Pulmonary Vascular Disease Flashcards Preview

MODHIII - Unit 3 > Pulmonary Vascular Disease > Flashcards

Flashcards in Pulmonary Vascular Disease Deck (54)
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1

Pulmonary Arteriovenous Malformations (PAVM): definition

- abnormal communication between artery and vein

2

Why do patients get hypoxemic with an AVM

Shunt: no O2 exchange

3

Mechanisms of injury to pulmonary vasculature

- pulmonary embolus
- pulmonary arteriovenous malformation
- inflammation of vessels
- scarring of vessels
- pulmonary edema

4

Types of pulmonary embolisms

- thrombus
- tumor
- fat
- air

5

What is a saddle PE

lodges in bifurcation of the pulmonary artery

6

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

8

Populations at risk for PE

- malignancy, pregnancy, stroke, hospitalized patients, nephrotic syndrome, acute spinal cord injury, joint replacements, inherited disorders

9

Prediction model of PE & probability

- Wells Score
- probability: high>6, moderate: 2-6, low

10

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

11

Why do PEs occur

- Virchow's Triad: venous stasis, endothelial injury, hypercoagulable state
- arise from lower extremity proximal veins usually

12

What happens when you get PE

- lung infarction
- low oxygen
- impairs CO
- V/Q mismatch

13

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

14

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

16

Pulmonary AVM: how are they grouped

- defined by size and how many feeding/draining vessels

17

Pulmonary AVM: location

- usually lower lobe (70%)

18

Pulmonary AVM associated with

- HHT (30%)
- trauma
- hepatopulmonary syndrome

19

Causes of mortality with pulmonary AVM

- stroke
- cerebral abscess
- hemoptysis
- hemothorax

20

Treatment of pulmonary AVM

- embolization: clot off vessels
- surgery

21

Differential Dx of cavitating lung nodules

1. infection: septic emboli, fungal infection
2. malignancy
3. vasculitis
4. primary rheumatologic disease

22

Lab presentation of ANCA vasculitis (granulomatous with polyangitis)

- elevated creatinine w/ sediment in urine
- C-ANCA elevated along w/ anti-PR3

23

Vasculitis most common location

- small vessels of the lung

24

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

25

Classification of vasculitis & those occurring lungs

- classified by size of vessels effected
- occurring in lungs: microscopic polyangitis, granulomatosis w/ polyangitis

26

Suggestive features of vasculitis

- mononeuritis multiplex (asymmetric polyneuropathy)
- palpable purpura
- pulmonary-renal
- fevers, myalgias, athralgias

27

Diagnosis of ANCA vasculitis

- clinical picture
- radiographs
- histology (BIOPSY)
- lab - ANCA

28

What is essential to diagnosis of vasculitis

- Tissue Biopsy

29

Features seen on biopsy w/ vasculitis

- granulomas
- inflammatory cells around vessels

30

Epidemiology of ANCA vasculitis: incidence & prevalence

- incidence: 15-20 per million/year
- prevalence: 90-300/million