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Systems: Resp. WK > 17. Pulmonary Vascular Disease > Flashcards

17. Pulmonary Vascular Disease Flashcards

1
Q

What is a pulmonary embolism?

A
  • thrombus forms in the venous system and embolises to the pulmonary artieries
  • blood clot travelling from one part of the body to the other
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2
Q

In which body region do most pulmonary embolisms form?

A

usually in deep veins of the legs

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3
Q

Pulmonary embolisms make up what percentage of all hospital admissions?

A

Around 1%

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4
Q

What other causes can lead to pulmonary embolisms except from blood clots (which are the most common)?

A

air embolisms ( but usually blood clots)

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5
Q

What can minor pulmonary embolisms be treated with?

A

anticoagulation drugs which have very good prognosis (and Warfarin for several months to reduce risk)

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6
Q

Can big pulmonary embolisms be fatal?

A

Yes

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7
Q

Describe the places a thrombus from the venous system will travel through before it causes a pulmonary embolism.

A
  • vena cava
  • r.atrium and r. ventricle
  • pulmonary artery
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8
Q

What are major risk factors for venous thromboembolism? (6)

A
  1. recent major trauma
  2. recent surgery
  3. cancer (tumours cause clots)
  4. significant cardiopulmonary disease e.g. myocardial infarction or COPD
  5. pregnancy
  6. inherited thrombophilia (inherited predisposition to clot) e.g. factor 5 Leiden
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9
Q

Why are surgical patients at risk of developing venous thomboembolisms?

A

After surgery, the clotting system in the body will be naturally activated and venous stasis arises (due to less movement in muscles) and blood is therefore more likely to clot post surgery.

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10
Q

What are 3 major symptoms of pulmonary embolism?

A
  1. pleuritic chest pain, cough and haemoptysis
  2. isolated acute dyspnoea
  3. syncope or cardiac arrest (massive PE)
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11
Q

What is pleuritic chest pain, cough and haemoptysis caused by in a pulmonary embolism?

A
  • Due to the blood clot in the pulmonary artery, the lung becomes obstructed.
  • Obstruction leads to less oxygen being delivered so necrosis of lung occurs and lung becomes inflamed which rubs against chest wall (causing pleurisy; inflammation of lung pleura,sharp chest pain and cough)
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12
Q

What is isolated acute dyspnoea caused by in a pulmonary embolism?

A
  • Areas of lung become ventilated but not perfused

- isolated breathlessness occurs

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13
Q

What is syncope (loss of consciousness) or cardiac arrest in a massive pulmonary embolism caused by?

A
  • least common but most serious
  • big clot blocks the main pul. artery and reduces cardiac output from heart leading to loss of blood to the brain
  • can lead to “black outs” and losing ability to move
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14
Q

What are characteristic and general symptoms in pulmonary embolisms? (what patients feels) (4)

A
  • acute dyspnea
  • pleuritic chest pain
  • haemoptysis
  • dizziness/ syncope
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15
Q

What are characteristic signs in pulmonary embolisms? (what doctor sees) (5)

A
  • pyrexia
  • pleural rub
  • pleural effusion
  • cyanosis
  • tachypnoea
  • tachycardia
  • hypoxia (heard only in acute dyspnoea patients+ major PE patients)
  • hypotension
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16
Q

While checking for pleural effusion, what can be heart through a stethoscope in a patient with a pulmonary embolism? (leading to pleuritic chest pain)

A

Stony dullness to percussion at base (suggesting pleural effusion)

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17
Q

What occurs in small pulmonary embolisms?

A
  • blood clots present around vessels around descending aorta
  • can be detected using a CT scan
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18
Q

What two scoring methods are used for pre-test probability calculations?

A
  1. Wells Score

2. Revised Geneva Score

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19
Q

What is Well’s Score based on? (4)

A
  • symptoms and signs of venous thromboembolism (VTE)
  • previous VTEs
  • risk factors
  • patient physiology
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20
Q

What is Revised Geneva Score based on? (2)

A
  • risk factors

- symptoms and signs (heart rate)

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21
Q

What investigations are done to diagnose pulmonary embolisms? (9)

A
  1. Full blood count: biochemistry, blood gases
  2. Chest X ray
  3. ECG
  4. D-dimer
  5. CT pulmonary angiogram (CTPA)
  6. V/Q scan
  7. Echocardiography
  8. Consider CT abdomen and mammography
  9. Consider thombophilia testing
22
Q

What is a D-dimer test?

A
  • product (protein) of clotting cascade in the blood often done first so more expensive tests are not needed
  • present in blood after a clot is degraded
  • helps detect thrombotic disease (high number of clots are degraded by fibrinolysis releasing this protein)
23
Q

Which of the tests is done when a massive embolism is suspected?

A

echocardiography

24
Q

What does V/Q scan indicate?

