pulmonary vascular Flashcards
mean PA pressure for dx with PH
equal or more than 25
PCWP in PAH
less than 15
PCWP in PVH
more than 15
will pulmonary pressure rise with a reduction in vessel radius?
yep
PH types
- PAH
- PH with lung disease or chronic hypoxia
- PH with left heart disease PCW more than PCW
- chronic thromboembolic PH
- Miscellaneous; sarcoid
PAH is associated with what heritable markers
BMPR2, ALK1 and endoglin
what are the precapillary levels for PVR and PCWP in PAH
PVR is increases drastically
PCWP is less than 15
PVH is associated with (3)
- LV systolic dysfunction
- LV diastolic dysfunction
- valcular
PVH post capillary values for PVR and PCWP
PVR is normal
PCWP is more than 15
hypoxic/pulmonary parenchymal HP is associated with
- COPD
- restrictive
- hypoventilatory
- sleep apnea
- high altitude
hypoxic/pulmonary parenchymal HP precapillary values for PVR and PCWP
PVR is mildly increased
PCWP is less than 15
pulmonary embolic HP caused by
chronic thromboembolic PH
pulmonary embolic HP pre capillary PVR and PCWP values
PVR is moderatly increased
PCWP is less than 15
Miscellaneous PH pre capillary values for PVR nad PCWP values
PVR is moderatly increased
PCWP is less than 15
Miscellaneous causes for PH
- sarcoid
- Gaucher
- hematologic
treatment for CTEPH
anticoagulation and more common now is thromboendarterectomy
CTEP follows acute PE in ___ %
3-4
best screening test for PH
echo for estimation of PA pressures
Gold standard in dx for PH
RHC
most common PH gene associated
Bone morphogenic protein receptor that regulates vascular proliferation and when it is not workign there is dysregulation of proliferation and vascularization of smooth muscle cells
what is important in the pathophysiology of PAH
- increased TBX and ET1 which promote vasiconstriction
- decreased in NO2 and PG12 that are vasodilators mediators
- endothelial injury
only group that responds to pharmalogical treatment
PAH- group 1
what is the treatment for PAH
vasodilators or vasoconstrictors antagonist
- PDE5 inhibitor
- endothelin receptor antagonist
- prostaglandins for vasodialtion
how do we treat he other groups of PH?
treat underlying disease
options for patient failing to respond to first line therapy
- lung transplantation
- atrial septostomy
PE is often missed
true
is there increased dead space in PE?
yep
how is hypoxemia related to PE
V/Q mismatch and shunt
in massive PE what are the signs
increase in JVD
increase in P2, right heart strain
virchow’s triad
- stasis
- inflammation
- hypercoagulability
westermark sign
sign of hypoperfusion and thus PE
Hamptom’s hump
peripheral wedge-shaped infiltrate
increased D-dimer helps in dx of PE?
nope, poor PPV
wich pre-test proabability has high valifity
wells scoring system
gold standard for PE dx
angiography
systolic murmur that increases in intensity with inspiration
cavallo’s sign- tricuspid regurgitation
clinical presentation ofr PAH
- increased P2
- carvallos
- RV heave/ right-sided S3
- JVD
