pulmonary vasculr disease Flashcards
what is Pulmonary Embolism
Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.
what are risk factors of venous Thromboembolism
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
Inherited thrombophilia e.g Factor V Leiden
what are symptoms of Pulmonary Embolism
Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (massive PE)
what are signs of Pulmonary Embolism
Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachpnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
what are tests to do for PE?
Full blood count, biochemistry, blood gases Chest X-Ray ECG D-dimer CT Pulmonary Angiogram (CTPA) V/Q scan Echocardiography Consider CT abdomen and mammography Consider thrombophilia testing
how do you treat PE
Oxygen Low molecular weight heparin e.g. dalteparin Warfarin Direct Oral Anticoagulants (DOAC) rivaroxaban, apixaban Thrombolysis Alteplase (rt-PA) Pulmonary Embolectomy
what is Pulmonary Hypertension
Elevated blood pressure in the pulmonary arterial tree.
causes of Pulmonary Hypertension
Secondary to chronic respiratory disease Secondary to left heart disease Chronic Thromboembolic PH (CTEPH) Miscellaneous collagen vascular disease portal hypertension congenital heart disease (L to R shunt) HIV infection
symptoms of Pulmonary Hypertension
Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope
signs of Pulmonary Hypertension
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
what are the investigations used for Pulmonary Hypertension
ECG Lung function tests Chest X-Ray Echocardiography V/Q scan CTPA Right heart catheterisation allows direct measure of pulmonary artery pressure measurement of wedge pressure measurement of cardiac output
what treatment would you use for Pulmonary Hypertension
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
what specific treatment would you use for Pulmonary Hypertensio
Calcium channel antagonist e.g. amlodipine Prostacyclin Endothelin receptor antagonists bosentan ambrisentan Riociguat Phosphodiesterase inhibitors sildenafil tadalafil
