Pulmonary Vascular Disease Flashcards
1) Pulmonary Embolism
Is the occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or air bubble.
Pulmonary emboli commonly arise from the deep veins in the thigh.
Virchow triad
Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels
2) Pulmonary Artery Hypertension (PAH)
Mean pulmonary artery pressure above 25 mm Hg at rest
Idiopathic, familial, or associated
3) Cor Pulmonale
Secondary to PAH
Right ventricular enlargement
Pulmonary hypertension, creating chronic pressure overload in the right ventricle
Pulmonary Embolism: Prevention of Venous Stasis & Treatment
Bed exercises, frequent position changes, early ambulation, and pneumatic calf compression
Prophylactic anticoagulation with unfractionated heparin, low–molecular-weight heparin, warfarin, or fondaparinux
Treatment: Oxygen and hemodynamic stabilization with fluids
Anticoagulation and/or fibrinolytic agent (streptokinase)
Percutaneous or surgical embolectomy
Pulmonary artery hypertension: Causes
Causes
Elevated left ventricular pressure
Increased blood flow through the pulmonary circulation
Obliteration or obstruction of the vascular bed
Active constriction of the vascular bed produced by hypoxemia or acidosis
PAH: Pathophysiology
Overproduction of vasoconstrictors and decreased production of vasodilators
Remodeling
Resistance to pulmonary artery blood flow, thus increasing the pressure in the pulmonary arteries
Workload of the right ventricle increases and subsequent right ventricular hypertrophy, may be followed by failure and eventually death
Cor Pulmonale: CM
Heart appears normal at rest
With exercise: Decreased cardiac output, chest pain
Cor Pulmonale: Treatment
Decrease workload of the right ventricle by lowering pulmonary artery pressure
Same as for PAH
Reversal of the underlying lung disease
Cor Pulmonale: Pathophysiology
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