Lecture 30 - Pulmonary Vascular Disease: Clinical

Question 1

Patients with PE may present with a feeling of ______, along with the usual signs. Be on the lookout for this, as it may help guide you toward PE rather than another cause of dyspnea, acute pleuritic chest pain, etc. Also be on the lookout for pain and swelling in the ______ _____.

Answer 1

Apprehension Lower leg

Question 2

Other signs of PE may include _____ (which might lead you to think of infection), accentuated _____ heart sound, and possibly localized ____/_____.

Answer 2

Fever

Second heart sound

Rales/Wheezing

Question 3

Deficiencies in Protein ___ and ___ or Factor ____ ____ put patients in a Hypercoagulable state, which is a risk for PE.

Answer 3

Protein C and S Factor 5 Leiden

Question 4

For PE patients, be on the lookout for Hampton’s Hump on CXR. What does it indicate?

Answer 4

It’s a wedge-shaped opacity on CXR, usually at the periphery of the lung, indicating an area of infarct secondary to PE.

Question 5

___-____ testing has a high Negative predictive value for PE. That is, if it is NOT elevated, PE is Unlikely.

Answer 5

D-Dimer

Question 6

ABG for patients with PE will show Respiratory _______ (due to tachypnea) and an _______ (increased or decreased?) A-a gradient.

Answer 6

Alkylosis Increased (Remember A-a gradient = PiO2 - (PaCO2/0.8) - PaO2

Question 7

Treatment for PE depends on the underlying disease state and severity of the symptoms. Anticoagulation is the go-to, and the duration is dependent on the patient’s _____ factors. Keep in mind anticoag does NOT dissolve the clot. ______, which would dissolve the clot, is only indicated for patients with _____ due to PE.

Answer 7

Risk factors (e.g. a patient with malignancy would be on anticoag therapy basically forever, while a patient who just came off a long flight would only be on anticoag temporarily.)

t-PA

Shock

Question 8

While EKG and CXR are used as diagnostic tools for Pulmonary HTN, the definitive test is what?

Answer 8

Right-heart catheterization

Question 9

Right Side Pulm HTN

Answer 9

Question 10

Left Side Pulm HTN

Answer 10

Question 11

Pulmonary Arterial HTN and/or Pulmonary HTN of unknow etiology is treated with 1 or a combination of 3 things. What are they?

Answer 11

PDE-5 inhibitors –> inhibit phosphodiesterase –> vasodilation

Prostanoids (increase Prostacyclin - aka PGI2 - effect –> which is vasodilation)

Endothelin receptor antagonists

Question 12

Treatment for CTEPH may include Thromboendarterectomy or ______ (which medication?)

Answer 12

Riociguat