Pulmonary Circulation, embolism, hypertension, edema, and ARDS Flashcards
Define dead space and the significance when a PE is present
some areas of the lung are perfused but have atelectasis and are not well ventilated
a consequence of PE is increased alveolar dead space
Define primary (idiopathic) pulmonary hypertension
One in a million disease – usually females in their mid 30s
3 year survivial 48-67%, hereditary predisposition with autosomal dominance.
Risk factors: drug use, collagen vascular disease, HIV, liver disease
Symptom: dyspnea
3 predisposing factors of a PE
stasis, hypercoagulability, initial injury
Most common signs of PE
dyspnea, pleauritic chest pain, cough, leg swelling, leg pain
Most common symptoms of PE
tachypnea, rales, tachycardia, fourth heart sound, increased pulmonary component of S2, DVT
What 2 findings on an EKG can indicate a PE?
S1Q3T3 pattern (ST segment depression in lead 1, Q wave present in lead 3 and T wave inversion in lead 3) New onset of Atrial fibrillation
What is the gold standard for dx of PE
Pulmonary angiogram
What does D-dimer test indicate
It is a fibrin split byproduct found in PE. Has a high sensitivity (>90% chance if it’s negative you don’t have it)
What is a V/Q scan used for
For pulmonary embolism
What happens to ABG with a PE
O2 levels less than 80
CO2 levels less than 40
What is Group 2 Pulmonary HTN d/t?
Cardiac disease: Increased pulmonary flow, elevated pulmonary venous pressure
What is Group 3 Pulmonary HTN d/t
Lung disease: COPD, Interstitial lunmg disease, hypoxemia
What is Group 4 Pulmonary HTN d/t?
Chronic thromboembolic disease: can be from a PE
What is Group 5 Pulmonary HTN d/t?
Multifactoral or uncertain factors: sarcoidosis, sickle cell disease, CKD, HIV related
Evaluation tests for pulmonary HTN
Pulse oximetry, ABG, Echocardiogram
Pathophysiology of pulmonary edema
fluid in the pulmonary interstitial spaces and alveoli
Etiology of pulmonary edema
cardiogenic: left heart failure
non-cardiogenic
Clinical presentation of pulmonary edema
progressive worsening of dyspnea over several hours has to sit upright BP elevated or low lungs may have rales, wheezes pulse could be anything skin pale, cool, diaphoretic
Tx of pulmonary edema
oxygen, NTG (decrease preload and afterload), Diuresis with a loop diuretic
What is the Diff Dx for Pulmonary Embolism
Pneumonia Pleurisy MI Asthma Pneumothorax Pleural effusion Pulmonary Edema Musculoskeletal chest pain
Identify signs that might alert the examiner the presence of a pulmonary embolus (PE).
- tachypnea
- rales
- tachycardia
- fourth heart sound
- increased pulmonary component of S2
- DVT
- diaphoresis
- temp > 38.5 degrees C
- wheezes
- Homan’s sign
- RV lift
- pleural friction rub,
- S3
- cyanosis
Identify symptoms that might alert the examiner the presence of a pulmonary embolus (PE).
- dyspnea
- pleuritic chest pain
- cough
- leg swelling
- leg pain
- hemoptysis
- palpitations
- wheezing
- angina-like pain
Describe the specificity of each test with regard to differential diagnosis for PE.
A pulmonary angiogram is the gold standard for evaluating a PE.
Other tests may include:
-Chest x-ray (may shows the presence of infiltrations, atelectasis, vessel cutoff [Westermark’s sign, enlarged right descending pulmonary artery [Palla’s sign], and elevated hemidiaphragms)
-EKG (non-specific ST-T changes, left axis deviation, right bundle branch block, S1Q3T3 pattern, new onset of atrial fibrillation may be an indicator of PE)
-Labs (CBC [non-specific], D-dimer [high sensitivity with low specificity], INR, ELISA, V/Q scan [normal scan may rule out PE], duplex ultrasound of lower extremities, and spiral CT [better for central clots, not as good for peripheral, better than V/Q if chest x-ray is abnormal or patient has COPD]).
Harrison’s Principles of Internal Medicine or the WELLS Criteria for PE may be used to rule in/out PE.
Describe pulmonary vascular and cardiac complications associated with PE.
- Decreased vascular flow due to clot in lungs, so lung not perfused properly (reduces gas exchange)
- Elevated blood pressure in pulmonary circuit due to clot (can cause pulmonary HTN)
- Can cause edema, fibrosis, or inflammation
- Can lead to right heart failure or biventricular failure
