome?

Mom makes too much sugar and sends it to baby who has an ormal pancreas that dishes out insulin. The insulin breaks down surfactant


Complications of neonatal respiratory distress syndrome

1. Hypoxemia - increases risk for persistence of patent ductus arteriosus and necrotizing enterocolitis

2. Supplemental oxygen increases risk for free radical injury


Supplemental oxygen, which increases risk for free radical injury, can lead to what?

- Blindness
- Damage to lungs during earlyl ung development