Pulmonary Vascular Diseases Flashcards Preview

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Flashcards in Pulmonary Vascular Diseases Deck (21):
1

What is a Pulmonary Embolism

is a blockage of the lung's main artery or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism)

2

What are the risk factors of PE

DVT - a clots that travels to a different part of the body

3

What causes DVT

The Virchow's Triad of Stasis, Endothelial Damage and Hyper-coagulability

4

What is stasis

alternation in the normal blood flow. this includes long surgical operation, prolonged sitting during traveling/immbolization after fracture and varicose veins. CHF, paralysis, stoke.

5

What is Endothelial Damage

like vessel piercing and damages arising from shear stress or hypertension.This is ruled by bacteria, foreign material, biomaterials of implant or medical devices and membrane of activates platelets. (TRAUMA AND INJURY)

6

What is hyper-coagulability

Hyper-coagulability - underlying malignancy, cancer treatment (Chemotherapy and hormonal ), exogenous estrogen administration and pregnancy. Also Prior history of DVT/PE, Nephrotic syndrome and coagulopathies: Factor V, Lediden, inherited deficiencies of antithrombin/ protein

7

What are the signs of PE

SOB
Pleuritic chest pain with deep breaths
Hemoptysis
Tachypnea

8

What are the lab diagnostic test of PE

D-dimer - D-dimer (or D dimer) is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrin protein.

Imaging test:
Chest x-ray
EKG - Tachycardia; S1Q3T3
Venous duplex ultrasound or Doppler
V/Q scan
Spiral CT scan
Pulmonary Angiogram

9

How do you manage PE

Management
O2
Pain relief - opioids
Acute anticoagulation - LMWH
Long term anticoagulation - Warfarin after 5 days
Inferior Vena Cava filter

10

What is DVT

Deep vein thrombosis, or deep venous thrombosis, (DVT) is the formation of a blood clot (thrombus) within a deep vein,[a] predominantly in the legs. Non-specific signs may include pain, swelling, redness, warmness, and engorged superficial veins. Pulmonary embolism, a potentially life-threatening complication, is caused by the detachment (embolization) of a clot that travels to the lungs.

11

What are the causes of DVT

Virchow's triad, Concentration of O2 and platelet activation

12

What is a differential diagnosis of DVT? and how do you rule it out

Cellulitis ( with a blood culture)

13

What are signs or DVT

Calf pain
Leg swelling
Erythema
Edema

14

What is Pulmonary Hypertension

is an increase of blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms.[1] Pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance.

15

What are the two mechanisms of pulmonary Hypertension

Hypoxia vasoconstriction
Volume/ pressure overload

16

What is hypoxia vasoconstriction

chronic hypoxia causes pulmonary vasoconstriction by a variety of actions of the pulmonary after endothelium and smooth muscle cells such as down regulation of endothelia nitric oxide synthase and alteration of voltage gated potassium channels leading to vasoconstriction

17

What is the volume and pressure overload

Significant HTN only occurs with excessive volume overload

18

What does Hypoxia vasoconstriction cause

COPD and Chronic alveolar hypoxia

19

What does volume and pressure overload cause

VSD,PDA,ASD

20

What are the signs of Pulmonary Hypertension

SOB - P2 - pulmonary valve stenosis
Fatigue - S4 - Ventricular hypertrophy

21

What is the treatment of Pulmonary hypertension

phosphodiestrae inhibitors (sildenafil)
Endothelia receptor antagnos. ( Bosentan)