16. Pulmonary Vascular Disease Flashcards
What is a Pulmonary Embolism(PE)?
The formation of a thrombus (blood clot) in the venous system
Where is a PE usually found?
In the deep veins of the legs
Where does a PE embolise to?
The pulmonary arteries
What percentage of all hospital admissions are PEs?
1%
Can a PE be fatal?
Yes, a massive PE can be
Can minor PEs be treated?
Yes, with anticoagulation. It has a very good prognosis
What are the major risk factors for Venous Thromboembolism?
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease (e.g. MI or COPD)
Pregnancy
Inherited thrombophilia (e.g. Factor V Leiden)
What are the symptoms of a PE?
- Pleuritic Chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (Massive PE)
What are the signs of a PE?
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachypnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
What are the Pre-test Probabilities?
Wells Score
Revised Geneva Score
What are the PE investigations?
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
What is the prognosis for PE?
Mortality at 30 days varies from 0 to 25%
PESI Score
- Based on age, sex, comorbidity and physiological parameters
How is PE treated?
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(PH)?
Elevated blood pressure in the pulmonary arterial tree, Defined as a mean pulmonary artery pressure of > 25 mmHg
Which type of hypertension is more common?
Secondary pulmonary (occurring in older age group)
