Pulmonary Vascular Conditions

Question 1

What is virchows triad?

Answer 1

Venous stasis
Hypercoagubility
Vessel wall damage

Question 2

What is the presentation of PE?

Answer 2

Hypotension 
Tachycardia 
Increased JVP 
Haemoptysis 
SOB 
Syncope

Question 3

What is the investigation of choice to rule out a PE?

Answer 3

D- dimer

Question 4

What investigation is gold standard for the diagnosis of PE?

Answer 4

CT PA

Question 5

When would you use an alternative to a CT PA and what would be the imaging modality of choice?

Answer 5

V/Q scan

Pregnant women and those with renal impairment

Question 6

What scoring system is used to assess the liklihood of PE and what would be an indicator of admission?

Answer 6

Wells score >4

Question 7

What are the ECG findings of PE?

Answer 7

Large S wave in Lead 1
Q wave in lead 3
Inverted T wave in lead 3

S1Q3T3 and tachycardia

Question 8

What is the management of choice for a suspected PE?

Answer 8

Anticoagulate with rivaroxiban or Heparin + warfarin, Vasopresor and O2

Question 9

What is the management of choice for confirmed PE with haemodynamic instability?

Answer 9

Thrombolytic therapy or embolectomy.

Question 10

What is the management of choice for confirmed PE with haemodynamic stability?

Answer 10

LMWH for 5 days or until INR >2 for 24 hours

Warfarin for 3 months (longer if not provoked)

Question 11

What is the definition of pulmonary hypertension?

Answer 11

Increase in the mean pulmonary arterial pressure >25mmhg at rest or >35mmhg with exercise

Question 12

What are pulmonary causes of pulmonary HTN?

Answer 12

COPD and Interstitial lung disease

Question 13

What are cardiac causes of pulmonary HTN?

Answer 13

Left heart failure due to systolic, diastolic or valvular heart disease

Question 14

What would be the diagnostic investigation of choice to diagnose pulmonary HTN?

Answer 14

Right heart catheterisation

Question 15

What autoimmune conditions should you screen for with a patient with pulmonary HTN?

Answer 15

Scleroderma and sarcoidosis

Question 16

What test should you do before determining management of pulmonary HTN?

Answer 16

Acute vasodilator testing

Question 17

What should you offer if acute vasodilator testing is positive?

Answer 17

Oral Calcium Channel Blockers

Question 18

What should you offer if acute vasodilator testing for pulmonary HTN is negative?

Answer 18

Prostacyclin analogues, endothelin receptor antagonists or phosphodiesterase inhibitors.

Question 19

In addition to vasodilators what other management should be given to patients with pulmonary HTN?

Answer 19

Oxygen, diuretics and anticoagulation with warfarin

Question 20

What is the definition of cor pulmonale?

Answer 20

Alteration of right ventricular function secondary to lung disease

Question 21

What is the most common cause of cor pulmonale?

Answer 21

COPD and Pulmonary HTN

Question 22

What are clinical features of Cor Pulmonale?

Answer 22

Worsening SOB
Fatigue
Oedema
Haemoptysis

Question 23

What tests are diagnostic of cor pulmonale?

Answer 23

Echocardiography and right heart catheterisation

Question 24

What would ECG changes of cor pulmonale? demonstrate?

Answer 24

Right ventricular hypertrophy - Right axis deviation, dominant R wave in V 1 and dominant S wave in V6

Peaked P wave - right atrial hypertrophy

Question 25

What are the long term management options for Cor Pulmonale?

Answer 25

Long term oxygen therapy 
Reduces pulmonary artery resistance 
Diuretics 
Long acting calcium channel blockers 
Transplantation in severe and intractable disease.