Pulmonary Vascular Disorders - Edema, Embolism, Hypertension, ARDS

Question 1

What are the four conditions covered under Pulmonary Vascular Disorders?

Answer 1

Pulmonary Edema, Pulmonary Embolism, Pulmonary HTN, Acute Respiratory Distress Syndrom (ARDS).

Question 2

What is Pulmonary Edema?

Answer 2

Pulmonary edema is the accumulatin of fluid in the alveoli.

Question 3

What is the most common cause of Pulmonary Edema?

Answer 3

Left-sided Heart Failure

Question 4

What are some non-cardiogenic causes of Pulmonary Edema?

Answer 4

IV fluid overload, Smoke Inhalation, Aspration, IV drug use.

Question 5

How does smoke inhalation cause pulmonary edema?

Answer 5

Inhalation of noxious fumes induces inflammation. Inflammation results in exudate and increased fluid into the lungs.

Question 6

Why does aspiration cause pulmonary edema?

Answer 6

Aspiration of anything that is not air into the lungs leads to massive lung damage.

Question 7

What is the pathophysiology of pulmonary edema?

Answer 7

Fluid from blood moves to the intersticial space and then into the aveoli. The increased fluid leads to decreased respiratory function.

Question 8

The presence of fluid in the alveoli increases the _____ _____, resulting in a decrease in the diffusion capabiltities.

Answer 8

diffusion distance

Question 9

What are lobules?

Answer 9

Lobule is the lung unit distal to the respiratory bronchioles. It is comprised for the alveolar ducts, alveolar sacs and alveoli.

Question 10

What are the manifestations of pulmonary edema?

Answer 10

Productive cough, Dyspnea, Decreased compliance, Crackles

Question 11

What is the treatment for pulmonary edema?

Answer 11

Respiratory support (O2, Respirator in worst case), Treat cause (CHF, inc heart function).

Question 12

What is Pulmonary Embolism?

Answer 12

Pulmonary embolism is a thrombus in a pulmonary vessel. It is potentially lethal and has an approximate recurrence rate of 10%.

Question 13

That is a thrombus?

Answer 13

A clot.

Question 14

What is an Embolis?

Answer 14

A moving/travelling clot.

Question 15

What is an Embolism?

Answer 15

The process of obstruction which begins with a thrombu, and then progesses to an embolis as it dislodges and moves.

Question 16

What is the etiology of pulmonary embolism?

Answer 16

Usually caused by a deep vein thrombosis. Can also be caused by other emboli.

Question 17

What are several other examples of emboli which can lead to pulmonary embolism? (Other than DVT)

Answer 17

Fat, Air, Amniotic Fluid

Question 18

How does fat cause pulmonary embolism?

Answer 18

Fat causeing embolism come from bone marrow when an individual fractures a bone which consequentially severes a blood vessel.

Question 19

How does amniotic fluid cause pulmonary embolism?

Answer 19

During labour amniotic fluid become free and the mother can be actively bleeding. Particulate matter can get into the mother blood stream and travel into the pulmonary circuit.

Question 20

What is the pathophysiology of pulmonary embolism?

Answer 20

A DVT (or other embolism cause) breaks free and the embolus travels and to the arterial bed and becomes a thrombus. The blocked vessel leads to impaired perfusion of the local tissues. Ventillation and perfusion imbalance leads to hypoxemia. Platelets degranulate leading to bronchial and pulmonary airway constriction and hemodynamic instability. The body then undergoes bronchoconstriction, leading to dreacrease cardiac output. There is a loss of surfactant which leads to atelactasis and ultimately right-sided heart failure.

Question 21

In the pathophysiology of pulmonary embolism the patient experiences decreased cardiac output. Why?

Answer 21

The obstruction in the pulmonary circuit prevents the blood from circulating as it normally would. The decrease in blood flow in the pulmonary circuit decreases the amount of blood delivered to the left-side of the heart, decreaseing the hearts output.

Question 22

Why does pulmonary embolism lead to right-sided heart failure?

Answer 22

The heart has to pump against resistance in the pulmonary circuit. The right-side of the heart is responsible for pumping blood through the resistance and then it is delivered to the left side of the heart.

Question 23

What are the manifestations of pulmonary embolism?

Answer 23

Manifestations are based on size and site. Usual manifestations are chest pain, tachypnea, and dyspnea. Tachycardia also manifests.

Question 24

Why are chest pain, tachypnea, dyspnea manifestations of pulmonary embolism? Why is tachycardia a manifestation?

Answer 24

Chest pain - d/t physical obstruction, and hypoxia which always presents with pain. Tachypnea - a compensatory mechanism. Dyspnea - d/t hypoxemia. Tachycardia - is a compensatory response to hypoxia.

Question 25

How is diagnosis of pulmonary embolism made?

Answer 25

Patient Hx, Physical, ABGs, LDH3, Lung Scan, CT Scan, Pulmonary Angiogram

Question 26

What is LDH3?

Answer 26

Lactate Dehydrogenase Isoenzyme 3 Is an enzyme found in the cells of the lung which have become damaged due to the pulmonary embolism. It helps to differentiate the type and location of damaged cells.

Question 27

Explan how a lung scan works, and what is I-HSA?

