2.2.3 Pulmonary Vascular Disease

Question 1

What are the normal pulmonary hemodynamics?

Answer 1

Question 2

What is pulmonary arterial hypertension defined as?

Answer 2

Question 3

What are some of the etiologies of PAH?

Answer 3

Question 4

What is the pathology of PAH?

Answer 4

Question 5

What is this an image of?

Answer 5

Normal pulmonary artery and alveolus

Question 6

What is this an image of? What are the defining characteristics?

Answer 6

Question 7

Why does pulmonary arterial hypertension end up killing patients?

Answer 7

Patients don’t die from increasing pulmonary pressures; they die from progressive right heart failure.

Question 8

What are the signs of PAH?

Answer 8

JVD

Trouble catching breathe

Periperial Swelling

Question 9

What is the role of prostacyclin in PAH?

Answer 9

Question 10

How does the NO pathway have a role in PAH?

Answer 10

PDE5 degrades cGMP not allowing it to ellicit its effects on smooth muscle

Question 11

What is the role of endothelin-1 in PAH?

Answer 11

As Dr. Wood said in the lecture in cardio, there is no stronger vasoconstrictor than endothelin. In PAH, it is thought that levels of endothelin-1 are elevated

Question 12

25 y/o presents to your clinic with complaints of dyspnea, lower extremity edema and chest pressure. On exam, you see bilateral lower extremity pitting edema and JVD. Her lungs are clear to auscultation bilaterally.

Answer 12

B. Fixed splitting of the pulmonic component of the second heart sound

Question 13

Answer 13

Yes it does.

Her PA pressure is greater than 25 and her wedge pressure is lower than 15

Question 14

What is a pulmonary embolism?

Answer 14

Question 15

What is this an image of?

Answer 15

MASSIVE PE

Question 16

Why do thrombi form?

Answer 16

• Blood stasis
• Hyper-coagulable states
• Vessel wall abnormalities

Question 17

Where are the main regions that emboli originate from?

Answer 17

Question 18

What happens when a PE occurs?

Answer 18

Question 19

What is the cause of death from a PE?

Answer 19

Cardiovascular collapse, rather than resp failure

Question 20

What are the symptoms of a PE?

Answer 20

Question 21

How do you diagnose of DVT or PE?

Answer 21

Question 22

What is the abnormality in this image?

Answer 22

Its a PE!

Question 23

39 y/o male was riding mountain bike and fell. He was admitted to surgery and repaired his broken femur. Surgery went well and he is sent home in a cast. He come back to the ED 3 days later with shortness of breath that came on suddenly. What is the most likely diagnosis?

Answer 23

Acute pulmonary embolus

Question 24

What are the two categories or problems that cause pulmonary edema?

Answer 24

Question 25

How do the lungs protect themselves from excessive movement of fluid into interstitial spaces?

Answer 25

Question 26

What is this?

Answer 26

Normal lung tissue

Question 27

What is this an image of?

Answer 27

Lung tissue with pulmonary edema

Question 28

What is the pathophysiology of pulmonary edema?

Answer 28

Question 29

What is the effect of alveolar edema on size?

Answer 29

It makes them larger

Question 30

What is this an image of?

Answer 30

Alveolar edema

Question 31

What are the symptoms of pulmonary edema?

Answer 31

Question 32

78y/o woman come to ED with shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She has a history of coronary artery disease and systemic hypertension. She is admitted for pulmonary edemaand treated with diuretics. If she were to undergo right heart cath at this time what would be found?

Answer 32

B