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CVPR > CVPR Week 6: Pulmonary Edema > Flashcards

CVPR Week 6: Pulmonary Edema Flashcards

1
Q

Objectives

A
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2
Q

Question

A

A.

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3
Q

Pulmonary edema definition

A
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4
Q

Pulmonary edema histological features

A
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5
Q

Pressure of the pulmonary circulation

A
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6
Q

Normal pulmonary hemodynamics

A
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7
Q

Question

A

D.

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8
Q

How does pulmonary edema fluid move into the lung

A

through extravasation through 2 cells the endothelial cell and the epithelial cell of the alveolus

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9
Q

Forces that affect fluid movement in and out of capillaries

A

Starling’s Law

  • The actual pressure inside/outside the vessel and the oncotic pressures inside/outside
  • The hydrostatic pressure gradient and oncotic pressure gradient
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10
Q

Hydrostatic pressure gradient and oncotic pressure gradient

A
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11
Q

The rate of fluid movement across the capillary wall

A
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12
Q

Fluid filtration vs reabsorption

A
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13
Q

Normal pulmonary capillary pressure

A

~ 7 mmHg

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14
Q

Normal pulmonary interstitial pressure

A

~ -8 mmHg

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15
Q

Normal pulmonary capillary osmotic pressure

A

~ 28 mmHg

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16
Q

Normal pulmonary intersitital osmotic pressure

A

~14 mmHg

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17
Q

Normal pulmonary capillary pressure

A
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18
Q

Question

A

B)

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19
Q

Filtered fluid is removed by?

A
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20
Q

Fluid filtration rates of removal and accumulation

A
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21
Q

Edematous lung histology

A
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22
Q

Question

A

C)

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23
Q

How do the lungs accommodate large changes in CO with little change in PA

A
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24
Q

Defenses against pulmonary edema

A
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25
Q

Distention and recruitment of pulmonary arteries

A
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26
Q

Question

A

C

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27
Q

Gross symptoms of pulmonary edema

A
  • worse when lying down
  • dyspnea
  • can be cyanotic
  • usually more hypoxia than hypercardia (hypercardia tends to be an issue with the airway)
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28
Q

Cardiogenic pulmonary edema Xray

A
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29
Q

Cardiogenic pulmonary edema CT

A
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30
Q

Cardiogenic pulmonary edema Xray

A
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31
Q

What is the physiological etiology of Cardiogenic pulmonary edema

A

high capillary pressure

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32
Q

The lung cannot accomodate large changes in?

A

Left Atrial Pressure

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33
Q

Cardiogenic pulmonary Edema AKA

A

Congestive Heart Failure

34
Q

CHF fluid filtration pressure

A

~19 mmHg in CHF vs 1mmHg when normal

35
Q

when does filtered fluid become edematous

A
36
Q

Edematous lung histology

A
37
Q

Question

A

D

38
Q

Mechanisms of pulmonary edema

A

usually due to elevated LAP which is in turn due to one of 3 major mechansims

39
Q

Mechanisms of increased pulmonary capillary pressure

A
40
Q

Increased blood volume and pulmonary edema

A

yes like renal failure can cause pulmnonary edema

41
Q

Poor cardiac out put and pulmonary edema

A

yes can cause congestion and pulmonary edema

42
Q

Mitral stenosis and pulmonary edema

A

Yes if blood cant pass to the LV than can cause congestion and pulmonary edema due to increased capillary pressures

43
Q

Increased afterload and pulmonary edema

A

yes because can cause increased pressures and left heart failure

44
Q

Common causes of increased intravascular volume that can cause pulmonary edema

A
  • Renal failure
  • Excess administration of fluids
45
Q

Common causes of poor cardiac output that can cause pulmonary edema

A
  • myocardial infarction
  • Cardiomyopathy
  • Arrhythmia
46
Q

Common causes of increased afterload that can cause pulmonary edema

A
  • hypertensive crisis
  • aortic stenosis
47
Q

Question

A

B

48
Q

Physiologic rationale for treatment of cardiogenic pulmonary edema

5 listed

A
49
Q

Techniques to decrease preload

5 listed

A
  • Diuretics
  • sitting up in bed
  • nitrates
  • morphine
  • dialysis
50
Q

