Pulmonary Approach to Dyspnea, Palpitations, and Fatigue Flashcards
diagnosing a patient with dyspnea has a heavy reliance on what?
the patient description
what is tachypnea defined as? what is hypoxemia defined as?
t: RR> 20/minute; hypoxemia: O2 sat <95%
what are two examples of pulmonary vascular dsiease?
pulmonary hypertension and pulmonary embolism
what is pulmonary hypertension defined as?
the mean pulmonary artery pressure being >20 mmHg
how does increased pulmonary pressure manifest?
it puts extra strain on the right ventricle, so you’ll get cor pulmonale (right-sided HF)–> JVD and bilateral LE edema
how does pulmonary hypertension present?
dyspnea on exertion, fatigue, chest pain (pleuritic); insidious in onset; signs of right sided heart failure
what things would you order when trying to diagnose pulmonary hypertension?
EKG, TTE, cardiac catheterization
what is the diagnostic gold standard for diagnosing pulmonary hypertension?
cardiac catheterization
what would an EKG show in a patient with pulmonary hypertension?
right ventricular hypertrophy: right axis deviation, RBBB, right atrial enlargement
how do you identify right atrial enlargement on EKG?
peaked P waves in lead II
how do you identify a RBBB on an EKG?
RsR’
when diagnosing pulmonary hypertension, what does a TTE do?
estimates pulmonary artery systolic pressure indirectly by using the tricuspid regurgitation gradient
how do you treat pulmonary hypertension if it is not primary?
treatment is fixing the underlying disease
what could cause hypercoagulability?
genetic mutations, nephrotic syndrome, hyper-viscosity due to malignancy, contraceptives, smoking
what is the role of proteins C and S?
they block sites at VIII and V to inhibit clotting cascade
what is the role of antithrombin III?
blocks site at II and X
what is involved in the anti-coagulation pathway?
proteins c and s; antithrombin III
what happens if there is a protein c and S deficiency?
ineffective regulation of factor VIIIa and Va
what happens if there is an antithrombin III deficiency?
ineffective regulation of Xa and IIa (thrombin)
what happens if there is a Factor V Leiden mutation?
mutation of factor V prevents binding of protein C
what are the symptoms of a PE?
chest pain, palpitations, dyspnea, syncope, LE edema +/-
how does a physician determine whether or not they need to work a patient up for a DVT or not?
the wells criteria
how does the well’s criteria work?
if you a get a score greater than 6, the index of suspicion is high- you would just automatically go for imaging
what is d-dimer?
it has a high negative predictive value