Flashcards in Pulmonary vascular disease Deck (17):
Where do the thrombi that embolise and cause pulmonary embolism arise from?
Venous system, usually the deep veins of the legs
What are the major risk factors for venous thromboembolism?
Recent major trauma
Significant cardiopulmonary disease e.g. MI
Inherited thrombophilia e.g. factor V Leiden
What are the symptoms of pulmonary embolism?
Pleuritic chest pain
Isolated acute dyspnoea
What are the clinical signs of pulmonary embolism?
Stony dullness at base (pleural effusion)
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
What investigations are carried out for PTE?
Full blood count
Arterial blood gases
CT pulmonary angiogram
CT of body for possible cancer
How do you treat PE?
Low molecular weight heparin
How long is treatment carried on after PE?
3 months, though can be lifelong if risk of it happening again is high
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)
What causes pulmonary hypertension?
Idiopathic (primary hypertension)
Secondary to chronic respiratory disease
Secondary to left heart disease
Chronic thromboembolic PH
Collagen vascular disease
Congenital heart disease (L to R shunt)
What are the symptoms of pulmonary hypertension?
Exertional pre syncope
What are the signs of pulmonary hypertension?
Right ventricular heave
Loud pulmonary second heart sound
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
CT pulmonary angiography
Right heart catheterisation - measure pressure
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
Lung or heart transplant
Name some Endothelin receptor antagonists
Name some phosphodiesterase inhibitors