16 - Pulm Vascular Dz Flashcards
upper limit of nl pulm arterial pressure (systolic and diastolic)
30/10 mmHg
NO works via what intracellular signalling molecule
inc cGMP
worldwide MCC pulm HTN
schistosomiasis
top 4 MCC pulm HTN in US
- left heart dz
- lung disease
- chronic thromboembolic pulm HTN
- unclear/multifactorial mech
who gets idiopathic pulm HTN
women > men
mean age 50s
clinical features of pulm HTN
dsypnea atypical cheset pain palps cough syncope hemoptysis hypotension tachycardia loud P2 JVD cor pulmonale
pulm HTN on CXR
clear lungs w/ enlarged pulm arteries
tx for pulm htn
tx underlying cause
supportive - O2, anticoag, diuretics, digoxin
vascular targeted therapy (prostacyclins, endothelin receptor agonists, NO pathway drugs)
surgical therapies for pulm HTN
lung transplant
atrial septostomy - dec RVEDP at expense of PaO2
pulm endarterectomy
cor pulmonale
RV hypertrophy > failure due to pulm HTN
usually occurs due to chornic pulm dz that affect the vasculature (MC: COPD)
causes of pulm embolism (types of emboli)
thrombus fat tumors trophoblast air amniotic fluid
Trousseau syndrome
hypercoagulability and venous thrombosis associated with malignancy
symptoms of DVT
pain, tenderness, swelling, Homan’s sign (pain in calf when foot is dorsiflexed with knee in extended position)
sx of pulm embolism
dyspnea, impending doom, palps/tachycardia, hemoptysis and pleuritic chest pain when infarction occurs (uncommon)
dx of DVT
contrast venography is gold standard
impedance plethysmography can be used to rule out
compression ultrasound is often used and is good in symptomatic patients
MRI - works but pricey
D-Dimer - low levels to r/o
