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Respiratory > Pulmonary Vascular Disease > Flashcards

Pulmonary Vascular Disease Flashcards

1
Q

Explain pulmonary embolism

A

Thrombus forms n venous system, usually in deep veins of the leg. It embolises to pulmonary arteries

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2
Q

What is the treatment for minor PE?

A

Anticoagulation which has very good prognosis

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3
Q

What are major risk factors for venous thromboembolism?

A

Recent major trauma, recent surgery, cancer, significant cardiopulmonary disease, pregnancy and inherited thrombophilia

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4
Q

What are the symptoms for small peripheral thrombus?

A

Pleuritic chest pain, cough and haemoptysis

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5
Q

What are the symptoms for multiple small peripheral emboli?

A

Isolated acute dyspnoea

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6
Q

What are the symptoms for massive embolism in pulmonary arteries?

A

Syncope or cardiac arrest

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7
Q

What are clinical signs of a small peripheral thrombus?

A

Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)

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8
Q

What are the clinical signs of multiple small thrombi?

A

Tachycardia, tachypnoea and hypoxia

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9
Q

What are the clinical signs of massive thrombus?

A

Tachycardia, hypotension, tachypnoea and hypoxia

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10
Q

How can you calculate pre-test probability?

A

Wells score and revised Geneva score

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11
Q

Explain Wells score

A

Includes symptoms and signs of VTE, previous VTE and risk factors

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12
Q

Explain revised Geneva score

A

Based on risk factors, symptoms and signs (heart rate)

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13
Q

What are some investigations for PE?

A

FBC, biochemistry, Tn1 and blood gases
CXR, ECG, D-diner, CT pulmonary angiogram, V/Q scan, Echocardiography, CT abdomen and thrombophilia testing

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14
Q

How can a V/Q scan show perfusion and ventilation?

A

Ventilation looks normal
Perfusion has absence of tracer as embolism has prevented perfusion

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15
Q

What is given for treatment if patient is hypoxic?

A

Oxygen

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16
Q

What is the treatment for PE?

A

Low molecular weight heparin ex. dalteparin
Warfarin is less common
Direct oral anticoagulants
Thrombolysis
Pulmonary embolectomy

17
Q

What is thrombolysis?

A

Breakdown of thrombus by medication so breaks down blood clot
Pulmonary embolectomy if cant give thrombolysis

18
Q

Explain prognosis in PE

A

Mortality at 30 days varies from 0 -25%
PESI score - age , sex, comorbidity, physiological parameters

19
Q

What is pulmonary hypertension?

A

Chronic illness
Elevated blood pressure in pulmonary arterial tree
Mean pulmonary artery pressure of > 25mm Hg
Primary or secondary to other conditions

20
Q

Explain epidemiology of pulmonary hypertension

A

Idiopathic pulmonary arterial hypertension is rare
Untreated can lead to premature death
Usually second to other medical conditions and usually older

21
Q

What happens to arteries and heart during pulmonary hypertension?

A

Arteries constrict which increases pressure
This causes pressure on right side of heart causing hypertrophy

22
Q

What are the causes of pulmonary hypertension?

A

Idiopathic
Secondary to left heart disease
Secondary to chronic resp. disease
Chronic thromboembolic PH (CTBPH)
Miscellaneous

23
Q

What is a miscellaneous cause for pulmonary hypertension?

A

Sarcoidosis

24
Q

What are some idiopathic causes for pulmonary hypertension?

A

Collagen vascular disease
Portal hypertension
Congenital heart disease
HIV infection

25
Q

What are the symptoms of pulmonary hypertension?

A

Exertional dyspnoea, chest tightness, exertional presyncope or syncope and haemoptysis

26
Q

What does the terms presyncope and syncope mean?

A

Presyncope - feeling of going to faint, light headedness
Syncope - fainting

27
Q

What are the clinical signs of pulmonary hypertension?

A

Elevated JVP, right ventricular heave, loud pulmonary second heart sound, hepatomegaly and ankle oedema

28
Q

What is hepatomegaly?

A

Enlarged liver due to congestion

29
Q

What investigations are needed for pulmonary hypertension?

A

ECG, lung function tests, CXR, Echocardiography, V/Q scan, CTPA and right heart catheterisation

30
Q

Explain right heart catheterisation

A

Allows direct measure of pulmonary artery pressure
Measurement of wedge pressure and cardiac output Vasodilator trial

31
Q

What is shown on ECG of patient with pulmonary hypertension?

A

More serious case
V1 is increased and P waves are tall and peaked
Both showing right atrium enlargement

32
Q

What does pulmonary hypertension look like on CXR?

A

Enlarged right atrium
Enlarged right main artery

33
Q

What is the general treatment for pulmonary hypertension?

A

Treat underlying condition
Oxygen
Anticoagulation
Diuretics

34
Q

What is the general treatment for pulmonary hypertension?

A

Treat underlying condition
Oxygen
Anticoagulation
Diuretics

35
Q

What is specific treatment used for pulmonary hypertension?

A

Calcium channel antagonists
Prostaglandins
Prostacyclin agonist
Riociguat
Endothelin receptor agonist
Phosphodiesterase inhibitors

36
Q

What treatment would you give if vasodilator trial was positive?

A

Calcium channel antagonists

37
Q

What are some other treatment for pulmonary hypertension?

A

Thromboendarterectomy (CTEPH)
Lung or heart lung transplant as can get fibrosis of pulmonary vessels

Respiratory (24 decks)

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