Lecture 6 Pulmonary Vascular Disease Flashcards
A swan catheter measures what?
LA pressure aka pulmonary capillary wedge pressure
Pulmonary arterial hypertension:
elevation of pulm arterial pressure to more than ____ at rest and with a pulmonary capillary wedge pressure less than ____ mm hg
25, 15
what generally causes pulmonary arterial hypertension? Who is the classic patient? (according to pathoma)
generally idiopathic (IPAH); young women
IPAH is heritable, due to a inactivating mutation in ____ gene, which normally inhibits ____ proliferation. Other gene mentioned in notes is ____
BMPR2;
vascular smooth muscle;
ALK1
what connective tissue disease is associated with PAH?
systemic sclerosis (Associated with poor prognosis)
_____ may be the most prevalent cause of PAH worldwide
shistosomiasis
clinical findings in PAH: increased \_\_\_ (heart sound). \_\_\_\_ lift. \_\_\_\_ regurg. late \_\_\_\_.
P2 (closing of pulmonic);
parasternal; tricuspid, cyanosis
2 drugs associated with pulm HTN (mentioned in notes/FA)
cocaine, anorexigens (also meth)
Give one particularly common example of Pulm HTN due to left heart disease
mitral stenosis (or regurg);
ie LV dysfunction, Aortic stenosis
Pulm HTN due to hypoxemia:
disease such as ____ cause hypoxemic _____ of blood vessels, leading to general vaso____ of pulmonary vessels
COPD (or sleep apnea, high altitdue);
vasoconstriction, constriction
Recurrent pulmonary _____ can cause pulm HTN due to ____ and decreased cross sectional area of the vascular bed
emboli; reorganization (of emboli)
Pulm Aterial HTN pathological changes:
medial ____ due to increased ___ ____;
____ fibrosis;
_____ arteriopathy (High Yield as per pathoma)
hypertrophy, smooth muscle;
intimal;
plexiform
what does scleroderma look like on CT (mentioned a few times in class)
honeycomb
Path of HTN:
name 2 vasodilators that are decreased;
name a vasoconstrictor that is increased
prostacyclin, NO;
endothelin
What should be given first to a patient with PAH?
Oxygen
______ syndrome can cause pulmonary HTN secondary to congenital heart defect
Eisenmenger’s
single classic symptom of Pulm HTN mentioned in pathoma
exertional dyspnea;
other symptoms = fatigue, syncope, cough
gold standard of diagnosing PAH:
right heart catheterization (Swan)
heart changes in pulm HTN:
initially _____, then death from decompensated ___ ___
RVH; cor pulmonale
With RVH, large ___ waves are seen in leads V1 and V2
R
2 biomarkers of PAH (Associated with survival)
BNP; hyponatremia
treatment of PAH:
endothelin receptor agonists such as ____.
PDE-5 inhibitors such as ____.
Prostacyclin analogs such as ____
bosentan;
sildenafil;
epoprostenol (or iloprost)
3 side effects of epoprostenol mentioned in FA:
flushing, jaw pain, hypotension
Virchow triad associated with developing DVT
SHE:
Stasis; hypercoaguability, endothelial damage
Pulmonary embolus presents as sudden-onset ____, chest pain, ______, and _____.
dyspnea; tachycarida, tachypnea (according to FA)
How would you treat a pulmonary embolus causing hemoptysis?
blood thinners (mentioned in lecture)
What happens to the V/Q ratio in PE?
obstruction–>moves ratio towards affinity (because very low Q)
prophylaxis/acute management of PE (according to FA)
LMWH or unfractionated heparin
long term prevention of PE (According to FA)
oral anticoagulants such as warfarin
CT pulmonary angiography of a patient with PE shows what?
filling defects (according to FA)
