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Respiratory > Pulmonary Embolism and Hypertension > Flashcards

Pulmonary Embolism and Hypertension Flashcards

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1
Q

what two conditions compose thromboembolic disease

A

deep vein thrombosis, pulmonary embolism

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2
Q

what is a pulmonary embolism

A

blockage of a pulmonary artery by a blood clot, fat, tumour or air

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3
Q

what is a pulmonary infarction

A

when blood flow and oxygen to the tissue is compromised (tissue may die)

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4
Q

what are the two locations of DVT

A

proximal (ileo-femoral), Distal (polpiteal)

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5
Q

a proximal DVT is a higher risk than a distal DVT as it is more likely to… (2)

A

most likely to;

  • embolise
  • lead to chronic venous insufficiency and venous leg ulcers
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6
Q

what is the clinical presentation of a DVT

A

whole leg or half calf involved depending on site; swollen, hot, red, tender

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7
Q

what are the differential diagnosis of a DVT

A

popliteal synovial rupture, superficial thrombophlebitis, calf cellulitis

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8
Q

how is a DVT investigated

A

ultrasound doppler leg scan, CT scan

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9
Q

how can a DVT turn into a pulmonary embolism

A

predisposing DVT may be silent, sub clinical, and can embolise

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10
Q

what does the clinical presentation of a pulmonary embolism depend on

A

the size of the clot

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11
Q

how does a large pulmonary embolism present

A

cardiovascular shock, low BP, central cyanosis, sudden death

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12
Q

how does a medium pulmonary embolism present

A

pleuritic pain, haemoptysis, breathless (goes out to periphery (lungs))

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13
Q

how does a small recurrent pulmonary embolism present

A

progressive dyspnoea (difficult breathing), pulmonary hypertension and right heart failure

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14
Q

what are the risk factors for DVT and PE

A

thrombophilia (abnormality of blood clotting), contraceptive pills (particularly in smokers), hormone replacement therapy, pregnancy, pelvic obstruction, trauma, surgery, immobility (Venastasis), malignancy, pulmonary hypertension, obesity

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15
Q

what is the history of a presenting complaint in PE

A

breathlessness, chest pain, haemoptysis, leg pain/swelling, collapse/ sudden death

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16
Q

what are the clinical features of a PE

A

tachycardia, tachyponea, cyanosis, fever, low BP, crackles, pleural effusion

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17
Q

describe the arterial blood gases of of a patient with a PE

A

decreased PaO2 and SaO2 (type one resp failure: PaCO2 normal or low)

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18
Q

describe the chest x ray of someone with a PE

A

basal atelectasis (lung collapse), consolidation, pleural effusion

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19
Q

how is a DVT prevented

A

early post-op mobilisation, compression stockings, calf muscle exercises, subcutaneous heparin pre-op, direct oral anticoagulant medication

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20
Q

what does an ECG show that helps to diagnose a PE

A

acute right heart strain pattern

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21
Q

what happens to D-dimers in PE

A

usuallt raised

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22
Q

what does an isotope lung scan show that helps to diagnose a PE

A

ventilation/ perfusion; sensitive for small peripheral emboli. Perfusion defect before infarction, p + v matched defect after infarction

