Pulmonary vascular disease

Question 1

What is two examples of pulmonary vascular diseases

Answer 1

Pulmonary embolism

Pulmonary hypertension

Question 2

Define pulmonary embolism

Answer 2

Blood clot traveling from one part of the body to antother part

Question 3

What is pulmonary embolism medically treated with

Answer 3

anti coagulation

Question 4

Where does the blood clot lodge in a pulmonary embolism

Answer 4

Peripheral pulmonary artery

Question 5

Major risk factors of pulmonary embolism

Answer 5

Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
Inherited thrombophilia e.g Factor V Leiden

Question 6

What is thrombophilia

Answer 6

A genetic disorder that means you have a predisposition to blood clots

Question 7

How can surgery cause blood clotting

Answer 7

In bed after operation, immobility results in clot

Surgery stimulates blood clotting

Question 8

What are the symptoms of small blood clots to the lungs

Answer 8

Pleuritic chest pain

Cough and haemoptysis

Question 9

Define pleuritic chest pain

Answer 9

burning or dull pain in the right or the left side of the heart during breathing

Question 10

Define Isolated acute dyspnoea, and what causes this in a pulmonary embolism

Answer 10

Difficulty in breathing, caused by the blood being ventilated but not perfused

Question 11

In a massive pulmonary embolism what is the symptom

Answer 11

Cardiac arrest

syncope - loss of consciences

Question 12

What are the signs of a small pulmonary embolism

Answer 12

Pleural rub - scrunching sound
Pleural effusion - fluid around the lung
Pyrexia - increased temp

Question 13

What are the signs of a major pulmonary embolism

Answer 13

Tachycardia - increased heart rate
hypotension - low BP
tachypnoea - rapid breathing
hypoxia

Question 14

How can you test the probability that someone has a pulmonary embolism

Answer 14

Symptoms and signs present
Previous history
Has risk factors

Question 15

List the different investigations to diagnose pulmonary embolism

Answer 15

Full blood count, biochemistry, blood gases
Chest X-Ray
ECG
D-dimer
CT Pulmonary Angiogram (CTPA)
V/Q scan
Echocardiography
Consider CT abdomen and mammography
Consider thrombophilia testing

Question 16

What is the purpose of a D-dimer test?

Answer 16

D-dimer is the product of blood clotting, if D-dimer is negative means unlikely have pulmonary embolism

Question 17

What does a V/Q scan show

Answer 17

The ventilation and perfusion in the lungs

Question 18

What does an ECG measure and what is it checking for?

Answer 18

Heart rhythms, checking for tachycardia

Question 19

When is a Echocardiography taken?

Answer 19

When a large pulmonary embolism is suspected

Question 20

Why would a CT abdomen and mammogram be taken

Answer 20

to rule out any other possibilities e.g. cancer

Question 21

For the prognosis what factors need to be taken into account

Answer 21

How many disease and conditions you have
the state of your health
Age
Sex

Question 22

What tablets are given to treat pulmonary embolism

Answer 22

antocoagulants:
Warfarin
apixaban
rivaroxaban

Question 23

What treatment is given to treat major pulmonary embolism

Answer 23

thrombolysis

Question 24

What works immediately to relive a pulmonary embolism

Answer 24

oxygen

Question 25

What treatment is Pulmonary Embolectomy

Answer 25

A cardiac surgeon opening up and removing embolism

Question 26

What is the definition for pulmonary hypertension

Answer 26

Elevated blood pressure in the pulmonary arterial tree

Question 27

What arterial pressure above is counted as hypertension

Answer 27

>25mmHg

Question 28

What is characteristics of primary hypertension

Answer 28

Rare Common amount young groups rapid and progressive if left untreated

Question 29

What is the characteristics of secondary hypertension

Answer 29

Stems from other conditions Common in older age group More common

Question 30

What can arise from left heart disease

Answer 30

pulmonar venous hypertension

Question 31

What are causes of pulmonary hypertension

Answer 31

idiopathic - spontaneous secondary: ``` chronic repiratory disease left heart disease collagen vascular disease portal hypertension congenital heart disease (L to R shunt) HIV infection chronic thromboembolic ```

Question 32

What is chronic thromboembolic

Answer 32

A pulmonary hypertension caused by blockages in the blood vessels to the lungs due to scar tissue. The scars are the result of blood clots that the body has not properly cleared

Question 33

What are the symptoms of pulmonary hypertension

Answer 33

Chest tightness Exertional presyncope - feeling light headed (blacking out) Exertional dyspnoea - shortness of breathe on exertion

Question 34

What are signs of pulmonary hypertension

Answer 34

``` Elevated jugular venous pressure Right ventricular heave Loud pulmonary second heart sound Hepatomegaly (congested liver) Ankle oedema ```

Question 35

What are the two signs that show advanced pulmonary hypertension

Answer 35

Hepatomegaly | Ankle oedema

Question 36

What investigation are used to diagnose pulmonary hypertension

Answer 36

``` ECG Lung function tests Chest X-Ray Echocariography V/Q scan CTPA Right heart catheterisation ```

Question 37

What does a tricuspid valve leaks allow us to measure

Answer 37

an indirect measurement to estimate pulmonary artery pressure

Question 38

What does a Echocardiography allow measurement of

Answer 38

Direct pulmonary artery pressure | Indirect pressure on the capillaries

Question 39

What does a right-heart catheterization measure

Answer 39

how well or poorly your heart is pumping, and to measure the pressures in your heart and lungs

Question 40

Where is catheter passed in a right-heart catheterization

Answer 40

Pulmonary artery

Question 41

What else does a right-heart catheterization allow indirect measurement of

Answer 41

measurement of wedge pressure | measurement of cardiac output

Question 42

What is the general treatment of pulmonary hypertension

Answer 42

``` Treat underlying condition Oxygen Anticoagulation Diuretics Lung or heart transplant Thromoendarterectomy - specialised surgery ```

Question 43

What is specific anticoagulant and diuretics treatments for pulmonary hypertension

Answer 43

``` Calcium channel antagonist e.g. amlodipine Prostacyclin Endothelin receptor antagonists: bosentan ambrisentan Phosphodiesterase inhibitors: sildenafil tadalafil ```