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Pathophys > Disease of the pulmonary vasculature > Flashcards

Disease of the pulmonary vasculature Flashcards

1
Q

What is normal pulmonary bp?

A

15-18 mm Hg

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2
Q

What is pulmonary HTN (PH)?

A
  • High blood pressure in the pulmonary arteries

- 5-10 above normal

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3
Q

T/F Primary Pulmonary HTN (PH) is rare.

A

True

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4
Q

PH is most common in what group/s of people?

A

young and middle-aged women

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5
Q

T/F PH may be idiopathic

A

True

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6
Q

What causes PH?

A

Diffuse narrowing of the pulmonary arterioles caused by hypertrophy of smooth muscle in the vessel walls and formation of fibrous lesions in and around the vessels

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7
Q

What are underlying causes of PH?

A
  1. Congestive HF (accumulation of blood)
  2. Blood clots in lungs
  3. HIV
  4. Cocaine/ methamphetamine use (decrease r)
  5. Liver disease
  6. Lupus, scleroderma, RA and other autoimmune diseases
  7. Lung diseases (emphysema, chronic bronchitis, pulmonary fibrosis)
  8. Congenital heart disease
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8
Q

Treatment for PH:

Right sided heart failure -

A

treatment of this failure

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9
Q

Treatment for PH:

Hypoxia due to chronic lung disease -

A

provide o2 and treat underlying disease

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10
Q

Treatment for PH:

Sleep apnea -

A

CPAP (keeps lungs inflated)

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11
Q

Treatment for PH:

Autoimmune disease

A

Management of disease

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12
Q

Treatment for primary pulmonary HTN -

A
  1. Prostaglandins - wall relaxation

2. Phosphodiesterase type 5 inhibitors (Viagra)

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13
Q

T/F Pulmonary HTN is difficult to diagnose.

A

True, Delay of 1 to 2 years between onset of symptoms and diagnosis

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14
Q

Describe impaired Aerobic Capacity/Endurance Associated with Pulmonary HTN:

A
  • Impairment of exercise performance
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15
Q

Prognosis for a patient diagnosed with PH?

A

poor without heart-lung transplantation

2-3 years

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16
Q

Risk factors for pulmonary embolism:

A
  1. Prolonged bed rest
  2. Hypercoagulability (birth control pills, smoking, polycythemia, cancer, surgery)
  3. Damage to walls of vein (increased clotting factors)
17
Q

Symptoms of PE:

A
  1. Chest pain
  2. Dyspnea
  3. Apprehension
  4. Cough
  5. Hemoptysis (coughing up blood)
  6. Palpitation
  7. CHest tightness
18
Q

Signs of PE:

A
  1. Tachypnea (resp>16/min)
  2. Tachycardia
    (pulse>100/min)
  3. Hypotension
  4. Temp >100.04
  5. Edema
  6. Murmur
  7. Cyanosis
19
Q

Clinical classifications for low risk PE:

A
  • Normotensive

- No RV dysfunction

20
Q

Clinical classifications for intermediate risk PE:

A
  • Normotensive
  • Rv dysfunction/dilation
  • Myocardial necrosis
21
Q

Clinical classifications for high risk PE:

A
  • Hypotension (SBP < 90 for > 15 min) or shock
  • Pulselessness
  • Profound bradycardia (HR < 40)
22
Q

Patient with PE that present with these characteristics are at risk for sudden death:

A
  1. Hypotension
  2. Syncope
  3. Bradycardia
  4. inability to maintain adequate oxygenation
23
Q

T/F Patients who presents with end organ damage but are hemodynamically stable can be considered intermediate risk

A

True

24
Q

Why is it so difficult to harvest a lung for transplant?

A

At the time of death there is a catecholamine storm leading to disruption of the pulmonary capillary beds leading to edema and difficulty in perfusing and ventilating the organ

25
Q

If patient receives a single lung transplant, where will the surgeon enter the body cavity?

A

posterolateral thoracotomy

26
Q

If patient receives a double lung transplant, where will the surgeon enter the body cavity?

A
  • bilateral anterior thoracotomies

- “clam shell”, imagine lifting the hood of a car

27
Q

If patient receives a heart-lung transplant, where will the surgeon enter the body cavity?

A

Midline sternotomy

28
Q

Cyclosporine and Tacrolimus are what type of drugs?

A

Anti-rejection drugs - Block the growth and proliferation of activated T cells and other immune responsive cells (IL-2)

29
Q

Lung Transplant PT implications:

A
  1. Patients badly deconditioned
  2. Wound management
  3. Airway clearance tech
  4. Lots of lines and wires
  5. Slow progression (bed mobility -> standing -> sitting bedside chair -> ambulation)
  6. Monitor O2 stats, vital signs and breathing patterns

Pathophys (16 decks)

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