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KEY wk 6 lec 2 Flashcards

1
Q

pulmonary pressures

A

very low for gas exchange

25/8mmHg

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2
Q

pulmonary hypertension

A

mean pulmonary artery >20 mmHg (use to be >25)

the mean pulmonary arterial pressure (mPAP) if healthy is 15mmHg

PAWP (pulmonary artery wedge pressure) <15 mmHg

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3
Q

changes in artery walls in pulmonary arterial hypertesnion

A

mild: thicken media
severe: intimal fibrosis and muscle thickening

grade 1, 2,3 are reversible, 4 is not

telangiectatic dilations (thin wall)

plexiform lesions

lumen obliteration and loose collagen

organized thrombus

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4
Q

6 types of pulmonary hypertension from sixth world symposium

A
  1. PAH
  2. Left heart disease
  3. Chronic lung
    disease or sleep- disordered breathing
  4. CTEPH
  5. Miscellaneous
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5
Q

primary pulmonary hypertension

A

pre capillary disorder; increase pulmonary arterial tone

idiopathic, hereditary, drugs or toxins that cause endothelial dysfunction, vascular remodel, resistnace ..

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6
Q

idiopathic pulmonary artery hypertesnion can lead to

more common in

leads to an increase in

A

right heart failure and early mortality

women

total pulmonary vascular resistnace (from changes in pulmonary arterial compliance)

To preserve cardiac output (CO) in the face of elevated right ventricular afterload, right ventricular work must increase.

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7
Q

sx of pulmonary artery hypertesnion

A

dyspnea

end stage: cardiac output declines and increase mPAP

extrapulnoanary vascular manifestations ie renal failure

systemic: increase aldosterone, angiotensin, estrogen, right ventricle fibrosis and dilation, muscle atrophy

cor pulmonale (death)

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8
Q

tx for pulmonary arterial hypertesnion

A

5 year survival via prostacyclin analogs, endothelin receptor antagonists and phosphodiesterase-5 inhibitors

usually do heart-lung transplant

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9
Q

pulmonary hypertension and left heart disease cause PWAP

A

> 15mmHg

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10
Q

pulmonary edema and causes

A

fluid accumulate in interstitial and alveolar spaces of lung

-increase capillary hydrostatic pressure (i.e. MI, heart fail)
-increased capillary permeability (i.e. sepsis, radiation)
-decreased colloid osmotic pressure

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11
Q

interstitial into alveolar pulmonary edema

A

pressure increases so much in interstitial space that it will fluid spill into alveoli

increase permeability and cause protein and red cells in alveolar fluid

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12
Q

interstitial vs alveolar edema

A

interstitial has little effect on pulmonary function

alveolar - cause alveoli to collapse and prevent ventilation; hypoxemia

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13
Q

sx of pulmonary edema

A

dyspnea and orthopnea (worse laying down)

suffocate or drown

cough with sputum

palpitations

anxiety

cold clammy

wheeze or gasp for breath

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14
Q

drugs for pulmonary edema

A

Diuretics
Inotrops
Antihypertensives
Morphine (acutely)

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15
Q

pulmonary hypertesnion associated with lung disease examples

A

COPD, interstitial lung disease, cystic fibrosis, sleep related respiratory disorders

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16
Q

pulmonary hypertesnion associated with lung disease changes in mPAP

A

pulmonary hypertesnion modest i.e. mPAP >20mmHG

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17
Q

venous thromboembolisms is 2 things

A

deep vein thrombosis (DVT) and pulmonary embolism (PE)

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18
Q

virchows triad for venous thrombi

A
  1. stasis of blood
  2. hypercoagulability
  3. intimal/endothelial injury
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19
Q

genetic mutations and aqduired causing hypercoagulability

A

factor V leidin (resistnace to activate protein C which should inactivate clotting factors)

prothrombin gene mutation (deficient in antithrombin, protein C and S which should stop coagulation)

acquired: antiphospholipid antibody syndrome

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20
Q

inflammation and triggers of DVT and PE

A

cancer, obese, smoking, OCP, pregnancy

psoriasis, T2DM, sepsis, pneumonia, lp(a)…

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21
Q

pulmonary embolism

A

thrombi from large veins travel to lungs and occlude pulmonary circulation

2 types: venous thrombi and nonthrombotic emboli (fat, air, amniotic fluid)

