Pulmonary Circulation d/o Flashcards
What is a pulmonary embolism?
thrombus embolizes from venous system into pulmonary arterial circulation
What is the pathophys of PE?
V/Q mismatch
So RV pressure = pulm artery (PA) pressure
With a PE, inc PA pressure so inc RV pressure
This gives us increased dead space of alveoli
increased dead space leads to atelectasis, leading to shunting
What usually goes hand-in-hand with a PE?
DVT or history of one
Which locations of DVTs are most common in PEs?
popliteal, iliofemoral, sometimes pelvic
Know this! Prof Wall wrote it down during lecture :D
s/s of PE?
HARD to recognize!
1 of following: tachypnea (MC sign), dyspnea (MC sx), pleuritic chest pain
sometimes tachycardia, palpitations, wheezing, hemoptysis
crackles from atelectasis
S4 gallop, dec S2 splitting (sounds like “ba-lub dub”)
How do you dx a PE?
DDIMER nonspecifically determines a clot
CT angiography
a) Pulmonary angiography* - high sens/spec, look for cut off blood flow
b) Helical spiral angiography - high sens/spec, big PEs can be seen
What do you expect to see on ABG and other diagnostic tests with a PE?
CXR, CBC, PT/INR, PTT, chemistries - ALL NORMAL (hopefully)
ABG shows resp alkalosis
What test would you use to diagnose a DVT?
Doppler ultrasound
How do you treat a PE?
Heparin or Warfarin! (fully acting anticoags)
6 month treatment course
For thrombolysis of clot: tPA, streptokinase, etc.
Who should get prophylaxis for DVT/PE?
Patients with hx of prior DVT/PE
pts undering surgery w/ immobilization
pregnant women
What is pulmonary HTN?
increased pulmonary vascular resistance causes RV hypertrophy –> R sided heart failure
What is primary pulmonary HTN?
50% idiopathic
BMPR2 gene defect
(this gene inhibits pulmonary vessel vasoconstriction)
Who gets primary pulmonary HTN
80% middle aged or young women (mean age is 50y)
What is secondary pulm HTN?
caused by pulm disease, cardiac, metabolic, or systemic dz
What are the 3 most commmon causes of secondary pulm HTN?
COPD
sleep apnea
PE
