Flashcards in Pulmonary Vascular Disease Deck (54)
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1
Pulmonary Arteriovenous Malformations (PAVM): definition
- abnormal communication between artery and vein
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Why do patients get hypoxemic with an AVM
Shunt: no O2 exchange
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Mechanisms of injury to pulmonary vasculature
- pulmonary embolus
- pulmonary arteriovenous malformation
- inflammation of vessels
- scarring of vessels
- pulmonary edema
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Types of pulmonary embolisms
- thrombus
- tumor
- fat
- air
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What is a saddle PE
lodges in bifurcation of the pulmonary artery
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Method of increased mortality of PE
- unstable: hypotesion (SBP15 min
- much higher mortality up to 72 hrs
7
Individuals at risk for PE
- Women have increased risk
- obesity, smoking, hypertension, prolonged travel, immobilization, oral contraceptives
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Populations at risk for PE
- malignancy, pregnancy, stroke, hospitalized patients, nephrotic syndrome, acute spinal cord injury, joint replacements, inherited disorders
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Prediction model of PE & probability
- Wells Score
- probability: high>6, moderate: 2-6, low
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Diagnosis: labs & imaging
- labs: D-dimer (fibrin degradation product indicating recent coagulation) **do this first, then proceed if positive
- imaging: CT angiogram (gold standard), VQ scan
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Why do PEs occur
- Virchow's Triad: venous stasis, endothelial injury, hypercoagulable state
- arise from lower extremity proximal veins usually
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What happens when you get PE
- lung infarction
- low oxygen
- impairs CO
- V/Q mismatch
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Why do you get impaired CO w/ PE
- increased PVR leads to RV dilation, flattening IV septum, compressing LV space, which ultimately leads to decreased CO
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Treatment of PE
- supportive care: oxygen, vasopressors, ventilator
- thrombolytics
- anticoagulation (minimum of 3 months): heparin or fondaparinux then go home with oral coumadin, factor Xa inhibitors, or direct thrombin inhibitors
- IVC filter (rarely used): net that catches things in IVC
15
What does presentation with cyanosis tell you?
- CHRONIC hypoxia
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Pulmonary AVM: how are they grouped
- defined by size and how many feeding/draining vessels
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Pulmonary AVM: location
- usually lower lobe (70%)
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Pulmonary AVM associated with
- HHT (30%)
- trauma
- hepatopulmonary syndrome
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Causes of mortality with pulmonary AVM
- stroke
- cerebral abscess
- hemoptysis
- hemothorax
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Treatment of pulmonary AVM
- embolization: clot off vessels
- surgery
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Differential Dx of cavitating lung nodules
1. infection: septic emboli, fungal infection
2. malignancy
3. vasculitis
4. primary rheumatologic disease
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Lab presentation of ANCA vasculitis (granulomatous with polyangitis)
- elevated creatinine w/ sediment in urine
- C-ANCA elevated along w/ anti-PR3
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Vasculitis most common location
- small vessels of the lung
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Vasculitis types that present w/ kidney disease
- granulomatosis w/ polyangitis (Wengener's/C-ANCA vasculitis)
- goodpasture's disease (antibodies to collagen in basement membrane-autoimmune disease)
- lupus
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Classification of vasculitis & those occurring lungs
- classified by size of vessels effected
- occurring in lungs: microscopic polyangitis, granulomatosis w/ polyangitis
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Suggestive features of vasculitis
- mononeuritis multiplex (asymmetric polyneuropathy)
- palpable purpura
- pulmonary-renal
- fevers, myalgias, athralgias
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Diagnosis of ANCA vasculitis
- clinical picture
- radiographs
- histology (BIOPSY)
- lab - ANCA
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What is essential to diagnosis of vasculitis
- Tissue Biopsy
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Features seen on biopsy w/ vasculitis
- granulomas
- inflammatory cells around vessels
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