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cardiovascular > pulmonary heart disease - pulmonary hypertension, PE > Flashcards

pulmonary heart disease - pulmonary hypertension, PE Flashcards

1
Q

what is mean pulmonary artery pressure

A

14

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2
Q

what is pulmonary hypertension

A

mPAP >25 mmHg

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3
Q

when is pulmonary hypertension measured

A

on right heart catheterisation

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4
Q

what changes are seen in pulmonary arteries of pulmonary hypertension

A
  • hypertrophy
  • proliferation
  • fibrotic changes
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5
Q

what mutations cause pulmonary hypertension

A

boen morphogenetic protein receptor type 2

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6
Q

what drugs cause pulmonary hypertension

A
  • fenfluramine
  • dexfenfluramine
  • toxic rapeseed oil
  • anorectic agents aminorex and benfluorex
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7
Q

symptoms of pulmonary hypertension

A
  • SOB
  • fatigue
  • weakness
  • angina
  • syncope
  • abdominal distension
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8
Q

sings of pulmonary hypertension

A
  • left parasternal heave
  • loud P2 heart sound
  • soft pan systolic murmur
  • tricuspid regurgitation
  • early diastolic murmur
  • pulmonary regurgitation
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9
Q

what does right heart failure lead to

A
  • jugular venous distension
  • ascites
  • peripheral oedema
  • hepatomegaly
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10
Q

what investigation can be done for pulmonary hypertension

A
  • blood test
  • CXR
  • ECG
  • echo
  • liver ultrasound
  • right heart catheterisation
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11
Q

what is seen on blood test for pulmonary hypertension

A

check for underlying rheumatic disease, HIV, hepatitis

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12
Q

what is seen on CXR for pulmonary hypertension

A
  • enlargement of pulmonary arteries
  • marked tapering of peripheral arteries
  • lung fields are Lucent
  • right atrial enlargement
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13
Q

what is seen on ECG of pulmonary hypertension

A
  • right ventricular hypertrophy

- right atrial enlargement

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14
Q

what is seen on echo of pulmonary hypertension

A
  • tricuspid regurgitation
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15
Q

what is on ultrasound for pulmonary hypertension

A

exclude liver cirrhosis and portal hypertension

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16
Q

what is done to confirm diagnosis

A

right heart catheterisation

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17
Q

what is done as treatment for pulmonary hypertension

A
  • anticoagulation
  • diuretics
  • digoxin
  • calcium channel blockers
  • prostanoids
  • PDE 5 inhibitor
  • ballon atrial septostomy
  • cardiac transplantation
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18
Q

what is done for physical treatment of pulmonary hypertension

A

remain physically active but avoid exertion

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19
Q

what precaution during pregnancy for pulmonary hypertension

A

there is a high mortality rate

should be counselled on conception

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20
Q

what precautions during travel for pulmonary hypertension

A

supplementary oxygen

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21
Q

what vaccination should be given for a patient with pulmonary hypertension

A

influenza and pneumococcal pneumonia

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22
Q

what precautions during surgery for patient with pulmonary hypertension

A

anaesthesia

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23
Q

when are diuretics used in pulmonary hypertension

A

when patients haver right heart failure and fluid overload

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24
Q

when is digoxin given in pulmonary hypertension

A

people with tachyarrhythmias

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25
Q

what is prostanoids

A

potent vasodilator that inhibits platelet aggregation and cell proliferation

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26
Q

what can prostanoids increase in patients iwht pulmonary hypertension

A

exercise capacity

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27
Q

what is endothelin-1

A

potent vasoconstrictor

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28
Q

what do PDE-5 inhibitor produce

A

vasodilatation in pulmonary vasculature

29
Q

is cardiac transplantation give a good prognosis for pulmonary hypertension

A

not really 5 year survival is only 50%

30
Q

where does pulmonary embolism thrombus form and where do they dislodge

A

in systemic veins
rarely in the right heart

  • dislodge and embolism into pulmonary arterial system
31
Q

where do most clots come from that cause PE

A

pelvic and abdominal veins

32
Q

why do clots form

A

as a result of combination of sluggish blood flow, local injury or compression of the vein and a hypercoaguable state

