Baker/Parks: Pulmonary Vascular Pathology Flashcards
T/F: Blood clots in the pulmonary arterial system are almost always embolic
True!!!
**95% of blood clots in pulmonary arterial system are from DVT
T/F: DVT = PE
false, not all DVTs result in a PE
however, PE = DVT in 95% of cases
T/F: Pulmonary embolisms cause significant increases in morbidity and mortality
True
1/2 of people with PE have long term complications
1/3 of PE recur over 10 yrs
10-30% die within one month
25% die of sudden death
3 risk factors for pulmonary embolism?
- endothelial injury (trauma, vasculitis, HTN)
- stasis of blood flow (immobility, venous compression)
- hypercoagulable (genetic predisposition, cancer, pregnancy)
Two main issues with PEs?
- respiratory compromise (V/Q mismatch - ventilation does not match tissue perfusion)
- hemodynamic compromise - lack of blood flow to lungs
What does the severity of symptoms and PE syndrome depend on?
size of PE
**large emboli can cause complete loss of blood flow, leading to hypoxemia, right heart failure and even instantaneous death
**smaller emboli travel deeper into the periphery and are less likely to cause death
This is a hemorrhagic lesion that occurs in 10% of cases of PE
Usu only occurs when underlying cardiopulmonary conditions are present (disrupts the ability of the bronchial arteries to compensate)
Typically occurs in lower lobes
pulmonary infarction
Clinical features of PE?
tachycardia **most common chest pain tachypnea dyspnea hypoxemia cough/fever
3 EKG findings in PE?
large S wave in lead 1
pathologic q wave in lead 3
inverted T wave in lead 3
**S1Q3T3
Two imaging modalities that can be used to diagnose PE?
chest x-ray: can show wedge-shaped infarcts or V/Q mismatch
CT scan: can show vessels with decreased blood flow if you use contrast
What is normal pulmonary arterial pressure?
15-30/4-12
sustained elevation of mean pulmonary arterial pressure to more than 25 mm Hg at rest or to more than 30 mm Hg with exercise
pulmonary hypertension
Two types of pulmonary hypertension?
primary = idiopathic secondary = many causes
What will you see histologically in pulmonary hypertension?
medial hypertrophy of muscular and elastic arteries
plexiform lesions (in long standing HTN)
pulmonary artery atheromas
What are the 5 clinical classifications of pulmonary arterial hypertension?
- PAH (primary)
- PH with left heart disease
- PH associated with lung disease
- PH due to chronic thrombotic/embolic disease
- Misc PH
Things that can cause secondary pulmonary arterial hypertension?
anything that increases pressure!
heart disease, chronic lung disease, obstructive sleep apnea
T/F: some patients can have multiple pulmonary emboli
True!
**multiple emboli can occlude vessels and lead to pulmonary hypertension
What can cause primary pulmonary hypertension?
still increased pressure
…but this time due to a mutation in BMPR2 which leads to a proliferation of vascular smooth muscle cells
may be due to environmental factors, too?
Who gets pulmonary arterial hypertension?
females age 20-40
Symptoms of PAH?
early on: dyspnea, fatigue, anginal chest pain
later: respiratory distress, cyanosis, RVH, cor pulmonale
**usu die within 2-5 yrs of diagnosis
How to treat pulmonary hypertension?
O2 calcium channel blockers digoxin diuretics PDE5 inhibitors (Viagra) inhaled NO lung transplant
Autoimmune disorder – autoantibodies against the basement membrane in alveoli and glomeruli - focal alveolar wall necrosis with intra alveolar hemorrhages
Hemorrhagic interstitial pneumonitis
Rapidly Progressive Glomerulonephritis (RPGN)
Goodpasture Syndrome
Who gets Goodpasture syndrome?
males > females
teens to 20s
Diagnostic linear Ig and complement deposits in basement membrane
Goodpasture syndrome