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22
Q

venous thromboembolism vs atherothrombosis

A

MI, PE and stroke overlap with likelihood and hyper coagulable, and inflam

atherothromsiss is atheroscletoritc plaque ruptures and cause thrombi (blood clot) and ischemia into stroke or heart attack

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23
Q

pulmonary embolism pathophysiology

A

right side of heart pumps deoxygenate blood to lungs

increase RV pressure and wall tension which causes dysfunction and ischmie

then decrease coronary perfusion and systemic pressure

can lead to decrease left ventricle preload and cardiac output

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24
Q

2 types of acute pulmonary embolism

A
  1. massive (high risk)
    –> systemic arterial hypotension and thrombosis affects 1/2 of pulmonary vasculature (dyspnea, syncope, hypertension, cyanosis, cardiogenic shock
  2. submassive (intermediate risk)
    –> RV dysfunction but normal systemic arterial pressure
  3. low risk (75% of cases)
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25
massive vs submissive pulmonary embolism
massive: hypotension, RV fail --> cardiac shock submassive: no hypotension, RV dilated but not failed
26
small vs medium vs massive emboli
small: maybe pulmonary hypertesnion medium: dyspnea, pleural friction rub, near normal chest radiograph massive: hemodynamic collapse (shock, pallor, cardiac arrest), hypotension
27
chronic thromboembolic disease (CTEPH) causes
pulmonary hypertension shows fibrosis, artery stricture, webbing of arteries, dearborization
28
cor pulmonale definition causes
right ventricle fails bc of high pulmonary artery pressures -pulmonary emboli -pulmonary vascular disease -parenchymal disease (i.e. COPD)
29
changes in right ventricle in car pulmonale
hypertrophy, thicker wall, dilated, remodelling (lose septum curvature)
30
miscellaneous causes of pulmonary hypertesnion
sarcoidosis (mutlisystem inflam with granulomas but can be in lungs) sickle cell disease (hemolysis and hypoxemia and high CO) schistosomiasis (parasite cause granulomas and portal hypertesnion from hepatosplenic disease)
31
pre capillary vs post capillary
pre: increase pressure in pulmonary arteries before blood reaches lungs (i.e. PAH, CTEPH) post capillary: increase pressure in pulmonary veins or left side of heart aging pressures in arteries that are downstream from it (I.e.left sided heart failure, ) capillary is in the pulmonary (i.e. sarcoidosis, asthma)
32
vascultitis
inflamed and damaged blood vessels ischemia of tissues granuloma, eosinophil, neutrophil, lymphoplasmacytic patterns single organ or many
33
vasculitis classified by vessel size
large: aorta medium: visceral arteries, i.e. renal, hepatic small vessels: capillaries, venules, arterioles
34
lung involvement is seen in which type of vasculitis most
primary, idiopathic, small vessel or antineutrophil cytoplasmic antibody associated vasculitides: -wegeners granulomatosis -microscopic polyangitis -churg-strauss syndrome
35
Allergic Granulomatosis and Angiitis (Churg-Strauss Syndrome)

small and medium arteries are necrotizing --> thrombosis and aneurysm granulomas and eosinophils asthma treat with corticosteroids
36
Granulomatosis with Polyangiitis
 (formerly Wegener Granulomatosis)
necrotizing vasculitis granulomas ANCA+ persistent bilateral pneumonitis, with nodular infiltrates that undergo cavitation involves many systems (i.e. lungs, kidneys, otitis media, sinusitis, eyes vision loss and conjunctivitis, skin, fever, weight loss, neuropathy...)
37
38
sarcoidosis
mutlisystemic; non-necrotizing non-caseating granulomatous inflammation (lungs and intrathoracic lymph common) genes and envo infectious or non infectious triggers
39
who's sarcoidosis most common in and associated with
40-55yoa black twins genes insecticides, cigarrets, microbes (mycobacterium)
40
pathology of sarcoidosis
noncaseating granulomatous infalmmation T cells and monocytes lung: multinucleated giant cells, and mononuclear cell inflammation lymph: epithelioid granulomas
41
immunopathogeneiss of sarcoidosis
APC and Th cell complex release cytokines that form granulomas which can resolve or cause fibrosis cytokines and circulating mediators go to organ and damage them via granulomas symptoms of fever, weight loss, fatigue, pain...
42
stages of sarcoidosis
stage 0= no signs on x ray stage 1= granuloma in lymph stage 2- granuloma in lymph and lung stage 3= granuloma in lung stage 4= pulmonary fibrosis on x ray
43
lofgrens syndrome stage 1 of sarcoidosis
erythema nodosum (red skin bumps) hilar adenopathy (enlarged lymphs at hilum of lungs) periarticular arthritis
44
Stage 2 of sarcoidosis – Pulmonary Sarcoidosis
 Granulomas in Lymph Nodes & Lungs
stand away hilar nodes paratracheal adenopathy (enlarged lymphs near trachea) reticulonodular infiltrates
45
Stage 3 & 4 – Pulmonary Sarcoidosis
 Granulomas - Fibrosis