A
  • Shows ventilation and perfusion through the lungs

- In a pulmonary embolism, ventilation should be uniform but there are clear differences in perfusion indicating a PE

25
Q

What is prognosis for a pulmonary embolism in term of mortality at 30 days?

A

varies from 0-25%

26
Q

What scoring system is used for a pulmonary embolism prognosis and what is considered in the score? (4)

A
  • PESI score:

age, sex, cormorbidity and physiological parameters

27
Q

What are the main treatment measures for a pulmonary embolism? (6)

A
  1. oxygen
  2. low molecular weight heparin (e.g. dalteparin)
  3. Warfarin (anti-coagulant)
  4. Direct oral anticoagulants (DOAC)
  5. Thrombolysis
  6. Pulmonary embolectomy
28
Q

What are 2 examples of Direct Oral Anticoagulants (DOAC)?

A
  • rivaroxaban

- apixaban

29
Q

What is an example of a thrombolysis? ( it doesn’t dissolve the clot but just prevents it getting worse which can stop a PE)

A

Alterplase (rt-PA_

30
Q

Which anticoagulants are used for lifelong anticoagulation?

A

DOAC

31
Q

What is pulmonary hypertension?

A

Elevated/ increased blood pressure in the pulmonary arterial or tree

32
Q

What is the mean pulmonary artery pressure in a pulmonary hypertension?

A

> 25mmHg

normal is 8-20mmHg in pulmonary artery

33
Q

Can pulmonary hypertension be either primary or secondary to other conditions?

A

Yes

34
Q

How rare is PRIMARY pulmonary hypertension?

A

VERY rare, only has an incidence of 1-2 per million population

35
Q

If left untreated, what can primary pulmonary hypertension lead to?

A

premature death (it’s rapidly progressive)

36
Q

What age group tends to experience more common SECONDARY pulmonary hypertension?

A

Older age group ( it’s much more common generally than primary)

37
Q

What age group tends to have PRIMARY pulmonary hypertension (which is less common)?

A

Younger people

38
Q

What are the main causes of pulmonary hypertension? (5)

A
  1. Idiopathic; no known cause
  2. Secondary to chronic respiratory disease (resp.)
  3. Secondary to left heart disease (cardiac)
  4. Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
  5. Miscellaneous (various types of causes)
39
Q

What are some miscellaneous (various) causes which lead to pulmonary hypertension? (4)

A
  • collagen vascular disease
  • portal hypertension
  • congenital heart disease (L to R shunt)
  • HIV infection
40
Q

What can Chronic Thromboembolic pulmonary hypertension (CTEPH) be developed from?

A

from pulmonary embolisms

41
Q

What are common symptoms for pulmonary hypertension? ( symptoms in early stages are very mild and subtle) (5)

A
  1. exertional dyspnoea
  2. chest tightness and pain
  3. exertional presyncope or syncome (unconsciousness/ fainting/blacking out)
  4. Oedema in legs, ankles and eventually abdomen
  5. fatigue
42
Q

What are signs for pulmonary hypertension?

A
  1. elavated JVP (jugular venous pressure)
  2. right ventricular heave
  3. loud pulmonary second heart sound
  4. hepatomegaly
  5. ankle oedema
43
Q

What investigations are done for suspected pulmonary hypertension? (7)

A
  1. ECG
  2. lung function tests
  3. chest X ray
  4. echocardiography
  5. V/Q scan
  6. CTPA; CT pulmonary angiography
  7. Right heart catheterisation
44
Q

What does right heart catheterisation allow doctors to do? (3)

A
  1. allows direct measure of pulmonary artery pressure to be taken
  2. measurement of wedge pressure
  3. measurement of cardiac output
45
Q

What can echocardiography allow radiographers to measure?

A

During pulmonary hypertension, the tricuspid valve leaks and radiographer can measure the velocity of the leak and indirectly estimate the pressure which can be picked up

46
Q

In an ECG what wave would be expected to be high?

A

P wave; indicates right arterial enlargement and possibly a pulmonary hypertension

47
Q

What are the general treatment options for a pulmonary hypertension? (4)

A
  1. treat underlying condition (that lead to pulmonary hypertension)
  2. oxygen
  3. anticoagulation
  4. diuretics (increases urine)
48
Q

What are 4 types of specific treatments for pulmonary hypertension?

A
  1. calcium channel antagonist (e.g. amlodipine)
  2. postacyclin
  3. endothelin receptor antagonist
  4. phsopodiesterase inhibitors
49
Q

What are 2 types of endothelin receptor antagonists?

A
  1. bosentan

2. ambrisentan

50
Q

What are 2 types of phosphodiesterase inhibitors?

A
  1. sildenafil (viagra)

2. tadalafil

51
Q

What other pulmonary hypertension treatments are there which are less commonly used than others?

A
  1. thromboendarterectomy (CTEPH); surgery which removes blood clots from the pulmonary artery
  2. lung or heart transplant

Systems: Resp. WK (40 decks)

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