RESPIRATORY - pulmonary vascular disorders: pulmonary embolism & PAH Flashcards
EXAM 2 content
what are the pulmonary vascular disorders?
pulmonary embolism & pulmonary artery hypertension
what is a pulmonary embolism? what does it result from?
an occlusion of a part of the pulmonary artery vasculature
- results from DVT (fat, air, bone, blood)
what is the pathophysiology of a pulmonary embolism?
embolus travels thru peripheral venous system
–> right side of heart
–> to lungs & lodges in pulmonary arteries
–> infarction of tissue
- dead space, v/q mismatch
- atelectasis (both cause hypoxemia)
–> inflammation mediators & neurohormonal substances released
–> vasoconstriction of pulmonary arteries
–> IF INFARCTION rapid decline to dysrhythmias, shock & death
–> IF NO INFARCTION there can be recovery
what are the risk factors of pulmonary embolism?
- genetics
- traumatic injury of bones
- triad of virchow
what is triad of virchow? what are the components?
the 3 major components that increase risk of a blood clot, especially a DVT in the lower body
- venous stasis: immobilization & heart failure/dysrhythmias
- hypercoagulability: hormone replacements, oral contraceptives, & pregnancy
- vessel injury: trauma & infection
what are pulmonary embolisms manifestations?
neuro: altered loc, sudden loss of consciousness! anxiety!
- CV: sudden onset of chest pain! tachycardia & hypotension
- resp: dyspnea on exertion, cough with blood tinged! hemoptysis! tachypnea, diminished breath sounds
- integ/musc: cyanosis
- psychosocial: feeling of impending doom!
what labs and diagnostics would we use for PE?
- ABGs: hypoxemia
- D Dimer: knowing that there are clots going on in the body
- V/Q scan: pt needs to be stable for this
- spiral CT: this is usually in combo with D dimer
- for chest pain we make sure to do a cardiac test first, if nothing happens its most likely a PE
what would we use to treat PE?
- oxygen
- anticoagulation: keep clot as small as possible
- thrombolytics: TPA to break up clot
what complications are associated with PE?
- pulmonary infarction
- pulmonary hypertension: bc of vasoconstriction
- cardiovascular collapse
- hypotension
- shock
- death
what can happen if it is such a large PE?
they can lose consciousness, this can happen very quickly
- cant revive them
- cant get them to oxygenate
- cant get them to stabilize
what is pulmonary artery hypertension?
consistent elevated pressure in the pulmonary artery
what is PAH’s pathophysiology? what is happening with the right side of heart?
something causes vasoconstriction of pulmonary artery
–> v/q mismatch (dead space), fibrosis, & more vasoconstriction of lungs + pulmonary arteries
–> reduced blood flow
–> hypoxia on exertion
–> pressure backs up from pulmonary artery to RIGHT SIDE of heart
–> Right sided HEART FAILURE –>
- right side is much weaker
- right heart enlargement –> co pulmonale
- right sided heart failure manifestations
what are the risk factors & causes of PAH?
- genetics
- left sided heart failure –> back up pressure –> PAH
- COPD
- chronic PE
- veno occlusive diseases
- lung fibrosis
what are the manifestations of PAH?
- neuro: altered LOC & confusion
- CV: tachycardia, murmur! JVD! peripheral edema!
- respiratory: tachypnea, dyspnea, chest pain –> exercise intolerance
- GI: n/v, hepatomegaly!
- GU: oliguria
- integ/musc: cyanosis & decreased capillary refill
what labs & diagnostics would we use for PAH?
- BNP
- EKG
- echocardiogram
- right cardiac catheterization: OFFICIAL DIAGNOSIS
