Pulmonary HTN and Emboli

Question 1

Where do most PEoriginate from?

Answer 1

Thrombi in the deep venous system of LE.

Question 2

What is a saddle embolus?

Answer 2

Emboli that lodge at the bifurcation of the main pulmonary artery or travel distally to lobar and peripheral arteries
(Large emboli more likely to cause hemodynamic compromise)

Question 3

What is the cause of the pleuritic chest pain in PE?

Answer 3

Smaller Emboli that effect the distal arteries

Question 4

What are the most common symptoms of PE?

Answer 4

Dyspnea at rest or exertion 73%
Pleuritic Chest Pain 44%
Calf or thigh Pain 41%
Cough 34% hemoptysis rare
>2 pilow orthopnea
Wheezing
Syncope

Question 5

What are the most common Signs of PE?

Answer 5

Tachypnea 54%
Tachycardia24%
Crackles 
Decreased Breath Sounds
Accentuated P2
JVD

Question 6

What are the criteria for the DVT-Well’s Score?

Answer 6

ALL +1
Cancer
Paralysis
Bedrest
Localized Tenderness
Entire Leg Swollen
Calf >3cm larger 
Pitting Edema
Collateral Superficial veins

-2 points
Alt Dx more likely than DVT

Score >3 75% risk

Question 7

What labs are ordered in PE Diagnosis?

Answer 7

Arterial Blood Gas
B type naturetic Peptide
Troponin
D-Dimer

Question 8

What is Present on the EKG in PE?

Answer 8

Sinus Tachycardia

SQT133 pattern

Question 9

What is seen on Chest Radiography in PE?

Answer 9

NOT DIAGNOSTIC
Atelectaisis
Westermark Sign: Loss of vascular markings in the lung and
Hampton’s hump: Wedge of Pulm infarct on CXR

Question 10

What imaging studies are used to diagnose PE?

Answer 10

Computed Tomography 
pulmonary angiography
-most common today
-Good for large vessels but not as useful in smaller vessels
V/Q Scan
Pulmonary Angiography
-gold standard

Question 11

What is Medical Tx for PE?

Answer 11

Anticoagulation STAT! Primary Tx for all!
-Unfractionated Heparin
-LowMWHep
Thrombolytic Therapy for massive PE with HDComp
With Hypotension, acute RVF or inability to oxygenate
-pressors and inotropes
-NO
-RV assist device
-ECMO

Question 12

What is an Inferior VC Filter?

Answer 12

Overused
Indicated in Proximal DVT and Contraindication to anticoagulation!
Massive PE hen addl emboli could be lethal

Question 13

What is post discharge therapy for PE?

Answer 13

…

Question 14

What defines Pulmonary Hypotension?

Answer 14

mPAP from RH cath of >25mmHg

norm is 8-20mmHg

Question 15

What are the 5 groups in The WHO Classification scheme?

Answer 15

G1) Pulmonary Arterial HTN
G2) Pulmonary Venous HTN
G3) PH from Lung disease or Hypoxia
G4) Chronic Thromboembolic PH
G5) PH with unclear multifactorial Mechanisms

Question 16

What are the S and S of PH?

Answer 16

Non-specific
Early- Dyspnea
Late- Syncope
Chest pain
Leg Edema
Abn Findings on CXR

Question 17

What is the Clinical Approach to PH?

Answer 17

Echocardiography

-Determine need for Right Heart Cath

Question 18

What differentiates WHO G1 from G2?

Answer 18

G1- Pre-capillary Pulmonary Arterial HTN
G2- PAWP > 15mmHG
POST CAPILLARY PVH from left sided heart disease (more common)

Question 19

What is the Tx for PH?

Answer 19

Calcium Channel Blockers

Question 20

How is G2 PH Treated?

Answer 20

Treat Left Sided Heart Disease

Question 21

How is G4 PH Treated?

Answer 21

Pulmonary Thromboarterectomy

Question 22

What are the goals of Tx for PH?

Answer 22

….