Pulmonary Embolism and HTN

Question 1

Signs of pulmonary embolism

Answer 1

Rales, wheezing
RR>20
HR>100
Accentuated 2nd heart sound
Fever
Signs of DVT

Question 2

Symptoms of pulmonary embolism

Answer 2

Acute onset dyspnea
cough, hemoptysis 
Chest pain, palpitations
Syncope, apprehension 
Leg swelling

Question 3

How does a PE look like on a CXR?

Answer 3

Normal most of the time
Can have:
Pleural effusion
Atelactasis 
Ham-toms hump***

Question 4

How does PE look like on an ECG?

Answer 4

Sinus tachy
Non specific ST/TW changes
S1Q3T3
RV strain pattern

Question 5

What is a D-dimer test?

Answer 5

Holds negative predictive value to determining whether or not there is a PE.

• > tells if there is a thrombus (byproduct of a thrombus being broken down), but is non specific
• > if neg, then no thrombus -> no PE

Question 6

How does the ABG test look like for PE?

Answer 6

Respiratory alkalosis
Hypoxemia
Increased A-a gradient

Question 7

Normal MPAP. Elevated?

Answer 7

12 - 16 mmHg

> 25 mmHg

Question 8

Signs of pulmonary HTN

Answer 8

Loud S2, high JVP
Tricuspid regurg, louder upon inspiration
Peripheral edema

Question 9

Symptoms of pulmonary HTN

Answer 9

Gradual onset 
Exertional dyspnea and lightheadedness, syncope 
Chest pain
Fatigue, decreased appetite 
Underlying dz symptoms

Question 10

Pulmonary HTN CXR

Answer 10

Look for enlarged pulm trunk or artery

Question 11

Pulmonary HTN ECG

Answer 11

Signs for RVH
Right axis deviation 
R:S >1 in VI
Bigger p wave in lead II (RA enlargement)
RBBB

Question 12

Pulmonary HTN Echo

Answer 12

Can see tricuspid regurg

RVH and IVS pushed to LV

Question 13

Pulmonary HTN Treatment

Answer 13

Diuretics if retaining fluid
Anticoagulants for certain PAH patients and CTEPH patients
O2 for hypoxemia