Pulmonary Circulation d/o

Question 1

What is a pulmonary embolism?

Answer 1

thrombus embolizes from venous system into pulmonary arterial circulation

Question 2

What is the pathophys of PE?

Answer 2

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

Question 3

What usually goes hand-in-hand with a PE?

Answer 3

DVT or history of one

Question 4

Which locations of DVTs are most common in PEs?

Answer 4

popliteal, iliofemoral, sometimes pelvic

Know this! Prof Wall wrote it down during lecture :D

Question 5

s/s of PE?

Answer 5

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”)

Question 6

How do you dx a PE?

Answer 6

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

Question 7

What do you expect to see on ABG and other diagnostic tests with a PE?

Answer 7

CXR, CBC, PT/INR, PTT, chemistries - ALL NORMAL (hopefully)

ABG shows resp alkalosis

Question 8

What test would you use to diagnose a DVT?

Answer 8

Doppler ultrasound

Question 9

How do you treat a PE?

Answer 9

Heparin or Warfarin! (fully acting anticoags)

6 month treatment course

For thrombolysis of clot: tPA, streptokinase, etc.

Question 10

Who should get prophylaxis for DVT/PE?

Answer 10

Patients with hx of prior DVT/PE

pts undering surgery w/ immobilization

pregnant women

Question 11

What is pulmonary HTN?

Answer 11

increased pulmonary vascular resistance causes RV hypertrophy –> R sided heart failure

Question 12

What is primary pulmonary HTN?

Answer 12

50% idiopathic

BMPR2 gene defect

(this gene inhibits pulmonary vessel vasoconstriction)

Question 13

Who gets primary pulmonary HTN

Answer 13

80% middle aged or young women (mean age is 50y)

Question 14

What is secondary pulm HTN?

Answer 14

caused by pulm disease, cardiac, metabolic, or systemic dz

Question 15

What are the 3 most commmon causes of secondary pulm HTN?

Answer 15

COPD

sleep apnea

PE

Question 16

What are the symptoms of pulm HTN?

Answer 16

dyspnea, chest pain

weakness, fatigue

cyanosis, syncope, edema

Question 17

What will you find on PE with pulm HTN?

Answer 17

mostly heart problems

S2 sounds funny

signs of R sided HF (inc JVP, peripheral edema, ascites)

systolic ejection click, regurg

heaves

Question 18

How do you initially workup pulm HTN?

Answer 18

CXR: enlarged pulm arteries, alveolar edema

ECG: cor pulmonale, RV hypertrophy, R –> L shunt

CBC: polycythemia, inc Hct

Question 19

What is the definitive dx for pulm HTN?

Answer 19

R sided catheterization: shows increased pulm art pressure (>25mmHg at rest)

Question 20

How do you treat pulm HTN?

Answer 20

Vasodilators: Calcium channel blockers*

(also PDE5 inhibitors, prostacyclins)

02 therapy, anticoags

Question 21

What is cor pulmonale?

Answer 21

Literally what i just described…

“abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.”

Question 22

What else do we need to know about core pulmonale?

Answer 22

I have no idea so this is where my studying stops