Techniques to improve cardiac performance

3 listed

A
  • Nitrates
  • Ionotropes
  • Digoxin
51
Q

Techniques to decrease afterload

A
  • ACE inhibitors
  • Nitroprusside
52
Q

Techniques to Increase PI

A

continuous positive airway pressure

mechanical ventilation

53
Q

Decreasing LPA or osmotic pressure for treating pulmonary edema

A

has not been attempted

54
Q

Non cardiogenic pulmonary edema

A

caused from leaky capillaries and not high pressures

55
Q

Factors that cause noncardiogenic pulmonary edema

A

so leaky capillaries allow proteins to leak accross and diminish the oncotic pressure gradient

in addition the interstitial pressure can be normal or even rise a bit

56
Q

the forces that oppose the hydrostatic pressure

A

increasing

57
Q

Describe the forces involved in noncardiogenic pulmonary edema

A

the onctic pressure gradient is lost

interstitial pressure can be normal or even rise

58
Q

Description of non-cardiac pulmonary edema

A
59
Q

Question

A

B

60
Q

Causes of non-cardiogenic pulmonary edema Rapid resolution

A
  • Transfusion-associated acute lung injury
  • Narcotic-associated pulmonary edema
  • Negative pressure pulmonary edema
61
Q

Causes of non-cardiogenic pulmonary edema usual resolution

7 listed

A
  • Sepsis
  • Pneumonia
  • Aspiration of acidic gastric contents
  • Pulmonary Contusion
  • Pancreatitis
  • Burns
  • Some medications
62
Q

Rapid resolution of pulmonary edema

A

24 - 48 hours

63
Q

Usual resolution of pulmonary edema

A

5+ days

64
Q

Treatment of non-cardiogenic pulmonary edema

3 listed

A
  • Removal of the offending source (infection, aspiration, inhalation)
  • Mechanical ventilation if necessary (with a low tidal volume and low pressure)
  • Many experimental therapies (anti-inflammatory among others)
65
Q

Differentiation of cardiogenic vs non-cardiogenic pulmonary edema

5 listed

A
66
Q

Chest Xray of cardiogenic vs non-cardiogenic pulmonary edema

A
  • noncardiogenic is spread more evenly
  • cardiogenic tends to be central and have lines superiorly
67
Q

Alveoli of cardiogenic vs non-cardiogenic pulmonary edema

A
68
Q

Causes of mixed cardiogenic vs non-cardiogenic pulmonary edema

A
  • Hantavirus cardiopulmonary syndrome
  • High altitude pulmonary edema (HAPE)
69
Q

Hantavirus description

A

a unique viral illness characterized by prodigious pulmonary edema and is associated with both cardiogenic and non-cardiogenic pulmonary edema mechanisms

70
Q

Hantavirus and pulmonary edema

A
  • Associated with both cardiogenic and non-cardiogenic pulmonary edema
  • Patients have increased PC (pulmonary capillary pressure) (due to heart failure) and increased permeability (increased LPA, decreased delta and decreased oncotic gradient)
71
Q

Hantavirus prognosis

A

Self-limited disease that resolves within 1 week for those that survive

72
Q

HAPE AKA

A

High Altitude Pulmonary Edema

73
Q

HAPE Description

A

A mixed form of pulmonary edema

74
Q

HAPE and Pulmonary edema

A
  • leaky capillaries probably due to stress failure secondary to over-perfusion
  • Increased PC probably due to venous constriction
  • Susceptible individuals have diminished ventilatory response to hypoxia and exaggerated pulmonary pressor response to hypoxia
75
Q

Risk factors for HAPE

3 listed

A
  • Susceptible individuals have diminished ventilatory response to hypoxia and exaggerated pulmonary pressor response to hypoxia
  • Underlying pulmonary illness increases risk
  • Previous episode of HAPE increases risk
76
Q

Prevention and treatments of HAPE

5 listed

A
77
Q

PC AKA

A

Pulmonary capillary pressure

78
Q

PC can be measured by

A

Swann-Ganz Catheter

79
Q

pulmonary edema onset

A

can be sudden or chronic

80
Q

pulmonary edema aggravating stimuli

A
  • worse when lying down

CVPR (93 decks)

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