Pulmonary Vascular Disease Flashcards
Describe what happens in a pulmonary embolism.
Thrombus forms in the venous systems, usually the legs, and embolises to the pulmonary arteries.
List some of the major risk factors for developing a pulmonary embolism.
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
Inherited thrombophilia e.g Factor V Leiden, Protein C or S deficiency
Why are you at an increased risk of developing a pulmonary embolism after major trauma or sugery?
Immobile so blood flow reduced
List the presenting symptoms for someone with a minor PE.
Pleuritic chest pain, cough and haemoptysis
What is meant by pleuritic chest pain?
Sharp pain, usually worse upon inspiration
Why may cancer increase risks of a PE?
There may be a tumour pressing on a vein and impacting blood flow.
Describe the presenting symptoms in someone with a major PE
Syncope- passing out/fainting
Cardiac arrest
What may be some clinical signs upon examination of a minor PE?
Pyrexia*, pleural rub, stony dullness to percussion at base (pleural effusion)
*raised temperature
What may be some clinical signs upon examination in someone with an intermediate sized PE?
Tachycardia, tachypnoea, hypoxia
What is meant by tachycardia?
HR over 100 bpm
Need to try and remember as this term comes up a lot
What may be some clinical signs upon examination in someone with a major PE?
Tachycardia, hypotension, tachypnoea, hypoxia
Why may a pre-test probability ranking be carried out?
To see how likely they are to have a PE before using time/resources ineffectively
Which two pre-test ranking tests may be used for someone w suspected PE?
Wells Score
Revised Geneva Score
Name some of the investigations which may be carried out in someone with a PE.
Full blood count, biochemistry, TnI, blood gases
Chest X-Ray
ECG
D-dimer
CT Pulmonary Angiogram (CTPA)
V/Q scan
Echocardiography
Consider CT abdomen and mammography
Consider thrombophilia testing
If d-dimer is negative, what does this indicate?
Unlikely to be a PE
List some of the treatment options available for those w PE.
Oxygen
Direct Oral Anticoagulants
Thrombolysis
Pulmonary Embolectomy
What is pulmonary hypertension?
Elevated blood pressure in the pulmonary arterial tree.
What value of mean artery pressure is associated with pulmonary hypertension.
> 20 mmHg.
What is meant by pulmonary infarction?
The portions of lung served by each blocked artery can’t get blood and may die
There are five groups of causes of pulmonary hypertension.
Discuss the group 1 causes of pulmonary hypertension
Idiopathic.
Includes-
-collagen vascular disease
-portal hypertension
-congenital heart disease (L to R shunt)
-HIV infection
Discuss the group 2 causes of pulmonary hypertension.
Secondary to left heart disease
Discuss the group 3 causes of pulmonary hypertension.
Secondary to chronic respiratory disease like sleep apnoea, COPD, etc.
Discuss the group 4 causes of pulmonary hypertension.
Chronic Thromboembolic PH- when the body is not able to dissolve a blood clot in the lungs
Discuss the group 5 causes of pulmonary hypertension.
Miscellaneous- like sarcoidosis
List some of the symptoms for pulmonary hypertension.
Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope*
Haemoptysis
*feeling you’re going to faint/ fainting
What are some signs upon examination which would suggest pulmonary hypertension?
Elevated JVP*
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema
*jugular venous pressure
List some of the possible investigations for someone with pulmonary hypertension.
ECG
Lung function tests
Chest X-Ray
Echocardiography
V/Q scan
CTPA
Right heart catheterisation
Name some of the general treatments for those with pulmonary hypertension.
Treat underlying condition
Oxygen
Anticoagulation (for IPAH only)
Diuretics
What are diuretics?
Water tablets to help remove sodium and water from the body.
Name some specific treatments for those with pulmonary hypertension.
Calcium channel antagonists
Prostaglandins
Prostacyclin agonist
Riociguat
Phosphodiesterase inhibitors
Endothelin receptor antagonists
Name some surgical treatments for those with pulmonary hypertension.
Thromboendarterectomy (CTEPH)
Lung or heart lung transplant
