Lungy Blood things Flashcards

1
Q

Define pulmonary hyptertension.

A

A mean arterial pressure of greater than 20mmHg at rest (30 on exercise) in the pulmonary arteries due to chronic pulmonary disease. may also be caused idiopathically.

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2
Q

Define cor pulmonale.

A

change in the structure and/or function of the right heart ventricle due to increased pressure in the pulmonary arteries caused by chronic lung disease.

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3
Q

Give me some causes of pulmonary hypertensions…. there’s loads.

A
  • drugs - cocaine, amphetamines
  • idiopathic
  • genetic
  • OSA
  • COPD
  • Left heart pathology - valvular, failure
  • connective tissue disease
  • chronic micro emboli
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4
Q

Most common cause of Acute onset Cor pulmonale.

A

PE

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5
Q

Causes of chronic cor pulmonale.

A

COPD
chronic OSA
idiopathic

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6
Q

Sx of pulmonary HTN.

A
  • dyspnoea on exertion
  • chest pain (similar to angina)
  • fatigue
  • cyanosis
  • Sx of underlying disease
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7
Q

How do you diagnose pulmonary hypertension?

A
  • doppler echocardiogram - RV dysfunction and dilation
  • right heart catheterisation - gives pressure reading
  • ECG - right axis deviation (cos RV hypertrophy)
  • CXR might show signs of increase RH volume
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8
Q

Treatment for pulmonary hypertension.

A

decrease pulmonary vascular resistance

  • CCB
  • long acting prostacyclin
  • diuretics

O2
treat underlying cause

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9
Q

Risk factors for PE?

A
  • Recent major surgery
  • HRT, OCP
  • Hypercoaguable state, thrombophilia
  • pregnancy
  • previous VTE
  • prolonged bed rest
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10
Q

Sx of PE.

A
pleuritic chest pain 
hypoxia 
dyspnoea 
haemodynamic instability 
unilateral leg swelling ?DVT
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11
Q

What investigations would you do for suspected PE?

A
  • bloods - FBC, U&E, clotting
  • ECG
  • Scoring system - Well’s score
  • CXR
  • D-Dimer >500 likely and therefore CTPA
  • CTPA
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12
Q

what makes up the wells score?

A
  • previous VTE
  • tachy >100
  • Sx of DVT
  • recent surgery
  • haemoptysis
  • active Ca

0-1 low
2-6 - moderate
7 & above - high risk

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13
Q

Acute management of a confirmed PE.

A
  • thrombolysis w/ fondaparinux
  • or thrombectomy inhigh risk pts
  • LMWH/unfractionated low risk pts
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14
Q

How long do you place a patient on anticoagulation for if…..a) provoked PE, b) unprovoked PE?

A

Provoked - 3-6months post surgery or transient risk factors

Unprovoked - 6months or greater

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