Pulmonary Hypertension & PTE Flashcards
(21 cards)
what are the three mechanisms of pulmonary hypertension?
increased CO, increased PVR, increased PVP
pulmonary vascular dz, left-sided heart dz, chronic pulmonary dz and/or hypoxia, thrombotic and/or embolic dz and miscellaneous are all underlying dz processes that can lead to what?
pulmonary hypertension
T/F: pulmonary hypertension usually occurs secondary to another condition
TRUE, must investigate further
clinical signs for pulmonary hypertension look similar to what cardiac dz?
L-CHF
what is the typical signalment for PH?
dogs, middle-age to older, small breeds
what major clinical sign might lead you to think a patient has PH?
syncope or pre-syncope (often exertion-induced)
what murmur might you find in a patient with PH?
tricuspid regurgitation (PMI right apex)
concurrent DMVD > left apical systolic
T/F: a patient with severe pulmonary hypertension may also have systemic hypertension
FALSE, systemic HYPOtension
what is the gold standard test for diagnosing PH in small animals?
echocardiography
what signs might you see in an echo of a patient with PH?
- right ventricular hypertrophy & dilation
- right atrial dilation
- diastolic flattening of ventricular septum
- dilated PA and branches
what is the most commonly used drug to treat PH in small animals?
sildenafil
what is the MOA of sildenafil?
phosphodiesterase V inhibitor (pulmonary vasodilator)
obstruction of a PA by a thrombus that originated in systemic venous circulation (or w/in the RA/RV)
pulmonary thromboembolism
what are the three components of virchow’s triad leading to thrombus formation?
hypercoaguability, endothelial injury, and blood stasis
what tests would you conduct for a definitive diagnosis of PTE?
CT, angiography, or radionuclide ventilation/perfusion scan
what would you expect to see in thoracic radiographs of a patient with PTE?
MAY APPEAR NORMAL
+/- focal interstitial/alveolar infiltrates
+/- lung lobe consolidation
**hypovascular area/lobe
an arterial blood gas of a patient with PTE would show what?
hypoxemia, hypocapnia, increased A-A gradient
snowy presents to you with dyspnea and tachypnea. the owner reports he’s been more lazy than normal and has been coughing. you think he may have a PTE. thoracic radiographs are normal as well as D-dimer levels. are you correct in your diagnosis?
NO, normal D-dimer levels in a patient with acute signs of PTE generally rules out PTE
what are the goals of treating PTE?
1) prevent growth of pre-existing thrombi and formation of new thrombi
2) support the respiratory and CVS
what is acute treatment for PTE?
- unfractionated heparin or LMWH
- O2
- fluids
what anti-platelet drugs would you consider in a patient with PTE?
clopidogrel and aspirin
