Pulmonary Vascular Disease Flashcards
Explain pulmonary embolism
Thrombus forms n venous system, usually in deep veins of the leg. It embolises to pulmonary arteries
What is the treatment for minor PE?
Anticoagulation which has very good prognosis
What are major risk factors for venous thromboembolism?
Recent major trauma, recent surgery, cancer, significant cardiopulmonary disease, pregnancy and inherited thrombophilia
What are the symptoms for small peripheral thrombus?
Pleuritic chest pain, cough and haemoptysis
What are the symptoms for multiple small peripheral emboli?
Isolated acute dyspnoea
What are the symptoms for massive embolism in pulmonary arteries?
Syncope or cardiac arrest
What are clinical signs of a small peripheral thrombus?
Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
What are the clinical signs of multiple small thrombi?
Tachycardia, tachypnoea and hypoxia
What are the clinical signs of massive thrombus?
Tachycardia, hypotension, tachypnoea and hypoxia
How can you calculate pre-test probability?
Wells score and revised Geneva score
Explain Wells score
Includes symptoms and signs of VTE, previous VTE and risk factors
Explain revised Geneva score
Based on risk factors, symptoms and signs (heart rate)
What are some investigations for PE?
FBC, biochemistry, Tn1 and blood gases
CXR, ECG, D-diner, CT pulmonary angiogram, V/Q scan, Echocardiography, CT abdomen and thrombophilia testing
How can a V/Q scan show perfusion and ventilation?
Ventilation looks normal
Perfusion has absence of tracer as embolism has prevented perfusion
What is given for treatment if patient is hypoxic?
Oxygen
What is the treatment for PE?
Low molecular weight heparin ex. dalteparin
Warfarin is less common
Direct oral anticoagulants
Thrombolysis
Pulmonary embolectomy
What is thrombolysis?
Breakdown of thrombus by medication so breaks down blood clot
Pulmonary embolectomy if cant give thrombolysis
Explain prognosis in PE
Mortality at 30 days varies from 0 -25%
PESI score - age , sex, comorbidity, physiological parameters
What is pulmonary hypertension?
Chronic illness
Elevated blood pressure in pulmonary arterial tree
Mean pulmonary artery pressure of > 25mm Hg
Primary or secondary to other conditions
Explain epidemiology of pulmonary hypertension
Idiopathic pulmonary arterial hypertension is rare
Untreated can lead to premature death
Usually second to other medical conditions and usually older
What happens to arteries and heart during pulmonary hypertension?
Arteries constrict which increases pressure
This causes pressure on right side of heart causing hypertrophy
What are the causes of pulmonary hypertension?
Idiopathic
Secondary to left heart disease
Secondary to chronic resp. disease
Chronic thromboembolic PH (CTBPH)
Miscellaneous
What is a miscellaneous cause for pulmonary hypertension?
Sarcoidosis
What are some idiopathic causes for pulmonary hypertension?
Collagen vascular disease
Portal hypertension
Congenital heart disease
HIV infection
What are the symptoms of pulmonary hypertension?
Exertional dyspnoea, chest tightness, exertional presyncope or syncope and haemoptysis
What does the terms presyncope and syncope mean?
Presyncope - feeling of going to faint, light headedness
Syncope - fainting
What are the clinical signs of pulmonary hypertension?
Elevated JVP, right ventricular heave, loud pulmonary second heart sound, hepatomegaly and ankle oedema
What is hepatomegaly?
Enlarged liver due to congestion
What investigations are needed for pulmonary hypertension?
ECG, lung function tests, CXR, Echocardiography, V/Q scan, CTPA and right heart catheterisation
Explain right heart catheterisation
Allows direct measure of pulmonary artery pressure
Measurement of wedge pressure and cardiac output Vasodilator trial
What is shown on ECG of patient with pulmonary hypertension?
More serious case
V1 is increased and P waves are tall and peaked
Both showing right atrium enlargement
What does pulmonary hypertension look like on CXR?
Enlarged right atrium
Enlarged right main artery
What is the general treatment for pulmonary hypertension?
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
What is the general treatment for pulmonary hypertension?
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
What is specific treatment used for pulmonary hypertension?
Calcium channel antagonists
Prostaglandins
Prostacyclin agonist
Riociguat
Endothelin receptor agonist
Phosphodiesterase inhibitors
What treatment would you give if vasodilator trial was positive?
Calcium channel antagonists
What are some other treatment for pulmonary hypertension?
Thromboendarterectomy (CTEPH)
Lung or heart lung transplant as can get fibrosis of pulmonary vessels
