Pulmonary vascular disease

Question 1

What is a pulmonary embolism (PE)

Answer 1

a thrombus forming in the deep veins
of the lower limbs. This spectrum of thromboembolic
disease, encompassing risk, deep vein thrombosis
(DVT) and subsequent embolus, is collectively termed
venous thromboembolism (VTE).

Question 2

what are the 3 components of Virchow’s triads

Answer 2

hypercoagulability
endothelial damage
venous stasis

Question 3

what are PE risk factors?

Answer 3

SPAM HD

surgery
pregnancy
age
maligenancy

Hormones (COCP/HRT)
DVT

Question 4

what is the S1Q3T3 pattern in PE

Answer 4

V1: S -wave
V3: Q-wave and inverted T-wave

Question 5

what are the components in the well score

Answer 5

signs of DVT-3
Alternative Dx less likely than DVT-3
HR>100bpm-1.5
immobility >3 days or surgery in the last 4 wks-1.5
Previous DVT/PE-1.5
Haemoptysis-1
Malignancy-1

Question 6

Management of PE

Answer 6

Wells score

is the score is >4, a PE is more likely. Then use CTPA
If there is allergy to CT contrast use V/Q SPECT

1. LMWH or fondaparinux.
   Unfractionated heparin if the patient has renal failure or at risk of bleeding
2. Continue LMWH/fondaparinus for 5 days or until INR is >= 2 for over 24hrs
3. Warfarin for those with provoked PED for 3 months
4. Unprovoked DVT/PE for 6 months

5 IVC filter

6 rivaroxaban can be alternative

Question 7

In the treatment of PE is the patient has renal failure and cannot have LMWH or fondaparinux what can we use instead?

Answer 7

unfractionated heparin (UFH) or at risk of bleeding

Question 8

What is pulmonary hypertension

Answer 8

an increase in mean pulmonary
arterial pressure ≥25mmHg at rest or ≥35mmHg with
exercise.

Question 9

investigation of pulmonary hypertension

Answer 9

Right heart catheterisation is confirmatory, but
other tests should be carried out, such as blood tests,
autoimmune screening (especially for scleroderma),
ECG, spirometry and echocardiography.

Question 10

Management of pulmonary hypertension

Answer 10

1. vasodilator testing

if positive–> CCB

if negative–>prostacyclin analogues

Endothelin receptor antagonists,

e. g. bosentan
iii. Phosphodiesterase inhibitors
e. g. sildenafil

Question 11

what is cor-pulmonale

Answer 11

cor pulmonale refers to an alteration
of structure and function of the right ventricle
secondary to lung disease, most commonly COPD and
pulmonary hypertension.

Question 12

management of cor-pulmonale

Answer 12

investigation vis echo

treat the underlying cause (COPD, VTE)

long-term oxygen therapy

Diuretics

CCB