Pulmonary Embolic disease

Question 1

What are the common causes of pulmonary venous hypertension?

Answer 1

LVF
Mitral regurgitation
Mitral stenosis
Cardiomyopathy

Question 2

List some common causes of pulmonary arterial hypertension?

Answer 2

Hypoxia (eg due to COPD)
Multiple pulmonary emboli
Pulmonary vasculitis
Drugs such as appetite sup presents
Primary pulmonary hypertension
Cardiac left to right shunt (seen in atrial or ventricular septal defect)

Question 3

What clinical signs would you suspect to see in pulmonary hypertension and right sided heart failure?

Answer 3

Dysponea
Central cyanosis
Raised JVP
Ankle and sacral oedema
Hepatomegaly
Tricuspid regurgitation (murmur and V waves on JVP)

Question 4

What investigations would you carry out if you suspected pulmonary hypertension?

Answer 4

ECG 
CXR
Oxygen Saturation
ABG
Pulmonary function tests
Echo
D dimers (PE)
VQ scan (PE)
CT pulmonary angiogram
Auto antibodies if you suspect vasculitis

Question 5

What are the signs of primary pulmonary hypertension? At what stage would you decide that this was the correct diagnosis?

Answer 5

Progressive dysponea and signs of right sided heart failure

This is once you have excluded all other secondary causes.

Question 6

How would you treat primary pulmonary hypertension?

Answer 6

Warfarin (prophylactic anticoagulant)
Oxygen if hypoxic
Pulmonary vasodilators such as PDE5 inhibitors (sildenafil) and IV epoprostenol

Question 7

What are the risk factors for a DVT and PE

Answer 7

Thrombophilia
Contraceptive pill and HRT
Pregnancy
pelvis obstruction
Trauma