Pulmonary Vascular Disease Flashcards
(41 cards)
What is a pulmonary embolism?
An embolus in the lung
What vessels do PE’s come from?
Venous
What is the usual origin of a PE?
Deep Vein Thrombosis
Besides blood, what else can PE’s be?
Air embolisms
What percentage of hospital admissions are PE’s?
1%
Which of the great vessels does a PE travel through to reach the lung?
Vena Cava then pulmonary artery
What are the major risk factors of PE’s?
- Recent major trauma - Surgery - Cancer - Massive cardiopulmonary disease - COPD - Pregnancy - Thrombophilia
Why does surgery increase the likelihood of PE?
- Blood is more likely to clot when in venous stasis
Why can cancer cause a PE?
- Cancer genesis increases clotting ability - Tumour can press on and narrow an organ
What is inherited thrombophilia?
- Over/under ability to clot
What is an example of an inherited thrombophilia?
Factor V Leiden
What are the main symptoms of a small PE?
- Pleuritic chest pain - Cough - Haemoptysis - Isolated acute breathlessness (dyspnoea)
Why does haemoptysis occur from a PE?
- Necrotic part distal to the PE can be coughed up
How does pleurisy result from this haemoptysis?
- Coughing up of the necrotic areas inflames the lung - Inflamed lung then rubs against the pleural cavity
Why does isolated acute dyspnoea occur from PE?
- Some areas of the lung are ventilated but not perfused - V/Q mismatch
What can be a result from a large PE?
- Syncope - Cardiac Arrest
- Why are vessels white in this CT?
- Where are the 2 pulmonary embolisms in the CT?
- IV contrast
- The small white circles with grey circles inside them
- Where is the PE in the CT?
- What is the name given to this PE?
- The large grey streak in the centre
- Saddle embolism
What are the two scoring systems used to indicate the liklihood of a patient having a PE?
- Wells’ Score
- Revised Geneva Score
What are the investigative steps taken to diagnose a PE?
- Full blood count
- Blood gases
- ECG
- D-dimer
What is a D-dimer?
Product of the clotting cascade?
If the D-dimer comes back postive what is the next step?
- CT pulmonary angiogram
- V/Q sca
- Echocardiogram
What would the echocardiogram examine and how would it allow PE diagnosis?
- Examine right ventricle
- If it is under strain then PE likely
Once a PE is diagnosed, BEFORE treatment what should the patient be started on?
- Potentially oxygen in V/Q scan is poor
