Pulmonary Vascular Disease

Question 1

What is a PE?

Answer 1

A thrombus forms in the venous system, usually in the deep veins of the legs, and embolises in the pulmonary arteries.

Question 2

What are the types of PE?

Answer 2

Massive - can be fatal.
Minor - treated with anticoagulants, good prognosis.

Question 3

What are the risk factors for VTE?

Answer 3

Recent major trauma or surgery.
Cancer.
Pregnancy.
Significant cardiopulmonary disease.
Inherited thrombophilia.

Question 4

What are the signs of PE?

Answer 4

Pleural effusion - pyrexia, pleural rub, stony dullness to percussion at base.
Tachycardia, tachypnoea, hypoxia, hypotension.

Question 5

What are the symptoms of PE?

Answer 5

Pleuritic chest pain, cough, haemoptysis.
Isolated acute dyspnoea.
Syncope or cardiac arrest - massive PE.

Question 6

What are the investigations of PE?

Answer 6

Pre-test probability (Wells Score, Revised Geneva Score).
Bloods - biochemistry, FBC, ABG, Troponin I.
CXR, CTPA, CT abdomen.
ECG, D-dimer, V/Q scan, echocardiography
Mammography and thrombophilia tests.

Question 7

What is the treatment of PE?

Answer 7

Oxygen.
Dalteparin and Warfarin.
Direct Oral Anticoagulants (DOAC) - Rivaroxaban, Apixaban.
Thrombolysis (Alteplase).
Pulmonary embolectomy.

Question 8

What is the prognosis of PE?

Answer 8

30 days mortality = 0-25%.
PESI Score - based on age, sex, comorbidities and physiological parameters.

Question 9

What is pulmonary hypertension?

Answer 9

Elevated BP in the pulmonary arterial tree; defined as a mean pulmonary artery pressure of >25mmHg. Usually primary or secondary to other conditions.

Question 10

What is the epidemiology of PH?

Answer 10

Idiopathy - rare.
Rapidly progressive conditions that leads to premature death if untreated.
More common as secondary to other medical conditions, tends to occur in older age.

Question 11

What are the causes of PH?

Answer 11

Idiopathic.
Secondary to left heart disease or chronic respiratory disease.
CTEPH.
Sarcoidosis.

Question 12

What are the signs of PH?

Answer 12

Elevated JVP.
Right ventricular heave.
Loud pulmonary second heart sound.
Hepatomegaly.
Ankle oedema.

Question 13

What are the symptoms of PH?

Answer 13

Exertional dyspnoea, presyncope or syncope.
Chest tightness.
Haemoptysis.

Question 14

What are the investigations of PH?

Answer 14

ECG, CXR, CTPA, V/Q scan, LFTs.
Echocardiography.
Right heart catheterisation - measures pulmonary artery pressure, wedge pressure and cardiac output; vasodilator trial.

Question 15

What is the treatment of PH?

Answer 15

Treat the underlying condition.
Oxygen, anticoagulation, diuretics.
Ca2+ channel antagonists.
Prostaglandins.
Prostacyclin agonists.
Endothelin receptor antagonists.
Phosphodiesterase inhibitors.
Thromboendarterectomy for CTEPH.
Lung or heart transplant.