Pulmonary Vascular Disease Flashcards
Where does a thrombus form?
In the venous system, usually in deep veins of the legs
Where does a thrombus normally embolise in a pulmonary embolism?
Embolises to the pulmonary arteries.
What is mortality rate for pulmonary embolism?
Massive PE fatal, although minor PE treated with anticoagulation has a very good prognosis.
What are major risk factors for venous thromboembolism?
Recent major trauma Recent surgery (Body responds by increasing clotting factors after surgery, immobilised so blood flow to the legs is less) Cancer - blood more likely to clot, tumour can obstruct blood flow Significant cardiopulmonary disease Pregnancy Inherited thrombophilia
What are the symptoms for pulmonary embolism?
Pleuritic chest pain, cough and haemoptysis (cough up blood due to dead and dying lung tissue) Isolated acute dyspnoea (difficult or laboured breathing) Syncope or cardiac arrest
When do you feel the pain in pleurisy?
Pain in the chest when taking a deep breath
How does PE affect V/Q mismatch?
Ventilation fine, perfusion reduced
What are the signs of PE?
Pyrexia Pleural rub Pleaural effusion Tachycardia Tachypnoea Hypoxia Hypotension
What tests are used to determine the likelihood of PE?
Wells score Revised Geneva score
What things does the revised geneva score take into consideration?
Previous pulmonary embolism or deep vein thrombosis Heart rate Recent surgery or immobilisation Clinical signs of deep vein thrombosis Alternative diagnosis less likely than pulmonary embolism Haemoptysis Cancer
What are the relevant PE investigations?
Full blood count, biochemistry, blood gases Chest X-ray ECG - Tachycardia D-dimer - product of clotting cascade CT pulmonary angiogram V/Q scan Echocardiography Consider CT abdomen and mammography Consider thrombophilia testing
What is a CT pulmonary angiogram?
Medical diagnostic test that uses computed tomography to obtain an image of the pulmonary arteries
What is an ECG?
An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of your heart.
What is echocardiography?
Echocardiography, is a painless test that uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart. They also show how well your heart’s chambers and valves are working.
What is a V/Q scan?
A ventilation–perfusion (VQ) scan is a nuclear medicine scan that uses radioactive material to examine ventilation and perfusion in the lungs. The aim of the scan is to look for evidence of any blood clot in the lungs, called pulmonary embolism.
What do the results of a V/Q scan look like?
What test assesses morbidity and mortality of PE?
The PESI score (pulmonary embolism severity index)
What is mortality at 30 days for pulmonary embolism?
Mortality at 30 days varies from 0 - 25%
What is treatment for PE?
Oxygen
Low molecular weight heparin (dalteparin) - anticoagulant, also naturally produced by basophils and mast cells
Warfarin
Direct oral anticoagulants (rivaroxaban, apixaban) - newer fancier drugs
Thrombolysis (alterplase - direct lysis of the clot)
Pulmonary emolectomy
What is pulmonary hypertension?
Elevated blood pressure in the pulmonary atrterial tree
(Mean pulonary arterial pressure of > 25 mmHg)
Can be a primary condition or a secondary condition
Is pulmonary hypertension common or rare?
Rare, incidence of 1-2 per million population
Is pulmonary hypertension a fatal illness?
Yes, •Untreated it is a rapidly progressive condition that leads to premature death.
Which is more common, primary or seconday pulmonary hypertension?
Secondary, Tends to occur in an older age group
What are the causes of pulmonary hypertension?
Idiopathic
Secondary to chronic respiratory disease
Secondary to left heart disease
Chronic Thromboembolic PH (High blood pressure resulting from embolism that cannot be reabsorbed by the body. 2 to 4 percent of people with PE develop CTEPH. It is a relatively rare disease.)
Miscelaneoud reasons
What are the symptoms of Pulmonary Hypertension?
Exertional Dyspnoea
Chest tightness
Exertional presyncope or syncope
What are the signs of Pulmonary Hypertsion?
Elevated jugular venous pressure
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly (abnormal enlargement of the liver)
Ankle oedema
What are the relevant investigations for pulmoary hypertension?
ECG
Lung function tests
Chest X-ray
Echocardiography
V/Q scan
CTPA
Right heart catheterisation
What is treatment for Pulmonary Hypertension?
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
What is specific treatment for Pulmonary Hypertension?
Calcium channel antagonist
Prostacyclin - relaxes smooth muscle in the pulmonary arteries causing vasodilation
Other treatments?
Thromboendarterectomy
Lung or heart lung transplant
