pulmonary causes of circulation problems Flashcards
what are the causes of pulmonary venous hypertension?
LVF, cardiomyopathies, mitral regurgitation/stenosis
what are the causes of pulmonary arterial hypertension?
hypoxia (COPD, OSA, fibrosis alveolitis), multiple pulmonary emboli, pulmonary vasculitis (SLE, scerosis), drugs (appetite suppressants), septal defect, primary hypertension
what are the signs of pulmonary hypertension/RHF?
central cyanosis, peripheral oedema, raised JVP with V waves (secondary tricuspid regurgitation), right ventricular heave, tricuspid murmur, hepatomegaly (pulsatile!)
what investigations should be done?
ECG, CXR, pulse oximetry, ABGs, spirometry, DLCO, echo/cardiac catheterisation, D dimers & V/Q scan (suspected PE), CT pulmonary angiogram, cardiac MRI, auto-antibodies (suspected vasculitis)
how is primary pulmonary hypertension diagnosed?
by exclusion
how does pulmonary hypertension present?
progressive shortness of breath on exertion with signs of right heart failure
how is primary pulmonary hypertension treated?
oxygen, prophylactic anticoagulation, vasodilators (calcium channel blockers, endothelin antagonist, PDE-5 inhibitor, prostanoids, guanylate cyclase stimulator)
what are the risk factors for DVT?
thrombophilia, contraceptive pill/HRT, pregnancy, surgery, malignancy, pulmonary hypertension, vasculitis, pelvic obstruction, trauma, immobility, recent MI
what DVT location is most likely to embolise and cause chronic venous insufficiency/ulcers?
ileofemoral
how does a DVT present?
swollen, hot, red, tender leg/calf (unilateral!)
how do you diagnose a DVT?
doppler ultrasound, CT scan
how does a PE present?
mild - progressive breathlessness, pulmonary hypertension and right heart failure
moderate - pleuritic pain, haemoptysis, breathlessness
severe - cardiovascular shock, hypotension, central cyanosis, death
what are the signs of a PE?
tachycardia, tachypnoea, cyanosis, fever, hypotension, crackles, pleural rub, pleural effusion
what investigations do we do for a PE? what would we expect to find?
ABGs (low O2 sats with type one respiratory failure), CXR (basal atelectasis, consolidation, pleural effusion), ECG (T inversion in V1-3), D-dimer (raised), V/Q scan (mismatch), US (silent DVT), echocardiogram (pulmonary pressure & RV size), DLCO
if these is no obvious underlying cause of a PE then what investigations should be done?
auto-antibodies (SLE), cancer testing, coagulation screening
what measures are taken to prevent DVT?
early mobilisation, TED stockings, calf exercises, peri-operative subcutaneous low dose LMWH, prophylactic dabigatron OR rifampicin
how do we treat DVT/PE?
parentral fast-acting heparin –> therapeutic does of LMWH (fragmin) for 3-5 days –> warfarin 3-6 months OR dabigatran/rivaroxaban
(MUST MONITER INR)
what increases anticoagulation?
alcohol, omeprazole, antibiotics, aspirin & NSAIDs, amiodarone
how do we treat a life threatening PE?
thrombolysis (streptokinase/TPA), IVC filter (recurrent PE), thrombo-embolectomy
how do we reverse over coagulation?
warfarin - vitamin k and prothrombin complex concentrate/fresh frozen plasma
heparin - protamine sulphate
