pHTN, PE, OSA, ILD Flashcards
What is pulmonary HTN?
mean pulmonary artery pressure >20mmHg
associated with mortality if untreated
What are the symptoms of pHTN?
DOE, fatigue, pleuritic chest pain, pre-syncope, edema, JVP
How is pHTN diagnosed?
EKG changs: RAD, iBBB, RAE in lead II
Labs: increased BNP
TTE: estimates pulm. artery systolic pressure, looks at RV size
Cardiac catheterization (Swan Ganz catheterization)
What is the best way to diagnose pHTN?
Swan Ganz catheterization
How is pHTN treated?
treat underlying cause
prostacyclin agonist
PDE inhibtor: Tadalafil
Endothelium antagonist: Ambrisentan
CCB
What is a PE?
VTE located in pulmonary vasculature usually arising from a DVT
What is virchow’s triad?
hypercoagulability
venous stasis
endothelial injury
What are the sx of PE?
chest pain
palpitations
dyspnea
syncope
+/- LE edema
How is PE diagnosed?
What is the Gold Standard?
Well’s criteria
D-Dimer (sensitive, rules out PE if normal)
EKG changes: sinus tach, S1Q3T3
CT Chest with Contrast is gold standard
VQ scan is second line image
If a D shaped LV champer is seen on Echo, what does this indicate?
PE
What is the treatment for an unstable PE?
(presents with hypotension)
- resuscitation
- thrombolytic therapy
if thrombolytic therapy fails, repeat thrombolysis, consider catheter-directed thrombolysis, or proceed to surgery
How to treat a stable PE?
Heparin
LMWH
Warfarin
DOACs
What is the mechanism of direct oral anticoagulants? (DOACs)
Do they require bridge therapy?
What are the cons?
Xa inhibitors-rovaroxaban, apixaban
approved to be used without LMWH bridge
expensive, may be hard to reverse
How long is treatment for PE?
at least three months
Pt’s with provoked DVT from travel, surgery or HRT do not require extended therapy
Who requires indefinite anticoagulation after PE?
those with underlying disease with high risk of VTE recurrence
- malignancy
- genetic mutations
What is the definition of OSA?
disruption in breathing pattern while sleeping that results inexcessive daytime somnolence despite adequate sleep periods and not explained by other causes
(snoring, gasping for air, breathing pause)
What is the definition of apnea?
reduction in breathing for at least 10 seconds with a noted drop in SpO2 by >3%
How is the Apnea-Hypopnea index calculated?
number of apnea episodes/hour
determines OSA severity
If OSA is untreated, what can occur?
death
Sleep related breathing disorders are associated with increased morbidity and mortality if left untreated
What is the number 1 cause/predictor of OSA?
What facial malformation can cause OSa?
obesity
micrognathia (small mandible)
What is the diagnostic criteria for OSA?
STOP-BANG
What is the Gold standard for diagnosing OSA?
PSG
occurs in sleep lab or at home, records sleep activity for 6-7 hrs
Monitors EEG, ECG, ocular movement, airflow, and O2sat
allows clinician to generate AHI and diagnose the severity of sleep apnea
What are the treatment options for OSA?
CPAP
oral appliances
What is interstitial lung disease?
group of pulmonary disorders with a variety of different causes that present with the same characteristics
what are the general characteristics of ILD?
restrictive pattern on PFTs
Decreased DLCO
DOE
absence of infection or malignancy
What part of the lung is affected with ILD?
the CT that supports the alveoli and capillaries to allow gas exchange
What are the main findings associated with idiopathic pulmonary fibrosis?
Velcro Lung
Honeycombing
treat with supportive care, steroids, imunimodulators, anti-fibrotics
50% survival at 3-5 years; early diagnosis=better prognosis
What are the main findings of Sarcoidosis?
non-caseating granulomas, lungs commonly affected
More common in African Americans, females, family members
Associated with Lofgren’s syndrome and Heerfordt’s syndrome
What is Lofgren’s syndrome
What is Heerfordt’s syndrome?
Erythema nodosum, hilar lymphadenopathy, fever, arthritis
Anterior uveitis, parotitis, CN VII palsy, fever
What is the treatment for sarcoidosis?
supportive care
steroids: 1st line therapy
immunosupression, biologics
What are the main findings in granulomatosis with polyangitis
small vessel vasculitis affecting sinuses, lungs, kidneys
+C-ANCA
Treat with steroids and cyclophosphamide
What are the main findings in Goodpasture’s syndrome?
autoimmune condition with Anti-GBM against the basement membrane in lungs and kidneys
+Anti-GBM
treat with plasmaphoresis
What are some ILD assicated with CT disease?
Sclerosis
RA
Dermatomyosistis/Polymyositis
What are some causes of hypersensitivity pneumonitis
repeated expsures to specific antigens that cause an extrinsic allergic alveolitis
- farmer’s lung
- Bird fancier’s lung
- woodworker’s lung
- baker’s lung
What are some common symptoms of HSN pneumonitis?
What is seen on histology?
cough, dyspnea
sx improve on vacation
PLasma cells on histology
What are some findings associated with Silicosis?
seen in miners, stone cutters, quarry workers
nodular lung disease and calcified hilar LN-simple silicosis
large nodules with fibrosis-complicated silicosis
increased risk for infection and TB
What are some findings associated with asbestosis?
insulation workers, construction, demolition
nodular opacities, effusions, fibrosis, increased risk for mesothelioma esp if smoker
What are some findings associated with coal-workers pneumoconiosis?
miners who inhale coal dust
may be asymptomatic or have small nodules
can have cough, dysnpea, restrictive pattern, and fibrosis with large nodules (Complicated CWP)
What are some findings associated with Berylliosis?
manufacturers of electronics
similar to HSN pneumonitis in acute setting
chronically, can have hilar LAD, infiltrates, restrictive pattern, obstruction due to LAD enlargement
increased risk for lung cancer
treat with steroids
What kind of biopsy is needed to diagnose asbestosis?
pleural biopsy
