pulmonary vascular/circulatory disorders Flashcards
what determines vasoconstriction and vasodilation
humoral and autonomic system
what does hypoxia trigger
vasoconstriction allowing for shunting of blood to the more aerated areas within the lungs
what does entire lung vasoconstriction lead to
pulmonary HTN
what is the supportive blood supply to the parenchyma and supportive structures
bronchial vessels
what is the purpose of the pulmonary lymphatics
removed both infectious material as well as excess fluid
moves toward the hilum
where does the pulmonary lymphatics drain into
the right thoracic lymphatic duct
what is a pulmonary embolism
blood clot within the pulmonary vasculature
what causes PE
DVT
fat embolism
air embolism
amniotic embolism
what is virchows triad
stasis
hypercoagulability
vessel wall injury
how long do we treat provoked clots
3 months
how long do we treat unprovoked clots
forever
where do DVTs form
on the valves and will disrupt valvular function and venous blood will pool more
what can occur with injury to long bone
fat embolism
what is the most common association with septic emboli
associated with IVDU as this will affect the right side of the heart
S. aureus
what are the causes of air embolism
iatrogenic
scuba diving - ‘the bends’, AKA decompression illness, N2 bubbles
what is an amniotic embolism
amniotic fluid is able to get into moms circulation
m/c occurs during labor or immediately postpartum
what increases your risk of amniotic embolism
premature delivery
advanced maternal age
abnormal attachment site of placenta
preeclampsia
c-section
polyhydramnios
what is the presentation of PE
pleuritic chest pain
SOB, hypoxia
syncope
shock (right sided HF)
findings of DVT
cough
emoptysis
tachycardia
what are the classifications of PEs
Massive
submassive PE with right heart strain
submassive PE without right heart strain
subsegmental
what is a massive PE
hemodynamic instability with hypotension
mortality rate 25-52%
causes hypotension with WBP <90 for 15+ min or constant drop of >40mmHg
what are the complications of PE
Right heart failure
decreased gas exchange
what does an elevated pulmonary vascular pressure lead to
increase in RV pressure
what is pulmonary arterial HTN
occlusion/constriction of the capillary arterioles within the pulmonary vasculature
- vasoconstriction associated with endothelial dysfunction
-remodeling of smooth muscles
-thrombosis
what are the common causes of pulmonary arterial HTN
PE
ARDS
COPD
interstitial lung disease
what is pulmonary venous HTN associated with
left sided heart disease
what is primary pulmonary HTN
pulmonary vasculature is only area affected
genetic predisposition
vascular wall remodeling
pulmonary vasoconstriction
increased risk of thrombi
what is primary pulmonary HTN associated with
HIV
dietary medications (amphetamines)
cocaine
chemo
smoking
collagen disorders
congenital shunting of blood
what is secondary pulmonary HTN
results when there is a known cause and something else is involved in disease process
LV dysfunction- pulmonary venous HTN
COPD, interstitial lung disease - that cause primary lung disease that then leads to pulmonary HTN
what are the classifications of Pulmonary HTN
Groups 1-5
what is cor pulmonale
or right-sided HF
an enlargement of RV due to high BP in lungs usually caused by chronic lung disease
