Disease of the pulmonary vasculature Flashcards
What is normal pulmonary bp?
15-18 mm Hg
What is pulmonary HTN (PH)?
- High blood pressure in the pulmonary arteries
- 5-10 above normal
T/F Primary Pulmonary HTN (PH) is rare.
True
PH is most common in what group/s of people?
young and middle-aged women
T/F PH may be idiopathic
True
What causes PH?
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
What are underlying causes of PH?
- Congestive HF (accumulation of blood)
- Blood clots in lungs
- HIV
- Cocaine/ methamphetamine use (decrease r)
- Liver disease
- Lupus, scleroderma, RA and other autoimmune diseases
- Lung diseases (emphysema, chronic bronchitis, pulmonary fibrosis)
- Congenital heart disease
Treatment for PH:
Right sided heart failure -
treatment of this failure
Treatment for PH:
Hypoxia due to chronic lung disease -
provide o2 and treat underlying disease
Treatment for PH:
Sleep apnea -
CPAP (keeps lungs inflated)
Treatment for PH:
Autoimmune disease
Management of disease
Treatment for primary pulmonary HTN -
- Prostaglandins - wall relaxation
2. Phosphodiesterase type 5 inhibitors (Viagra)
T/F Pulmonary HTN is difficult to diagnose.
True, Delay of 1 to 2 years between onset of symptoms and diagnosis
Describe impaired Aerobic Capacity/Endurance Associated with Pulmonary HTN:
- Impairment of exercise performance
Prognosis for a patient diagnosed with PH?
poor without heart-lung transplantation
2-3 years
Risk factors for pulmonary embolism:
- Prolonged bed rest
- Hypercoagulability (birth control pills, smoking, polycythemia, cancer, surgery)
- Damage to walls of vein (increased clotting factors)
Symptoms of PE:
- Chest pain
- Dyspnea
- Apprehension
- Cough
- Hemoptysis (coughing up blood)
- Palpitation
- CHest tightness
Signs of PE:
- Tachypnea (resp>16/min)
- Tachycardia
(pulse>100/min) - Hypotension
- Temp >100.04
- Edema
- Murmur
- Cyanosis
Clinical classifications for low risk PE:
- Normotensive
- No RV dysfunction
Clinical classifications for intermediate risk PE:
- Normotensive
- Rv dysfunction/dilation
- Myocardial necrosis
Clinical classifications for high risk PE:
- Hypotension (SBP < 90 for > 15 min) or shock
- Pulselessness
- Profound bradycardia (HR < 40)
Patient with PE that present with these characteristics are at risk for sudden death:
- Hypotension
- Syncope
- Bradycardia
- inability to maintain adequate oxygenation
T/F Patients who presents with end organ damage but are hemodynamically stable can be considered intermediate risk
True
Why is it so difficult to harvest a lung for transplant?
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
