Pulmonary Embolism and Pulmonary Hypertension Flashcards
Name two thromboembolic diseases?
DVT
PE
What is a PE?
Pulmonary Embolism
- blockage of a pulmonary artery dueto a blood clot, fat, tumor or air
What is Pulmonary Infarction?
If blood flow and hence oxygen supply to lung tissue is comprimised then the tissue may die
Is a proximal or distal DVT more likely to embolise?
proximal
What is the clinical presentation of a DVT?
Whole leg or calf:
swollen
red
hot and tender
What are the investigations of DVTs?
Ultrasound Doppler leg scan - non invasive
CT scan of ileo femoral veins, IVC and pelvis
What is the clinical presentation of each size of PE?
–Large: cardiovascular shock, low BP, central cyanosis, sudden death
–Medium: pleuritic pain, haemoptysis, breathless
–Small recurrent: progressive dyspnoea, pulmonary hypertension and right heart failure
What are the investigations of PEs?
ECG - acute right heart strain pattern
D-dimers - usually raised
Isotop lung scan - V/P
CT pulmonary angiogram
leg and pelvic ultrasound to detect silent DVT
Echocardiogram - measure pulmonary artery pressure
What are the risk factors for DVTs and PEs?
thrombophillia contraceptive pill pregnancy trauma surgery immobility malignancy pulmonary hypertension obesity
What are the treatment options for DVTs and PEs?
anticoagulation to prevent clot propagation
- heparin (3-5days) and warfarin (3-6months)
- target range for warfarin 2.5-3.5
for life threatening PE - thrombolysis
IVC filter to prevent embolism from ileofemoral clot
How do you reverse warfarin action?
Vitamin K
How do you reverse heparin action?
Protamine
What is normal pulmonary arterial pressure?
12-20mmHg
What figure constitutes pulmonary hypertension?
> 25mmHg
What can cause Pulmonary Venous Hypertension? - left side
Left Ventricular Systolic Dysfunction
Mitral Regurgitation/Stenosis
Cardiomyopathy
What can cause Pulmonary Arterial Hypertension? - right side
Hypoxia Multiple PEs Vasculitis Drugs HIV Cardiac left -> right shift Primary pulmonary hypertension
What is Cor Pulmonale?
fluid retention due to hypoxia
- right sided HF which is secondary to a lung disease i.e. COPD
What are the clinical signs of Pulmonary Hypertension?
central cyanosis dependant oedema raised JVP tricuspid region murmur enlarged liver
What are the investigations of Pulmonary Hypertension?
ECG
CXR
SaO2 and arterial blood gases
Pulmonary function incl DLCO (diffusion capacity)
Echocardiogram – estimate right ventricular systolic pressure (RVSP)
Cardiac Catheterisation – measure mean pulmonary arterial pressure (mPAP)
D dimers and VQ scan if PE suspected
CT Pulmonary Angiogram
Cardiac MRI
Auto-antibodies if vasculitis suspected
What is Primary Pulmonary Hypertension?
Progressive SOB
Signs of right heart failure
What is the treatment for primary pulmonary hypertension?
CA Channel Blockers
Endothelin antagonists
PDES - inhibitors
Lung transplant
What is Chronic Thromboembolic Pulmonary Hypertension (CTEPH)?
recurrent pulmonary embolisms which lead to chronic pulmonary hypertension
What is the treatment for CTEPH?
Riociguat – pulmonary arterial vasodilator
Pulmonary endarterectomy –curative (2% op. mortality)
Balloon angioplasty