fibrocystic sarcoidosis lung scarring, bulbous and cystic changes, hilar retraction parenchymal infiltrates
46
pulmonary function test in sarcoidosis
restrictive impairment; reduce FVC and FEV1 reduced diffusing capacity obstructive impairment (advanced fibrocystic disease) resting hypoxemia and exercise O2 desaturation pulmonary hypertension
47
clinical manifestations of sarcoidosis
pulmonary: reduced diffusing capacity, restrictive, obstructive, fibrocystic constitutional: fever, sweat, fatigue Upper respiratory tract: hoarseness, laryngeal obstruction, sinusitis skin: nodules and plaques, alopecia, lesion on nose, eyes, cheek, maculopapular lesions on trunk ocular abdominal: spleen, rib and spine increased activity on CT and PET cardiac: arrhythmia, death
48
lupus pernio
extra pulmonary sarcoidosis causing lesions on nose, eyes, cheek
49
cardiac sarcoidosis
i.e. AV block, sudden cardiac death, congestive heart failure, ventricular tachycardia
50
Progressive Systemic Sclerosis (Scleroderma) effects the lungs how
pulmonary fibrosis, intestinal lung disease via connective tissue autoimmune, pulmonary hypertension
51
systemic Lupus Erythematosus effects the lungs how
pleuritis, pulmonary infiltrates, interstitial inflammation leading to fibrosis, shrinking lung syndrome, intra-alveolar hemorrhage, pulmonary arterial hypertension
52
how rheumatoid arthritis affects the lungs
pleuritis fibrosis- interstitial lung disease respiratory failure pulmonary hypertesnion
53
occupational lung diseases inorganic vs organic dusts
inorganic - asbestos -silica -coal dust -metals --> i.e. fibrosis, cancer, organic: -cotton -grain -agriculture --> ie.. asthma, bronchitis, COPD
54
asbestos-related lung disease complications
primary exposure: miners and millers secondary exposure: manufacturing plants complications; -nonmalignant pleural -asbestosis -malignant mesothelioma -lung cancer
55
asbestosis
initial macrophage alveolitis if fibers of asbestos arent cleared then cause fibrosis interstitial pneumonitis and fibrosis fibrosis on walls of respiratory bronchioles septa thicken
56
clinical prevention of asbestosis
parenchymal fibrosis dyspnea, bibasilar rales restrictive ventilatory impairment
57
silicosis
alveolitis ground glass appearance calcify hilar nodes process to cause obstructive and restrictive ventilatory impairment
58
progressive massive silicosis
Obstructive & restrictive ventilatory impairment Respiratory failure rheumatoid arthritis and scleroderma lung infections: mycobacterium tuberculosis mesothelioma (cancer)
59
coal workers pneumoconiosis
simple: chronic bronchitis and COPD complicated: Caplan syndrome of coal/silica and rheumatoid arthritis
60
pathology in coal worker pneumoconiosis
-coal macule -collect coal dust in macrophages -centriacinar emphysema
61
sx in coal worker pneumoconiosis
cough and sputum, dyspnea obstructive, restrictive emphysema, fibrosis reduce gas exhange hypoxia, pulmonary arterial hypertesnion
62
beryllium disease (work exposure)
acute pneumonitis chronic granulomatous disease (become sensitized and then get a positive BeLPT) sensitization phase (bc hypersensitivity) --> chronic

BMS250 (52 decks)

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