Pulmonary - cardiovascular causes Flashcards
What is pulmonary edema?
Excessive fluid moving from pulmonary vascular system into the parenchyma = usually intestitial areas
Pulmonary Edema
What are the 2 categories?
- cardiogenic
- non-cardiogenic
Pulmonary edema
What is the cause of cardiogenic?
Heart failure
Pulmonary edema
What are the causes of non-cardiogenic?
could be lympathatic system insufficiency or ARDS
Pulmonary edema
Left sided heart failure results in what?
fluid backing up into the pulmonary veins = increase pressure in pulmonary circulation
Pulmonary edema
Increased pressure in the pulmonary circulation results in what eventually?
Increases fluid buildip into the interstitial area and alveoli
Pulmonary edema
What sx eventually lead to RLD?
- work of breathing increases
- lung complaince decreases
- disruption in gas exchange
Pulmonary edema
What are the sx?
- respiratory distress
- dyspnea (at worse lying down)
- paroxysmal distress
- cyanotic
- increased RR
- labored breathing
- pallor
- diaphoresis
- anxiety
- cough = pink, frothy sputum
Pulmonary edema
What do we find with an exam?
- decreased breath sounds
- crackles
- increased tactile
- S3
- LE edema may be present
Pulmonary edema
What are the treatments?
- supplemental O2
- control underlying condition
- bronchial hygiene to aid in secretion clearance
Pulmonary embolism
What is the prevelance in the U.S?
1-2 per 1000 affected annually
60k-100k die of DVT/PE
- sudden death = 25% of people who have a PE
- 10-30% die in 1 month of dx
- 30-50% long-term complications
- 33% will have reccurrence within 10 years
Pulmonary embolism
Who is at risk?
- CHF
- acute MI
- CVA
- under 40 y.o
- obesity
- lupus
- immobilized or bed rest
- SCI
- trauma
- oral contraceptives
- post-op ortho surgery
- prior DVT
Pulmonary embolism
What are the causes?
Because of a complication of a DVT
- most commonly from leg contributes to sudden block of pulm artery
Pulmonary embolism
What are the sx?
- acute dyspnea or tachypnea
- chest pain
- cough with hemoptysis
- tachy and weak
- hypotensive
- lightheaded
- dizzy
- syncope
- anxiety
Pulmonary embolism
What is the treatment?
- prevention of DVT with exercise and medications
- heparin therapy is most common to treat DVT
Pulmonary embolism
What are the risk factors?
For LE thrombus formation
Pulmonary embolism
What is indicative of immediate medical intervention?
confirmed hypotensive or cardiogenic shock
Pulmonary embolism
What is the PE is non-emergent?
Low risk = complete Well’s score
- peform D-dimer
Pulmonary embolism
What is a D-dimer?
a marker for fibrinolysis
- measures by product of blood clotting
- released when blood clot starts to break down
- high sensitivity/low specificity for detecting PE/DVS
Pulmonary embolism
What is the norms?
Normal < .050
elevated is +
Pulmonary embolism
What if its moderate to high-risk?
Go straight to imaging:
- CPTA
- V/Q scan ventilation perfusion scan was used historically
Pulmonary embolism
What is the gold standard for imaging?
CPTA
Pulmonary embolism
What is the primary management?
Prevention
- compression stockings
- intermittent pneumatic compression
- early mobilization
- anticoagulants
- IVC filter
Pulmonary embolism
What is the acute management?
thrombolytic therapy + pulmonary embolectomy
- heparin is most commonly to treat PE
What is pulmonary hypertension?
high BP in the lungs
Pulmonary hypertension
What are the causes?
Blood vessels in the lungs become damaged, stiff, narrow
- need right-side of heart to work harder
Pulmonary hypertension
What is the signs and sx?
- jugular venous distention
- irregular heart sonds
- edema in abdomen or LEs
Pulmonary hypertension
What is group 1?
pulmonary arterial hypertension
arteries in lung narrow, thicken, stiffen
- can progress from normal to thrombi formation
- BP can’t overcome the resistance = flow backs up so decreased blood to lungs and O2 is reduced
Pulmonary hypertension
Leaving group 1 untreated will lead to?
R-sided HF and death
Pulmonary hypertension
What is the treatment of group 1?
therapy targeted for pulmonary arteries
Pulmonary hypertension
What is the goal of group 1?
sx relief
QOL
slow disease progression
Pulmonary hypertension
What is the most common causes of group 1?
- dyspneea on exertion
- fainting
Pulmonary hypertension
What is group 2?
due to left-sided heart heart disease
- systolic/diastolic dysfunction
Pulmonary hypertension
What occurs when the L-side can’t keep up with the blood coming from the lungs?
theres a backup of blood = raising pressure in the lungs
Pulmonary hypertension
What is the treatment of group 2?
management of L HF
Pulmonary hypertension
What is group 3?
due to lung disease
chronic lung disease and/or chronic hypoxemia
Pulmonary hypertension
What is the possible causes of chronic lung diseases for group 3?
- obstructive and RLD
- sleep apnea
- licing in high altitude for a long time
Pulmonary hypertension
What is treatment of group 3?
manage underlying lung condition
Pulmonary hypertension
The artries in the lungs will tighten causing?
Tighten so that blood can only go to well ventilated areas of the lungs
Pulmonary hypertension
What is group 4?
Due to chronic blood clots in the lungs
- not able to dissolve the blot in the lungs
Pulmonary hypertension
What does chronic thromboembolic lead to?
scarring in the artery = increasing resistance
R side needs to work harder
Pulmonary hypertension
What is the treament for group 4?
thromboendarterectomy surgery or medication if not a surgical candidate
Pulmonary hypertension
What is group 5?
Because of associated condition or unknown origin
sarcoidosis, sickle-cell anemia, splenectomy, metabolic disorders
