Pulmonary Vascular Disease Flashcards
Describe the pathogenesis of deep vein thrombosis, pulmonary embolism, and pulmonary infarction.
Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.
Pulmonary embolism symptoms
Symptoms:
- Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (massive PE)
PE signs.
Signs:
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachypnoea hypoxia
- Tachycardia, hypotension, tachypnoea hypoxia
PE investigations
Investigations:
- Full blood count, biochemistry, Tnl, blood gases
- CXR
- ECG
- D-dimer
- CT pulmonary Angiogram
- V/Q scan
- Echocardiography
- Consider CT abdomen and mammography
- Consider thrombophilia testing
PE treatment
Treatment:
- Oxygen
- Low molecular weight heparin
- Warfarin
- Direct Oral Anticoagulants - rivaroxaban, apixaban
- Thrombolysis - Alteplase
- Pulmonary Embolectomy
PE prognosis
Prognosis:
- Mortality at 30 days varies from 0 to 25%
- PESI score - based on age, sex, comorbidity and physiological parameters
Define pulmonary hypertension
- Elevated blood pressure in the pulmonary arterial tree.
- Defined as a mean pulmonary artery pressure of >20mmHg
- Either primary or secondary to other conditions.
Causes of PH
Idiopathic (group 1)
- Includes,
- collagen vascular disease
- portal hypertension
- congenital heart disease (L to R shunt)
- HIV infection
Secondary to left heart disease (group 2)
Secondary to chronic respiratory disease (group 3)
Chronic Thromboembolic PH (CTEPH) ( group 4)
Miscellaneous (group 5)
- Sarcoidosis
PH symptoms
Symptoms:
- Exertional Dyspnoea
- Chest tightness
- Exertional presyncope or syncope
- Haemoptysis
PH signs
Signs:
- Elevated JVP
- Right ventricular heave
- Loud pulmonary second heart sound
- Hepatomegaly
- Ankle oedema
PH investigation.
Investigation:
- ECG
- Lung function tests
- CXR
- Echocardiography
- V/Q scan
- CTPA
- Right heart catheterisation - allows direct measure of pulmonary artery pressure, measurement of wedge pressure, measurement of cardiac output and vasodilator with nitric oxide
General treatment for PH
General treatment:
- Treat underlying condition
- Oxygen
- Anticoagulation
- Diuretics
Specific treatment for PH.
Calcium channel antagonists (if positive vasodilator trial)
Prostaglandins e.g. iloprost
Prostacyclin agonist (selexipag)
Phosphodiesterase inhibitors
sildenafil
tadalafil
Endothelin receptor antagonists
bosentan
ambrisentan
Riociguat (for CTEPH)