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23
Q

what does a PESI score mean

A

pulmonary embolism severity index- calculates risk

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24
Q

how can troponin and BNP show that the heart is under strain

A

troponin rises, BNP/ pro-BNP present

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25
how is a low risk PE managed
ambulatory pathway to home
26
describe the clinical factors of a low risk PE
-ve troponin, low PESI, no oxygen, no co-morbidities
27
what are the clinical factors of a high risk PE
cardiovascular compromise
28
how is a high risk PE managed
may require thrombolysis (breakdown of clots), BP monitoring, medical high dependency unit
29
how is a intermediate/intermediate-high risk PE treated
ward or MHDU
30
how does anticoagulant prevent DVT/PE
prevents clot propagation, tips balance to thrombolysis, body dissolves clot
31
describe how heparin is administered
subcutaneous low mol weight (rarely IV) once daily
32
what drug is started at the same time as heparin to treat a DVT/PE
warfarin
33
how does warfarin prevent a DVT/PE
blocks the formation of vitamin K clotting factors. antagonises vit k dependant prothrombin
34
what anti clotting treatment is as effective as heparin + warfarin
DOACs- direct oral thrombin inhibitor (dabigatran) or factor x inhibitor (rivaroxaban) (use both solely from start)
35
how long does warfarin take to work
3 days
36
what should happen after 3-5 days on a herparin + warfarin combo when the patient's INR>2
stop heparin, or use NOAC (novel oral) without LMWH
37
how long should the warfarin be administered for
3-6 months
38
how is warfarin use monitored
with INR- target range
39
what substances can interact with warfarin
alcohol, antibiotics, aspirin, NSAIDS, amiodarone, cimetidine, omeprazole, grapefruit.
40
what is a thrombolysis
treatment to dissolve clots- tissue plasminogen activator (tPA- tenecteplase)
41
what are the features of a life threatening PE
low bp, severe hypoxaemia due to main pulmonary artery occlusion
42
when is a thrombolysis used
in life threatening PEs
43
what is used to prevent embolisation from large ileofemoral/ IVC clot (in recurrent PEs)
IVC filter (inferior vena cava)
44
what are the relative risks of a PE and how should they be treated be treated
pregnancy/ post partum
45
what anticoagulant drugs have long half lives
low MW heparin, warfarin
46
when does the use of anticoagulant need to stop and effect reversed
if bleeding
47
how is warfarin reversed
with vitamin K
48
how is heparin reserved
protamine
49
how are NOACs reversed
no reversal agents
50
what does the duration of treatment depend on?
balance of risk (rpt clot) vs bleeding
51
how should intravenous drug users or people with active cancer be treated
fragmin only
52
when is life long treatment necessary
recurrent DVT/PE
53
describe the flow and pressure of a healthy pulmonary circulation system
high flow, low pressure
54
what is normal mean pulmonary arterial blood pressure
12-20 mmHg
55
when is mPAP pulmonary hypertension
>25 mmHg
56
how is mPAP measured
right heart catheter
57
how can systolic pulmonary pressure be estimated
with an ECHO doppler
58
what is left heart disease
pulmonary venous hypertension
59
what can cause primary pulmonary hypertension
hypoxia, multiple PE, vasculitis, drugs, HIV, cardiac left to right shunt
60
what is cor pulmonale
right heart disease secondary to lung disease
61
what are the components of cor pulmonale
fluid retention due to hypoxia +/- right heart failure
62
what can cor pulmonale complicate
COPD, fibrotic lung disease, chronic PE, chronic ventilatory failure
63
what are the clinical signs of pulmonary hypertension and right heart failure
central cyanosis (if hypoxic), dependant oedema (influenced by gravity), raised JVP, enlarged liver
64
how is pulmonary hypertension investigated
ECG, CXR, SaO2 and ABGs, pulmonary function with DLCO, echo, cardiac catherterisation, D-Dimers, VQ scan, CTPA, cardiac MRI, auto-antibodies (if vasculitis suspected)
65
what is primary pulmonary arterial hypertension a disease of
pulmonary arteries/arterioles
66
what is a symptom of primary pulmonary arterial hypertension
progressive exertional breathlessness
67
what is the prognosis of primary PAH without treatment
3 years
68
how is primary PAH treated
prophylactic anticoagulant (warfarin), O2 if hypoxic, pulmonary vasodilators- (primary disease only), lung transplant
69
how is chronic thromboembolic pulmonary hypertension treated
ricoiguat (pulmonary arterial vasodilator), pulmonary endarterectomy (surgical procedure to unblock a carotid artery)

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