Pulmonary Vascular Conditions Flashcards
What is virchows triad?
Venous stasis
Hypercoagubility
Vessel wall damage
What is the presentation of PE?
Hypotension Tachycardia Increased JVP Haemoptysis SOB Syncope
What is the investigation of choice to rule out a PE?
D- dimer
What investigation is gold standard for the diagnosis of PE?
CT PA
When would you use an alternative to a CT PA and what would be the imaging modality of choice?
V/Q scan
Pregnant women and those with renal impairment
What scoring system is used to assess the liklihood of PE and what would be an indicator of admission?
Wells score >4
What are the ECG findings of PE?
Large S wave in Lead 1
Q wave in lead 3
Inverted T wave in lead 3
S1Q3T3 and tachycardia
What is the management of choice for a suspected PE?
Anticoagulate with rivaroxiban or Heparin + warfarin, Vasopresor and O2
What is the management of choice for confirmed PE with haemodynamic instability?
Thrombolytic therapy or embolectomy.
What is the management of choice for confirmed PE with haemodynamic stability?
LMWH for 5 days or until INR >2 for 24 hours
Warfarin for 3 months (longer if not provoked)
What is the definition of pulmonary hypertension?
Increase in the mean pulmonary arterial pressure >25mmhg at rest or >35mmhg with exercise
What are pulmonary causes of pulmonary HTN?
COPD and Interstitial lung disease
What are cardiac causes of pulmonary HTN?
Left heart failure due to systolic, diastolic or valvular heart disease
What would be the diagnostic investigation of choice to diagnose pulmonary HTN?
Right heart catheterisation
What autoimmune conditions should you screen for with a patient with pulmonary HTN?
Scleroderma and sarcoidosis
What test should you do before determining management of pulmonary HTN?
Acute vasodilator testing
What should you offer if acute vasodilator testing is positive?
Oral Calcium Channel Blockers
What should you offer if acute vasodilator testing for pulmonary HTN is negative?
Prostacyclin analogues, endothelin receptor antagonists or phosphodiesterase inhibitors.
In addition to vasodilators what other management should be given to patients with pulmonary HTN?
Oxygen, diuretics and anticoagulation with warfarin
What is the definition of cor pulmonale?
Alteration of right ventricular function secondary to lung disease
What is the most common cause of cor pulmonale?
COPD and Pulmonary HTN
What are clinical features of Cor Pulmonale?
Worsening SOB
Fatigue
Oedema
Haemoptysis
What tests are diagnostic of cor pulmonale?
Echocardiography and right heart catheterisation
What would ECG changes of cor pulmonale? demonstrate?
Right ventricular hypertrophy - Right axis deviation, dominant R wave in V 1 and dominant S wave in V6
Peaked P wave - right atrial hypertrophy
What are the long term management options for Cor Pulmonale?
Long term oxygen therapy Reduces pulmonary artery resistance Diuretics Long acting calcium channel blockers Transplantation in severe and intractable disease.
