Pulmonary Vascular Disease Flashcards
(41 cards)
What is a pulmonary embolism?
Thrombus forms in venous system (usually deep veins of legs), all/part of it propagates + travels up IVC to heart and ends up in a pulmonary artery
What are risk factors for PE?
Recent major trauma/surgery
Cancer (large tumour pressing on veins –> venous stasis)
Significant cardiopulmonary disease, e.g. MI
Pregnancy
Inherited thromophilia
COPD
Why do major surgery/trauma predispose to PE?
Clotting system is activated and immobilisation/stasis
What are potential features of a PE?
Chest pain (pleuritic) SoB Haemoptysis Tachycardia Tachypnoea
Why do you get haemoptysis in PE?
Blood clot in pulmonary artery –> tissue infarction (so cough up necrotic tissue)
Why do you get pleuritic chest pain in PE?
Inflamed lung rubs against chest wall
How might a massive PE present?
Syncope or cardiac arrest (e.g. if clot in main pulmonary artery)
What are signs of a small clot causing a PE?
Pyrexia, pleural rub (sounds like walking on snow), stony dullness to percuss at base (pleural effusion)
What are signs of a bilateral PE?
Tachycardia, tachypnoea, hypoxia
What are signs of a massive PE?
Shock - hypotension, tachycardia, tachypnoea, hypoxia
All patients presenting with signs/symptoms suggestive of a PE should have what?
CXR to exclude other pathology
What key change was made to the investigation and management of VTE in 2020?
Use of the pulmonary embolism rule out criteria - this should be used if there is low possibility of PE but you want more reassurance it is not a PE
Low probability is <15% if higher than this move straight to a two level PE wells score
What is the two level PE well score?
Clinical sx/sx of DVT (minimum of leg swelling + pain on palpation of deep veins) -3
Alt diagnosis less likely - 3
HR >100bpm - 1.5
Immobilisation >3 days/surgery in prev 4 weeks - 1.5
Prev. DVT/PE - 1.5
Haemopytsis - 1
Malignancy (on treatment, treated in last 6 months or palliative) - 1
What wells score indicates PE is likely?
> 4 points
If PE is likely what should you do?
Arranged immediate CTPA (if delay then start interim therapeutic anticoagulation until scan is performed)
What interim therapeutic anticoagulation is given for PE?
DOACs, e.g. apixiban or rivaroxiban
What should you do if PE is unlikely?
Arrange D-dimer
If +ve –> immediate CTPA (interim anticoagulation if unable to get it immediately)
If -ve –> PE unlikely, consider alt diagnosis
If the patient has an allergy to contrast/renal impairment what should be done instead of a CTPA?
V/Q scan
What are the classic ECG changes seen in PE?
Large S wave in lead I, large Q wave in lead III and inverted T wave in lead III (S1Q3T3)
Right bundle branch block + right axis deviation
Sinus tachycardia
What do you typically see on CXR in PE?
Usually normal
What (other than a current PE) may cause a V/Q mismatch on a V/Q scan?
Old PEs, AV malformations, vasculitis, prev. RT
What is the gold standard investigation for diagnosing PE?
Pulmonary angiography
List all the investigations that should be considered qfor a suspected PE
FBC, biochemistry, ABG CXR ECG D-dimer CTPA VQ scan ECHO Thrombophilia testing?
What is the PESI score?
PE severity index, based on age, sex, comorbs, physiological parameters
