Lungy Blood things Flashcards
Define pulmonary hyptertension.
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.
Define cor pulmonale.
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.
Give me some causes of pulmonary hypertensions…. there’s loads.
- drugs - cocaine, amphetamines
- idiopathic
- genetic
- OSA
- COPD
- Left heart pathology - valvular, failure
- connective tissue disease
- chronic micro emboli
Most common cause of Acute onset Cor pulmonale.
PE
Causes of chronic cor pulmonale.
COPD
chronic OSA
idiopathic
Sx of pulmonary HTN.
- dyspnoea on exertion
- chest pain (similar to angina)
- fatigue
- cyanosis
- Sx of underlying disease
How do you diagnose pulmonary hypertension?
- 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
Treatment for pulmonary hypertension.
decrease pulmonary vascular resistance
- CCB
- long acting prostacyclin
- diuretics
O2
treat underlying cause
Risk factors for PE?
- Recent major surgery
- HRT, OCP
- Hypercoaguable state, thrombophilia
- pregnancy
- previous VTE
- prolonged bed rest
Sx of PE.
pleuritic chest pain hypoxia dyspnoea haemodynamic instability unilateral leg swelling ?DVT
What investigations would you do for suspected PE?
- bloods - FBC, U&E, clotting
- ECG
- Scoring system - Well’s score
- CXR
- D-Dimer >500 likely and therefore CTPA
- CTPA
what makes up the wells score?
- previous VTE
- tachy >100
- Sx of DVT
- recent surgery
- haemoptysis
- active Ca
0-1 low
2-6 - moderate
7 & above - high risk
Acute management of a confirmed PE.
- thrombolysis w/ fondaparinux
- or thrombectomy inhigh risk pts
- LMWH/unfractionated low risk pts
How long do you place a patient on anticoagulation for if…..a) provoked PE, b) unprovoked PE?
Provoked - 3-6months post surgery or transient risk factors
Unprovoked - 6months or greater
