What is pulmonary HTN?
mean pulmonary artery pressure >20mmHg
associated with mortality if untreated
What are the symptoms of pHTN?
DOE, fatigue, pleuritic chest pain, pre-syncope, edema, JVP
How is pHTN diagnosed?
EKG changs: RAD, iBBB, RAE in lead II
Labs: increased BNP
TTE: estimates pulm. artery systolic pressure, looks at RV size
Cardiac catheterization (Swan Ganz catheterization)
What is the best way to diagnose pHTN?
Swan Ganz catheterization
How is pHTN treated?
treat underlying cause
PDE inhibtor: Tadalafil
Endothelium antagonist: Ambrisentan
What is a PE?
VTE located in pulmonary vasculature usually arising from a DVT
What is virchow's triad?
What are the sx of PE?
+/- LE edema
How is PE diagnosed?
What is the Gold Standard?
D-Dimer (sensitive, rules out PE if normal)
EKG changes: sinus tach, S1Q3T3
CT Chest with Contrast is gold standard
VQ scan is second line image
If a D shaped LV champer is seen on Echo, what does this indicate?
What is the treatment for an unstable PE?
(presents with hypotension)
2. thrombolytic therapy
if thrombolytic therapy fails, repeat thrombolysis, consider catheter-directed thrombolysis, or proceed to surgery
How to treat a stable PE?
What is the mechanism of direct oral anticoagulants? (DOACs)
Do they require bridge therapy?
What are the cons?
Xa inhibitors-rovaroxaban, apixaban
approved to be used without LMWH bridge
expensive, may be hard to reverse
How long is treatment for PE?
at least three months
Pt's with provoked DVT from travel, surgery or HRT do not require extended therapy
Who requires indefinite anticoagulation after PE?
those with underlying disease with high risk of VTE recurrence
What is the definition of OSA?
disruption in breathing pattern while sleeping that results inexcessive daytime somnolence despite adequate sleep periods and not explained by other causes
(snoring, gasping for air, breathing pause)
What is the definition of apnea?
reduction in breathing for at least 10 seconds with a noted drop in SpO2 by >3%
How is the Apnea-Hypopnea index calculated?
number of apnea episodes/hour
determines OSA severity
If OSA is untreated, what can occur?
Sleep related breathing disorders are associated with increased morbidity and mortality if left untreated
What is the number 1 cause/predictor of OSA?
What facial malformation can cause OSa?
micrognathia (small mandible)
What is the diagnostic criteria for OSA?
What is the Gold standard for diagnosing OSA?
occurs in sleep lab or at home, records sleep activity for 6-7 hrs
Monitors EEG, ECG, ocular movement, airflow, and O2sat
allows clinician to generate AHI and diagnose the severity of sleep apnea
What are the treatment options for OSA?
What is interstitial lung disease?
group of pulmonary disorders with a variety of different causes that present with the same characteristics
what are the general characteristics of ILD?
restrictive pattern on PFTs
absence of infection or malignancy
What part of the lung is affected with ILD?
the CT that supports the alveoli and capillaries to allow gas exchange
What are the main findings associated with idiopathic pulmonary fibrosis?
treat with supportive care, steroids, imunimodulators, anti-fibrotics
50% survival at 3-5 years; early diagnosis=better prognosis
What are the main findings of Sarcoidosis?
non-caseating granulomas, lungs commonly affected
More common in African Americans, females, family members
Associated with Lofgren's syndrome and Heerfordt's syndrome
What is Lofgren's syndrome
What is Heerfordt's syndrome?
Erythema nodosum, hilar lymphadenopathy, fever, arthritis
Anterior uveitis, parotitis, CN VII palsy, fever
What is the treatment for sarcoidosis?
steroids: 1st line therapy