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Respiration > Pulmonary vascular disease > Flashcards

Pulmonary vascular disease Flashcards

1
Q

What is a pulmonary embolism (PE)?

A

Thrombus forms in the venous system, usually in the legs, and breaks off and travels through the venous system and R heart and into the pulmonary arteries.

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2
Q

What is the prognosis for PEs?

A

Minor = treated with anticoagulants and has very good prognosis
Major = often fatal

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3
Q

What are some risk factors of PEs?

A

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

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4
Q

Why does recent major trauma increase your risk for a PE?

A

You’re often immobile = blood pools
Blood clotting system is activated to prevent bleeding = more clots

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5
Q

How is pregnancy a risk factor for PE?

A

Clotting factors increase
Mechanical effect of enlarging foetus pressing on veins

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6
Q

What are the symptoms of a PE?

A

Pleuritic chest pain
Cough
Haemoptysis
Isolated acute dyspnoea
Syncope or cardiac arrest (massive PE)

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7
Q

How does pleuritic chest pain come about in a PE?

A

With small peripheral thrombus causing a large infarction.
Gives inflammation of lung surface = pleuritic chest pain

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8
Q

How does syncope or cardia arrest come about in PE?

A

Large thrombus lodged in main pulmonary artery.
Present with collapse, syncope or even cardiac arrest.
Complete obstruction of blood.

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9
Q

What are some signs of a mild PE?

A

Pyrexia = fever
Pleural rub
Stony dullness to percussion at base (pleural effusion)

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10
Q

What are some signs of moderate PE?

A

Tachycardia
Tachypnoea
Hypoxia

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11
Q

What is a moderate PE?

A

Multiple small pulmonary emboli

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12
Q

What are some signs of a massive PE?

A

Tachycardia
Tachypnoea
Hypoxia
Hypotension

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13
Q

What is a pulmonary infarction?

A

Death of tissue as a result of partial loss of blood supply to that section

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14
Q

What tests can be done for a PE?

A

Wells score
- Includes symptoms, signs of VTE, previous VTE and risk factors
Revised Geneva score
- Based on risk factors, symptoms and signs

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15
Q

What investigations are done with PE?

A

FBC
Biochemistry
Tni (if elevated = strain on heart)
ABG
Chest X-ray
ECG
D-dimer
CT pulmonary angiogram
V/Q scan
Echocardiography
Consider CT abdomen and mammography
Consider thrombophilia testing

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16
Q

What is a D-dimer and what do results demonstrate?

A

Haematological test
If low/negative the PE is very unlikely

17
Q

When is echocardiography useful and what does it look for?

A

Useful in suspected massive PE
Assess for right ventricular strain

18
Q

What are treatment options for a PE?

A

*Oxygen
*Low molecular weight heparin
*Direct oral anticoagulants (DOAC)
*Thrombolysis
*Pulmonary embolectomy
Warfarin

19
Q

What is an example of low molecular weight heparin and when are they given?

A

Dalteparin
Always give at start of treatment/straight away

20
Q

Give 2 examples of DOACs?

A

Rivaroxaban
Apixaban

21
Q

Give an example of a thrombolysis drug and how it has an effect?

A

Alteplase
Will dissolve the clot quickly so quick recovery

22
Q

When is a pulmonary embolectomy done?

A

Very rarely
Only for massive PE

23
Q

What is the prognosis of PEs and how can you work it out?

A

Mortality at 30-days 0-30%
PESI score
- Based on age, sex, comorbidity and physiological parameters

24
Q

Define pulmonary hypertension?

A

Elevated blood pressure in the pulmonary arterial tree.
Defined as a mean pulmonary artery pressure of >20mmHg

25
Q

Explain primary (idiopathic) arterial hypertension?

A

Rare: incidence of 1-2 per million
Untreated is rapidly progressive leading to premature death.

26
Q

Explain the pathology of pulmonary hypertension?

A

Smaller pulmonary arteries get thickened, arteries constrict and pressure builds up, affects right side of heart (hypertrophy and eventual failure).
Increased blood pressure in your lungs.

27
Q

What are the 5 groups of causes of pulmonary hypertension?

A
  1. Idiopathic
  2. Secondary to heart disease
  3. Secondary to chronic respiratory disease
  4. Chronic thromboembolic PH (CTEPH)
  5. Miscellaneous
27
Q

What are the 5 groups of causes of pulmonary hypertension?

A
  1. Idiopathic
  2. Secondary to heart disease
  3. Secondary to chronic respiratory disease
  4. Chronic thromboembolic PH (CTEPH)
  5. Miscellaneous
28
Q

What are some things that fall into group 1 (causes of PH)?

A

Collagen vascular disease
Portal hypertension
Congenital heart disease (L to R shunt)
HIV infection

29
Q

Give an example of a group 5 condition causing PH?

A

Sarcoidosis

30
Q

What are some symptoms of PH?

A

Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope
Haemoptysis

31
Q

What is a presyncope?

A

Light headedness on exercise

32
Q

What are some signs of pulmonary hypertension?

A

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

33
Q

What investigations are done for PH?

A

ECG
Lung function tests
CXR
Echocardiography
V/Q scan
CTPA
Right heart catheterisation (confirms PH)

34
Q

How does right heart catheterisation work?

A

Allows direct measure of pulmonary artery pressure.
Measurement of wedge pressure (if elevated suggest left heart problem).
Measurement of cardiac output.
Vasodilator trail with nitric oxide.

35
Q

What are the common treatments for PH?

A

Treat underlying condition
Oxygen
Anticoagulation (for IPAH only)
Diuretics

36
Q

What are some specific treatments for PH?

A

Calcium channel antagonists - if +ve vasodilator trial)
Prostaglandins - iloprost
Prostacyclin agonist - selecipag
Phosphodiesterase inhibitors - sildenafil, tadalafil
Endothelin receptor antagonists - bosentan, ambrisentan
Riociguat (for CTEPH)

37
Q

What are some other treatments for PH?

A

Thromboendarterectomy (CTEPH)
Lung or heart transplant

Respiration (27 decks)

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