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RESP > Clinical aspects of pulmonary embolism and hypertension > Flashcards

Clinical aspects of pulmonary embolism and hypertension Flashcards

1
Q

What are the two main types of thrombo-embolic disease?

A
  1. DVT

2. Pulmonary embolism

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2
Q

What is PE?

A

Blockage of a pulmonary artery by primarily a blood clot.

Could also be air, tumour, fat.

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3
Q

What is pulmonary infarction?

A

Death of lung tissue due to inadequate perfusion

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4
Q

DVT’s can be proximal or distal. Which is more likely?

A
  1. Proximal- Ileo-femoral. Most likely to embolise. Can cause venous insufficiency and ulcers
  2. Distal- Popliteal, least likely
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5
Q

Clinical presentation of DVT? (4)

A
  1. Swollen
  2. Hot
  3. Red
  4. Tender

Can involve all of leg or calf

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6
Q

Differentials of DVT? (3)

A
  1. Popliteal synovial rupture
  2. Superficial thrombophlebitis
  3. Calf cellulitis
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7
Q

Investigations for DVT? (2)

A
  1. Ultrasound doppler leg scan

2. CT scan- ileofemoral veins, IVC, pelvis

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8
Q

What are the clinical presentations of PE based on size

  1. Small (3)
  2. Medium (3)
  3. Large (4)
A
  1. Small
    - Progressive Dyspnoea
    - Pulmonary hypertension
    - RHF
  2. Medium
    - Pleuritic chest pain
    - Dyspnoea
    - Haemoptysis
  3. Large
    - Cardiovascular Shock
    - low BP
    - Central cyanosis
    - Sudden death
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9
Q

What are the risk factors for DVT and PE? (5)

A
  1. Thrombophilia
  2. Pregnancy
  3. Contraceptive
  4. Pelvic obstruction
  5. Trauma

Others- surgery, malignancy, obesity, p.hypertension, immobility

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10
Q

Long flights and periods of immobility can cause _

A

DVT then PE

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11
Q

Main symptoms of DVT/PE? (5)

A
  1. Pleuritic Chest pain
  2. Breathless
  3. Haemoptysis
  4. Leg pain/swell
  5. Collapse
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12
Q

What are the clinical signs of DVT/PE? (7)

A
  1. Tachycardia
  2. Tachypnoea
  3. Fever
  4. Cyanosis
  5. Low BP
  6. Crackles/rub
  7. Pleural effusion
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13
Q

What are the ABG findings in DVT/PE?

A

Low PaO2 and SaO2 (Type 1 Respiratory failure)

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14
Q

Main CXR findings in DVT/PE?

A

Consolidation, P effusion, basal atelectasis (collapse)

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15
Q

What investigations are needed in DVT/PE? (6)

A
  1. ABG
  2. D dimers- reveals level of clotting
  3. CXR
  4. ECG- Right heart strain pattern
    5 CT- pulmonary artery filling defect
  5. Ultra sound- leg and pelvis
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16
Q

What preventative measures can be taken for DVT/PE/? (4)

A
  1. Post op mobilisation
  2. TED compression stockings (increases venous flow and pressure, reducing coagulation)
  3. Calf exercises
  4. Drugs
17
Q

What are the treatment options for DVT/PE? (3)

A
  1. LMWH- Fragmin
  2. Warfarin
  3. Oral thrombin inhibitor- Dabigatran OR factor X inhibitor- Rivoroxiban.

Stop LMWH 2-3 days later when INR>2 (level of coagulation)

18
Q

What is thrombolysis? In what cases of DVT/PE is it used for?

A

Artificially busting a clot using enzymes (tissue plasminogen factor).

Only for severe cases

19
Q

Normally mean pulmonary arterial pressure is 12-20 mmHg. What would this value be in pulmonary hypertension?

A

> 25mmHg

20
Q

What are the causes of pulmonary Venous and pulmonary Arterial hypertension?

A
  1. Venous (Left sided heart problems)
    - LVSD
    - Cardiomyopathy
    - Mitral regurgitation/stenosis
  2. Arterial (Right sided heart problems)
    - Hypoxic (COPD, fibrosis)
    - Multiple PE (Lupus, Systemic sclerosis)
    - Vasculitis
    - Drugs
    - HIV
    - Left to Right Shut
21
Q

What is Cor pulmonale?

A

Right sided heart failure secondary to lung disorders (hypertension, PE).

Can also result in fluid retention due to hypoxia.

22
Q

What are the clinical signs of pulmonary hypertension and RHF? (6)

A
  1. Central cyanosis if hypoxic
  2. Dependent oedema
  3. Raised JVP with V waves
  4. Tachycardia
  5. Pan systolic murmur
  6. Hepatomegaly.
23
Q

What investigations are useful in pulmonary hypertension? (4)

A
  1. ECG- right ventricular strain, right axis deviation
  2. CXR- enlarged right atrium/ventricle
  3. ABG + SaO2
  4. CT pulmonary angiogram
24
Q

What are the treatments used in pulmonary hypertension? (4)

A
  1. Treat underlying cause- eg COPD, infection
  2. Treat respiratory failure- Oxygen, Pulmonary Vasodilators (eg Diltiazem)
  3. Treat cardiac failure- diuretics
  4. Lung transplant
25
Q

What is the drug Riociguat?

A

A pulmonary arterial vasodilator. Used in Chronic Pulmonary Hypertension.

Other chronic treatments
- Angioplasty , pulmonary endarterectomy

RESP (25 decks)

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