Pulmonary Circulatory Disorders Flashcards
What is the first symptom of PE in 25% patients?
Sudden death
50% are never diagnosed
The blockage of a main artery of the lung, or one of its branches, by a substance that has traveled elsewhere in the body through the bloodstream
Pulmonary Embolus (PE)
Blood clot from a systemic vein through the right side of the heart to the pulmonary circulation.
Venous thromboembolism
Where do PEs usually start?
Lower extremities (DVTs, but rarely from calf) upper extremities are rare (catheters or pacing wires
What factors contribute to clot formation?
Virchow’s triad:
Venous Stasis
Hypercoagulability
Injury to a vessel wall
What are the types of pulmonary emboli?
(FAT BAT)
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor
How is a DVT diagnosed?
Duplex Ultrasound
What sign is it when you flex your foot and get calf pain?
Homan’s sign
What are the classic symptoms of PE?
Triad: (Sudden dyspnea, pleuritic chest pain, hemoptysis)
Tachypnea (seen more often than hemoptysis)
Anxiety, Lightheadedness, Low blood pressure
What might you see on a physical exam in a PE?
Nonspecific signs... Tachycardia/Tachypnea Various lung sounds Increased pulmonic component of 2nd heart sound Right sided S3 or S4 JVD Pain/Edema of lower extremity (thrombus) *Mild to moderate hypoxemia with low PaCO2*
What signs in a ventilated patient would concern you of a PE (until proven otherwise!)?
sudden onset of hypotension, tachycardia, or hypoxia
What criteria help determine the probability of a PE?
The Wells criteria
How do ECG changes help diagnose PE?
They are generally nonspecific, though often (70%) abnormal.
Commonly Sinus tachy, non specific ST and T wave changes
T wave inversion in anterior leads (V1-V4)
S1Q3T3
Describe S1Q3T3.
Prominent S in Lead I
Q wave in Lead III
T wave inversion in Lead III
(seen in both PE and Cor Pulmonale)
What finding will you see most often in an ABG with a PE?
Respiratory alkalosis
How specific is a D-Dimer test with PE?
Not very, but it can tell you if a PE DIDN’T happen (good negative predictor value)
What most common signs will you see in a chest xray for a PE?
Still nonspecific, but:
Pleural effusion
Atelectasis
What is a prominent central pulmonary artery with local oligemia on an xray?
Westermark sign (difficult to see)
What is a pleural based area of increased opacity that represent intraparenchymal hemorrhage?
Hampton hump
What is becoming the new test of choice for PE?
CT pulmonary angiogram (75-95% sensitive)
What precautions must you take with a CT pulmonary angiogram?
It uses dye, so you must not be allergic to the dye.
What does a V/Q scan show?
Absence of perfusion to occluded areas, and Absence of ventilation to blocked areas.
What test is used most prominently to detect a proximal DVT?
Venous ultrasound
How many PE patients will have a DVT on ultrasound?
70%
If positive for a DVT on ultrasound, how do you proceed?
Treat them for a PE
What is the most definitive test for PE?
Pulmonary Angiography
but it is very invasive
What is the initial treatment of a PE?
Supportive
Oxygen
Analgesics
Meds to maintain BP
How long should a patient be treated with anticoagulants with a PE?
3 months (if first episode and provoked) 6-12mo extended therapy unprovoked or recurrent with low/mod risk of bleeding Indefinite with nonreversible risk factors
What additional measures can be taken to treat a PE?
IVC filter (to catch a clot in the IVC) Pulmonary embolectomy (emergency procedure, last resort)
What are signs of pulmonary hypertension?
Dyspnea
Dull, retrosternal chest pain (resembles angina)
Fatigue/syncope on exertion
Cardiac sounds
How do you treat pulmonary hypertension?
Primary: Meds, lung transplant.
Secondary: Treat the underlying condition…
