Pulmonary vascular disease Flashcards Preview

Respiratory system 2017 > Pulmonary vascular disease > Flashcards

Flashcards in Pulmonary vascular disease Deck (17):
1

Where do the thrombi that embolise and cause pulmonary embolism arise from?

Venous system, usually the deep veins of the legs

2

What are the major risk factors for venous thromboembolism?

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

3

What are the symptoms of pulmonary embolism?

Pleuritic chest pain
Cough
Haemoptysis
Isolated acute dyspnoea
Syncope
Cardiac arrest

4

What are the clinical signs of pulmonary embolism?

Pyrexia
Pleural rub
Stony dullness at base (pleural effusion)
Tachycardia
Tachypnoea
Hypoxia
Hypotension

5

What tests are used to assess probability of pulmonary embolism?

Wells score - symptoms, signs, previous VTE, risk factors

Revised Geneva score - risk factors, symptoms and signs

PESI risk score - age, sex, comorbidity, physiological parameters

6

What investigations are carried out for PTE?

Full blood count
Arterial blood gases
CXR
D-dimer
CT pulmonary angiogram
V/Q scan
Echocardiography
Thrombophilia test
CT of body for possible cancer

7

How do you treat PE?

Oxygen
Low molecular weight heparin
Warfarin
Anticoagulants
Thrombolysis
Pulmonary embolectomy

8

How long is treatment carried on after PE?

3 months, though can be lifelong if risk of it happening again is high

9

Describe pulmonary hypertension

Elevated blood pressure in pulmonary tree, with a mean pulmonary artery pressure of >25mmHg

Can be primary or secondary (usually in elderly with preexisting medical conditions)

10

What causes pulmonary hypertension?

Idiopathic (primary hypertension)
Secondary to chronic respiratory disease
Secondary to left heart disease
Chronic thromboembolic PH
Collagen vascular disease
Portal hypertension
Congenital heart disease (L to R shunt)
HIV

11

What are the symptoms of pulmonary hypertension?

Exertional dyspnoea
Chest tightness
Exertional pre syncope
Syncope

12

What are the signs of pulmonary hypertension?

Elevated JVP
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema

13

What investigations are carried out for pulmonary hypertension?

ECG - high P waves, tall R waves (RV strain)
Lung function tests
CXR - large pulmonary arteries
ECHO - leaky tricuspid, enlarged atria etc
V/Q scan
CT pulmonary angiography
Right heart catheterisation - measure pressure

14

How do you treat hypertension?

Treat underlying condition in secondary
Oxygen if hypoxic
Anticoagulation if needed/at risk
Diuretics for oedema
Ca channel antagonists e.g. amlodipine
Prostacyclin - relax SM of arteries
Endothelin receptor antagonists
Phosphodiesterase inhibitors

Thromoendarterectomy
Lung or heart transplant

15

Name some Endothelin receptor antagonists

Bosentan
Ambrisentan

16

Name some phosphodiesterase inhibitors

Sildenafil
Tadalafil

17

What is Thromoendarterectomy?

Removal of thrombi and webbing from arterial tree