Year 1- Respiratory > Pulmonary Vascular Disease > Flashcards

Pulmonary Vascular Disease Flashcards

(41 cards)

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1
Q

How does a pulmonary embolism occur?

A
  • A thrombus (clot) forms in the venous system (usually in the deep veins of the leg)
  • It embolises through the veins through the heart and lodges in the pulmonary arteries
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2
Q

Whats the prognosis for a minor PE?

A

Very good if treated with anticoagulation

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3
Q

Whats the mortality rate for PE?

A

At 30 days mortality is between 0-25% (closer to 25% in a massive PE)

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4
Q

How do we determine the risk of mortality?

A

Using a PESI score based on:

  • Age
  • Sex
  • Comorbidity
  • Physiological Parameters
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5
Q

What are the Major Risk Factors for a Pulmonary Embolism?

A
  • Recent Major Trauma
  • Recent Surgery
  • Cancer
  • Significant cardiopulmonary disease e.g. MI
  • Pregnancy
  • Inherited Thrombophilia
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6
Q

What is a thrombophilila?

A

An inherited disorder with a predisposition to produce clotting factors (e.g. Factor V Leiden)

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7
Q

What happens if you get a small PE in a peripheral artery??

A

A section of the lung is infarcted.

This leads to local tissue inflammation, necosis and rubbing against the pleura

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8
Q

What are the signs and symptoms of a small Peripheral PE?

A

Symptoms:
Pleuritic Chest Pain (from rubbing)
Cough and Haemoptysis

Signs:
Pyrexia
Stony Dullness to percussion at base (due to pleural effusion)

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9
Q

What happens if there multiple small PEs?

A

Several areas are infarcted

This means perfusion of the lung in general becomes low

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10
Q

What are the signs and symptoms of multiple small PEs?

A

Symptoms:
pleuritic chest pain, cough, haemoptysis, isolated acute dyspnoea

Signs:
Tachycardia, Tachpnoea, Hypoxia

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11
Q

What happens during a massive PE?

A

A general lack of pulmonary blood flow leads to hypoxia and loss of blood pressure

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12
Q

What are the signs and symptoms of a massive PE?

A

The loss of blood pressure can lead to syncope or even cardiac arrest.

Signs:
Tachycardia, Hypotension, Tachypnoea, Hypoxia

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13
Q

How do we determine how likely someone is to get a PE?

A

By various scoring systems:

  • Wells Score
  • Revised Geneva Score
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14
Q

What early tests do we do when we suspect a PE?

A
  • A full blood count, blood gases & biochemistry.
  • A CXR (rules out other conditions)
  • ECG (shows tachycardia)
  • D-dimer (-ve indicates unlikely to have a PE)
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15
Q

What is the main test we use to determine a PE?

A

A CT pulmonary Angiogram (CTPA)

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16
Q

What test would we use to determine if the right ventricle is under strain?

A

An echocardiograph

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17
Q

What the use of a V/Q scan?

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A

To show areas of ventilation and perfusion.

A PE would be indicated by normal ventilation but areas (or whole thing) of reduced perfusion

18
Q

Why would we consider doing abdomen CTs and mammography?

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A

In the case of a PE in someone with little clinical risk we would use these tests to see if the cause is occult cancer.

19
Q

When would we do thrombophilia testing?

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A

If the person had a PE without much clinical risk wed test for inherited disease

20
Q

What treatments do we use for someone with a minor PE?

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A
  • Oxyegn
  • BloodThinners
  • Direct Oral Anticoagulatants (DOAC)
21
Q

What treatment would we add for a massive PE?

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A

Thrombolysis

If contraindicated then a pulmonary embolectomy is performed

22
Q

Name some blood thinners?

Study These Flashcards
A
  • Low Molecular Weight Heperarin (e.g. dalteparin)

- Warfarin

23
Q

Name some Direct Oral Anticoagulants (DOAC)?

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A
  • Rivaroxaban

- Apixaban

24
Q

In what situation do we put someone on permanent anticoagulants?

Study These Flashcards
A

IF they have a very high risk of future PE

25
Name an agent of thrombolysis?
Alteplase (rt-PA)
26
What is the level of pressure in pulmonary hypertension?
Pressure in pulmoary arterial tree >25mmHg
27
What is the incidence of primary PH?
1-2/million (very rare)
28
In what age group does secondary PH normally occur?
The elderly
29
Name some causes for Pulmonary Hypertension?
- Idiopathic (Primary) - Secondary to chronic respiratory disease - Secondary to left heart disease - Chronic Thromboembolic PH (CTEPH) - Miscellaneous
30
How does a chronic respiratory disease lead to pulmonary hypertension?
The disease is bad enough it leads to hypoxia That leads to pulmonary vasoconstriction This leads to hypertension
31
What are the miscelaneous causes of Pulmonary Hypertension?
- Collagen Vascular Disease - Portal Hypertension - Congenital Heart Disease (L to R shunt) - HIV infection
32
What are the symptoms of Pulmonary Hypertension?
Symptoms: - Exertional Dyspnoea - Chest Tightness - Exertional Presyncope or syncope (i.e. lightheaded or passing out on exercise)
33
What are the signs of pulmonary hypertension?
- Elevated Jugular Venous Pressure (JVP) - Right Ventricular Heave - Loud pulmonary second heart sound - Hepatomegaly - Angle Oedema
34
What tests do we do in pulmonary hypertension to see if its secondary to pulmonary diseasE?
- ECG - Lung Function Tests - CXR
35
Whats the use of an echocardiograph in pulmonary hypertension?
The echocardiograph involves inducing a leak and measuring its velocity. This way you can indirectly work out the arterial pressure to determine hypertension.
36
What scans do we use testing for pulmonary hypertension?
A V/Q scan | A CTPA
37
Why do we use a right heart catheterisation in pulmonary hypertension?
- Allows direct measure of pulmonary artery pressure - Allows measurment of wedge pressure - Allows measurement of cardiac output. All these rule out heart disease as the cause
38
What is wedge pressure?
An indirect measure of pulmonary venous system pressure. | This tells us if theres a problem with the heart's left side
39
What are the general treatments for Pulmonary hypertension?
- Treat underlying condition (if secondary) - Oxygen (if hypoxic) - Anticoagulation - Diuretics (if theres oedema)
40
what are the specific treatments for PH?
- Calcium channel antagonist - Prostacyclin (smooth muscle relaxant for vasodilation) - Endothelial Receptor Antagonists - Phosphodiesterase inhibitors
41
What are the surgical treatments for PH?
Thromboendoarterectomy (For chronic thromboembolic PH) | Lung or heart transplant
Year 1- Respiratory
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