Pulmonary vascular disease

Question 1

What are the major risk factors for venus thromboembolism?

Answer 1

-Recent major trauma
-Recent surgery- (not moving/bed ridden)
-Cancer - blood more coagulable
Significant cardiopulmonary disease e.g. MI
-Pregnancy
-Inherited thrombophilia e.g. Factor V Leiden

Question 2

Where does a thrombus normally form?

Answer 2

Usually in deep veins of the legs

Question 3

Where does a thrombus normally embolise?

Answer 3

Pulmonary arteries

Question 4

How many hospital admissions are because of this?

Answer 4

Estimated 1%

Question 5

What is an embolism?

Answer 5

A blood clot travelling from one part the body to another

Question 6

What symptoms arise if there is an isolated small blood clot in a large peripheral artery?

Answer 6

Pleuritic chest pain, cough and haemoptysis

Question 7

What happens when there is an isolated small blood clot in a large peripheral artery?

Answer 7

Part of the lung becomes infarcted= necrotic tissue. Surface of lung becomes inflammed pleura rubs against chest wall= pleurisy

Question 8

What are the symptoms of 2 bilateral clots in the pulmonary arteries.

Answer 8

Isolated acute dyspnoea (breathlessness)

Question 9

What are the symptoms of a massive pulmonary embolism

Answer 9

Syncope (black out) or cardiac arrest

Question 10

What are the signs of an isolated small blood clot in a large peripheral artery?

Answer 10

Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)

Question 11

What are the signs of 2 bilateral clots in pulmonary arteries?

Answer 11

Tachycardia, tachpnoea and hypoxia

Question 12

What are signs of a major pulmonary embolism?

Answer 12

Tachycardia, hypotension, tachypnoea (fast resp rate), hypoxia

Question 13

What pre-test probability scores exist to determine likelyhood of developing a PE

Answer 13

• Wells score
• -Includes symtoms and sings of VTE
• Revised Geneva score
• -Based on risk factors , symptoms and signs

Question 14

What Investigations are used to determine if some has a PE?

Answer 14

• Full blood count,biochemistry, blood gases
• Chest X-ray
• ECG
• D-dimer
• CT Pulmonary angiogram
• V/Q scan
• Echocardiography
• Consider CT abdomen and mammography
• Consider thrombophilia testing

Question 15

What might show up in a chest X-ray when a patient has a PE?

Answer 15

Small pleural effusion

Question 16

What is the most common ECG for someone with a PE?

Answer 16

Simple tachycardia

Question 17

What is a D-dimer test?

Answer 17

Blood test clotting pathway in blood if high continue tests

Question 18

What part of the heart should be specifically looked at when a suspected PE is present and how?

Answer 18

Right atrium with echocardiography

Question 19

What is the prognosis of a PE and how is it determined?

Answer 19

• Mortality at 30 days varies from 0 to 25%

- PESI Score (based on age, sex, comorbidity and physiological parameters)

Question 20

What is the treatment for PE?

Answer 20

• Oxygen
• Low molecular weight heparin e.g. dalteparin
• Warfarin
• Direct Oral anticoagulants (DOAC)
• Thrombolysis (If extreme)
• Pulmonary Embolectomy

Question 21

Name 2 direct oral antocoagulant (DOAC)

Answer 21

• Rivaroxaban

- Apixaban

Question 22

Name a drug used for thrombolysis?

Answer 22

Atlepase (rt-PA) recombinant tissue plasminogen activator

Question 23

What is pulmonary hypertension?

Answer 23

-Elevated blood pressure in the pulmonary hypertension.

Question 24

What is the pressure to define pulmonary hypertension?

Answer 24

> 25mmHg

Question 25

What are the causes of pulmonary hyertension?

Answer 25

- Idiopathic - Secondary to chronic respiratory disease - Secondary to left heart disease - Chronic Thromboembolic PH (CTEPH) - Miscellaneous

Question 26

What are the miscellaneous causes of pulmonary hypertension?

Answer 26

- Collagen vascular diease - Portal hypertension- liver disease - Congentital heart disease (SHUNT) - HIV infection

Question 27

What are the symptoms of pulmonary hypertension?

Answer 27

- Extertional dyspnoea - Chest tightness - Exertional presyncope or syncope

Question 28

What are the signs of pulmonary hypertension?

Answer 28

- Elevated (jugular venous pressure) - Right venticular heave - Loud pulmonary second heart sound - Hepatomegaly - Ankle oedema- increased pressure of venous tissue

Question 29

What investigation of pulmonary hypertension are there?

Answer 29

- ECG - Lung function tests - Chest x-ray - Echocardigraphy - V/Q scan - CTPA (CT pulmonary angiogram) - Right heart catherisation

Question 30

Describe what right heart catheterisation

Answer 30

- Allows direct measure of pulmonary artery pressure - measurement of wedge pressure - measurement of cardiac output

Question 31

What is the general treatment of pulmonary hypertension?

Answer 31

- Treatment of underlying condition - Oxygen - Anticoagulantion - Diuretics

Question 32

What is the specific treatment for pulmonary hypertension

Answer 32

- Calcium channel antagonist - Prostacyclin - Endothenlin receptor anatagonists - Phosphodiesterase inhibitors

Question 33

What is the function of prostacyclin?

Answer 33

Vasodilation

Question 34

name 2 endothelial receptor antagonists?

Answer 34

- Bosentan | - Ambrisentan

Question 35

Name 2 phosphodiesterase inhibitors

Answer 35

- Sidenafil-Viagra | - Tadalafil

Question 36

What are the alternative treatments to Pulmonary Hypertension?

Answer 36

- Thromboendarterectomy | - Lung transplant/heart transplant