Answer 27

HSA is human serum albumin. A lung scan is a nuclear scanning test. Human serum albumin is biomarked with an radiated iodine marker (131). It is then injected into the vasculature and travels through the bod and into the lungs. Pictures are then taken of the lungs, showing which areas are not receiving enough blood, denoting the location and presence of a pulmonary embolism.

Question 28

In pulmonary embolism diagnosis why should a pulmonary angiogram be avoided, if possible?

Answer 28

If a lung scan can be used with effect, it should be avioded because it is an invasive procedure.

Question 29

What is the treatment for Pulmonary Embolism?

Answer 29

Stat treatment will mean a better prognosis. Anticoagulants and thrombolytics. Treatment wil aim to maintain cardiopulmonary function to avoid shock. If the patient has a DVT, it will also be treated.

Question 30

What is Pulmonary hypertension?

Answer 30

Sustained high pressure in the pulmonary circuit (>25mmHg; Normal = 15mmHg)

Question 31

What is mmHg is considered Pulmonary HTN?

Answer 31

>25mmHg

Question 32

What is the normal pressure in the pulmonary circuit?

Answer 32

15mmHg

Question 33

If cardiac output increases, what happens to pulmonary pressure?

Answer 33

It rises as well, but only slightly.

Question 34

Pulmonary vasoconstriction leads to ____?

Answer 34

Increased pressure in the pulmonary circuit.

Question 35

What is the cause of pulmonary HTN? What are the three categories of causes?

Answer 35

It is caused as a secondary problem to cardiac and pulmonary problems. The three categories are: Increased pulmonary volume, Hypoxemia, Increased pulmonary venous pressure.

Question 36

What is an example of increased pulmonary volume causing pulmonary HTN?

Answer 36

Cardiac Septal Defects

Question 37

Why would hypoxemia cause pulmonary HTN?

Answer 37

Normally hypoxemia causes vasodilation in the vasculature, however, in the pulmonary circuit the arteries constrict In the presence of hypoxia redirecting blood flow to alveoli with higher oxygen content.

Question 38

What may cause increased pulmonary venous pressure?

Answer 38

Left-ventricle dysfunction (The blood in the heart doesn't get fully delivered to the body, thus it stacks into the pulmonary circuit.

Question 39

What are some manifestations of pulmonary HTN?

Answer 39

Dyspnea, Syncope and Chest pain on exertion. Manifestations of right-sided heart failure. Fatigue. Some manifestations can also be seen on an x-ray.

Question 40

What manifestations of pulmonary HTN may possibly show on a chest x-ray, and why does the patient show the manifestations of RSHF?

Answer 40

Right Ventricle hypertrophy, Distended pulmonary arteries. The patient is experiencing RSHF manifestations because the right ventricle is pushing against increased resistance in the pulmonary circuit due to the pulmonary hypertension.

Question 41

What is treatment for pulmonary HTN?

Answer 41

The cause of the HTN must be addressed. If d/t hypoxemia, solving the hypoxemia will solve the problem. Otherwise, it is difficult to treat. Vasodilators can be administered, but have limited success. Prognosis is poor if severe.

Question 42

What does ARDS stand for?

Answer 42

Acute Respiratory Distress Syndrome

Question 43

What is ARDS?

Answer 43

Acute Respiratory Distress Syndrome is severe damage to alveolar and capillary walls. It is also called "post tramatic lung".

Question 44

What is the mortality rate of ARDS?

Answer 44

40-60% mortality.

Question 45

What are some examples of etiology of ARDS?

Answer 45

Aspiration, Massive smoke inhalation, Fat embolus, Septicemia, Near drowning, Cocaine and Heroin misuse.

Question 46

What is the pathophysiology of ARDS? (Beginning at Lung Trauma)

Answer 46

Lung trauma triggers an influx of netrophils. Activated neutrophils release a variety of products like free radicals, phospholipids and proteases which directly damage the capillary endothelial layer and alveoli epithelium. The damage results in increased permiability allowing an influx of proteins, cells and fluid into the intersticial space and alveoli, causing edema. Edema results in decreased compliance and impaired gas exchange. The patho of ARDS is also characterized by three main occurances with-in the lung. 1) Surfactant becomes defective and inactivated leading to atelectasis. 2) Thick protein and cell rich exudate lines the alveoli, preventing gas exchange. 3) An impervious hyaline membrane lines the alveoli. Profound hypoemia is the result.

Question 47

What are the manifestations of ARDS?

Answer 47

Acute onset respiratory distress, Dyspnea, Tachypnea, Massive hypoxemia, early resp alkalosis, late met acidosis, Diffuse consolidation.

Question 48

Why would someone with ARDS exterience early respiratory alkalosis? Why does it eventually atler and become metabolic acidosis?

Answer 48

1) Initially, the patient may experience respiratory alkalosis because the patient will have the capacity to expel C02, but have a low PaO2. The patient will not have enough CO2 to form Carbonic Acid (H2CO3), therefore they will present with Alkalosis. 2) Eventually, due to a worsening PaO2 level, and increased PaCO2, along with metabolic imbalances (Anarobic metabolism = Lactic Acid) will create the metabolic or mixed acidosis. It will be be accompanied by a low vetilation-to-perfusion ratio.

Question 49

What is the treatment for ARDS?

Answer 49

Early intervention, Reverse cause, Respiratory support, Complications.