Lung & Heart Flashcards
How do you distinguish pulmonary arterial/precapillary htn from pulmonary venous/postcapillary htn?
Arterial=not due to L heart disease
PAP>25 resting/30 exercise
PCWP<15 mmHg
Venous=due to L heart disease
PAP>25 resting/30 exercise
PCWP>15 mmHg
What are the stages of syndromes that occur when PCWP increases in left heart disease?
Normal: PCWP 8-12
Pulmonary vascular redistribution: PCWP 12-18
Pulm blood flow redirected to upper lobes; can be asymptomatic
Pulm Interstitial Edema: PCWP>18
Fluid gets into lung itself, Kerley B lines=interlobular edema
Pulmonary Edema: PCWP>25
White alveolar lung –> difficulty breathing, cough up blood
*Chronic pt can accomodate a higher PCWP than an acute pt = fewer radiological and clinical signs
What are the symptoms of pulmonary venous congestion?
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Hemoptysis
Cough
Fatigue
Can leads to RV failure
How can you distinguish heart or lung causes of dyspnea?
Troponin in blood=sign of ischemic heart disease
BNP increases when LAP increases (does not do this in pt with lung disease)
What’s the differential of dyspnea?
Suden onset? Pulm edema, pulm embolism, pneumothorax, asthma
On exertion? heart failure, pregnancy, pleural effusion from cancer
Anemia, obesity, deconditioning, anxiety
What is the differential for cough due to heart disease?
PVH
pulmonary embolism
aortic aneurism
compression tracheobronchial tree
Why does the right ventricle fail in PVH?
It’s sensitive to P and V overloads (thin)
What is the result of RV failure?
Systemic venous congestion: ascites, RUQ discomfort (liver fluid), ascites, cyanosis (central or peripheral)
What is the differential for edema?
CHORD
Cardiac
Hepatic
Obstruct SVC (lung cancer)
Renal
DVT
What’s the differential for RV failure?
L heart failure=most common
RV infarction
Parenchymal pulmonary disease “cor pulmonale” = R heart failure due to increase bp in PA’s and RV or heart
Pulmonary vascular disease (emboli, primary pulmonary htn)