think Virchow’s triad

33
Q

what can emboli occur from

A
  • tumour
  • fat
  • amniotic fluid
  • foreign material during IV misuse
34
Q

what happens to lung tissue after PE

A

lung tissue is ventilated but not perfused producing intrapulmonary dead space

35
Q

what does the lung no longer produce if it is not perfused

A

surfactant

36
Q

how can right ventricular ischaemia be detected

A

with elevations of troponin and creatine kinase

37
Q

what does distal embolisation lead to

A

alveolar haemorrhage with haemoptysis, pleural inflammation and effusion

38
Q

symptoms of PE

A
  • sudden onset SOB (unexplained)
  • pleuritic chest pain
  • haemoptysis
39
Q

what is usually the only symptoms present in PE

A

SOB

40
Q

what is seen on examination of PE

A
  • tachypnoeic
  • localised pleural rub
  • coarse crackles
  • fever
41
Q

what can develop because of PE

A

exudative pleural effusion (blood stained)

42
Q

what happens to patient if there is a massive PE

A
  • sudden collapse
  • severe central chest pain
  • shocked
  • pale
  • sweaty
  • syncope
  • death
43
Q

what JVP wave is seen in massive PE

A

prominent a-wave

44
Q

what is cardiovascular signs of massive PE

A
  • right ventricular heave
  • gallop rhythm
  • split second heart sound
45
Q

what investigation are done for PE

A
  • CXR
  • ECG
  • blood gases
  • cardiac troponin
  • D-dimer
  • V/Q scan
  • ultrasound
  • CTPA
  • MRI
  • echo
46
Q

what is seen on CXR for PE

A
  • often normal

but

  • linear atelectasis
  • blunting of costophrenic angle
  • wedge shaped pulmonary infarct
47
Q

what is seen on ECG of PE

A
  • sinus tachycardia
  • right atrial dilatation
  • tall peak P waves in lead II
  • right ventricular strain with right axis deviation
  • T wave incursion in right precordial leads
48
Q

when are cardiac troponin elevated in PE

A

when it is severe

49
Q

when is plasma D-dimer elevated in PE

A

when patients have thromboembolism

elevated doesn’t always mean there is a PE as it can be elevated by cancer, pregnancy, elderly

50
Q

what is a good diagnostic investigation for PE

A

V/Q mismatch

51
Q

what can ultrasound detect in PE

A

clots in pelvic or iliofemoral veins

52
Q

what is another good investigation that can exclude PE

A

CTPA

53
Q

what should be done for a pregnant mother

A

CTPA exposes the mother to greater radiation risk than V/Q scan but delivers lower radiation to the foetus

54
Q

what can be seen in echo for PE

A

good for evidence of right ventricular dysfunction

55
Q

what is first line investigation if no shock for PE

A

D-dimer

56
Q

if D-dimer is positive what is done next for PE

A

CT angiography

57
Q

what is useful when CTPA cannot be done for PE

A

echo

58
Q

what is done for a massive PE

A

thrombolysis

59
Q

what are treatments for PE

A
  • high flow oxygen
  • initial anticoagulation
  • IV fluids
  • thrombosis
  • surgical embolectomy
60
Q

who should get oxygen in PE

A

everyone unless significant chronic lung disease

61
Q

what anticoagulation should be given for PE

A

LMWH or fondaparinux

or IV heparin

62
Q

what can improve perfusion quicker than anticoagulant

A

thrombolysis

63
Q

is surgical embolectomy necessary

A

rarely

64
Q

what is given to precent further emboli

A

anti coagulated with vitamin K antagonist = warfarin for 3-6 months
or
dabigatran, rivaroxaban are used in patients with venous thromboembolism (they are safer than warfarin)

65
Q

what is given to pregnant ladies and those with cancer to precent emboli

A

long term LMQH

66
Q

what is given to patients when anticoagulation is contraindicated

A

vena cava filter inserted via the femoral vein to above the level of the renal veins

67
Q

what type of respiratory failure is a PE

A

type 1 respiratory failure

68
Q

what are the ABG’s for PE

A

respiratory acidosis

cardiovascular (36 decks)

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