Pulmonary Vascular Disease Flashcards
(24 cards)
define pulmonary embolism (PE)
development of a thrombus (blood clot) within the pulmonary arterial vasculature, that typically develops from and underlying DVT and embolises
risk factors of PE
immobility recent surgery long haul flights/travel pregnancy hormone therapy with oestrogen malignancy
clinical features of PE
sudden-onset dyspnoea
pleuritic chest pain
cough with/without haemoptysis
signs of PE
tachycardia tachypnoea hypoxia raised respiratory rate low grade pyrexia
signs of massive PE
hypotension
cyanosis
right heart strain - JVP, parasternal heave and loud P2
important sign to look for in PE
a unilateral, swollen tender/painful calf
potential signs of PE on an ECG
normal or sinus tachycardia
if massive:
- P pulmonale
- right axis deviation
- right bundle branch block
what score system is used to assess patient risk of PE?
Wells Score - assess risk factors and clinical signs present and deems patient ‘likely’ or ‘unlikely’
blood investigations in PE
ABG - can be normal or show Type I respiratory failure and/or respiratory alkalosis
FBC, CRP, U+E and clotting function
additional blood investigation in PE
D-dimer - used if patient deemed unlikely (Wells Score <4) to have PE but still suspicious
investigations in PE
CT pulmonary angiogram (CTPA)
contraindications of CTPA use and alternative imaging methods
use V/Q scan or lower limb duplex if patient has:
- renal impairment
- pregnancy
- contrast allergy
when is bedside echocardiogram used in PE
if patient thought to have a massive PE in order to assess for thrombolysis suitability
management of massive PE
if patient haemodynamically unstable or right heart strain present, perform thrombolysis (IV or direct)
examples of thrombolytic agents
streptokinase, alteplase and tenecteplase
initial management of PE
low molecular weight heparin (LMWH) for 5 days and until 48hr of INR >2 achieved
long-term management of PE
warfarin - same as LMWH
DOCAs (apxiban and rivaroxaban)
define pulmonary hypertension
an increase in mean pulmonary arterial pressure (15 mmHg) and resistance
causes of pulmonary hypertension
parenchymal lung disease
pulmonary vascular disease
hypoventilation
left heart disease
clinical features of pulmonary hypertension
dyspnoea
syncope
fatigue
signs of pulmonary hypertension
raised JVP tachycardia hepatomegaly peripheral oedema S3 sound pulmonary and/or tricuspid regurgitation
investigations of pulmonary hypertension
ECG
CXR
right heart catheterisation
echo
common findings on ECG in pulmonary hypertension
right ventricular hypertrophy
right axis deviation
right bundle branch block
management of primary pulmonary hypertension
IV prostanoids
endothelin receptor antagonists
phosphodiesterase-5 inhibitors
