pHTN and pulmonary lung disease Flashcards
Where do most emboli that cause PEs originate from? Where else?
Deep veins in the leg
Less commonly in the pelvic, renal, or UE veins
What percent of patients with a PE will be symptomatic?
less than 50%
What percent of isolated calf vein thrombi will propagate above the popliteal fossa?
25%
What percent of LE venous emboli being in the proximal veins without prior calf involvement?
20%
When emboli originate from the upper extremities, what is this usually due to?
PICC or other lines in place
What percent of calf DVTs will resolve spontaneously? What happens if they do not?
75%
Other 25% will develop into a proximal DVT
What is the risk of developing a PE with a clot that does not grow proximally from the popliteal vein?
Rare
What is a chronic PE?
Embolus that lodges in the pulmonary vasculature, and causes occlusion of a vessel
What happens to the BP with a massive PE?
SBP less than 90 or drop of greater than 40 mmHg in less than 15 minutes
Where do PEs lodge, generally?
Bifurcation of the main pulmonary artery (saddle)
lobar and peripheral arteries
What type of PEs are most likely to cause hemodynamic compromise?
large ones that occlude the main Pulmonary artery
What are the ssx of smaller PEs?
Usually affect the distal arteries and cause pleuritic chest pain.
What percent of emboli are associated with a document pulmonary infection
10%
When does RV failure occur with a PE?
If the embolus causes a 75% compromise in pulmonary blood flow
What is the most common presentation of a PE?
Dyspnea at rest or DOE
Pleuritic chest pain
Calf/thigh pain
Pleuritic chest pain from a PE indicates what about it?
That it has been there long enough (a day) to cause local inflammation/irritation
What causes hemoptysis with a PE?
Death of lung tissue
What causes wheezing with a PE?
Showering of clots throughout the pulmonary vasculature
What causes the crackles with a PE?
Atelectasis
What are the two most common exam findings with a PE?
Tachypnea
Tachycardia
What causes an accentuated P2?
pHTN
What are the components of the Well’s criteria?
- CA
- Immobilization/hypercoagubility
- Local TTP
- Leg swelling
- Calf greater than 3 cm
- Pitting edema
- Collateral superficial veins
What is the value of Well’s criteria that warrants further workup? What is an alternative diagnosis is more likely?
Greater than 2
If alternative more likely, than subtract 2
What is the pattern of ABG findings with a PE?
Respiratory alkalosis and hypoxemia
Will the BNP be elevated with a PE?
can be
What percent of patients with a PE will have an elevated troponin?
30-50%
What is a D-dimer?
FIbrin degradation product
What is the EKG pattern that can be seen with a PE?
S1
Q3
T3