Pulmonary Vascular Disease Flashcards
1
Q
Pulmonary embolism
A
- Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.
- Massive PE can be fatal, although minor PE treated with anticoagulation has a very good prognosis.
2
Q
Venous thromboembolism - Major risk factors
A
- 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
3
Q
Symptoms of pulmonary embolism
A
- Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest (massive PE)
4
Q
Signs of pulmonary embolism
A
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachypnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
5
Q
Pre-test probability of pulmonary embolism
A
- Wells Score
- Includes symptoms and signs of VTE, previous VTE and risk factors
- Revised Geneva Score
- Based on risk factors, symptoms and signs (heart rate)
6
Q
Investigations for pulmonary embolism
A
- 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
7
Q
Treatment for pulmonary embolism
A
- Oxygen
- Low molecular weight heparin e.g. dalteparin
- Warfarin
- Direct Oral Anticoagulants (DOAC)
- rivaroxaban, apixaban
- Thrombolysis
- Alteplase (rt-PA)
- Pulmonary Embolectomy
8
Q
Duration of treatment for pulmonary embolism
A
- Provoked PE – 3 months anticoagulation
- Unprovoked PE – Haematology to assess annual risk of recurrence and consider lifelong anticoagulation.
9
Q
Prognosis of pulmonary embolism
A
- Mortality at 30 days varies from 0 to 25%
- PESI Score
- Based on age, sex, comorbidity and physiological parameters
10
Q
Pulmonary hypertension
A
- Elevated blood pressure in the pulmonary arterial tree.
- Defined as a mean pulmonary artery pressure of > 20 mmHg.
- Either idiopathic or secondary to other conditions.
11
Q
Epidemiology of pulmonary hypertension
A
- Idiopathic pulmonary arterial hypertension is rare and has an incidence of 1-2 per million population.
- Untreated it is a rapidly progressive condition that leads to premature death.
- Pulmonary hypertension secondary to other medical conditions is more common and tends to occur in an older age group.
12
Q
Causes of pulmonary hypertension
A
- Idiopathic (group 1)
- idiopathic
- 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
13
Q
Symptoms of pulmonary hypertension
A
- Exertional dyspnoea
- Chest tightness
- Exertional presyncope or syncope
- Haemoptysis
14
Q
Signs of pulmonary hypertension
A
- Elevated JVP
- Right ventricular heave
- Loud pulmonary second heart sound
- Hepatomegaly (enlarged liver)
- Ankle oedema
15
Q
Investigations for pulmonary hypertension
A
- ECG
- Lung function tests (reduced gas transfer)
- Chest X-Ray
- Echocardiography
- V/Q scan
- CTPA
- Right heart catheterisation
- allows direct measure of pulmonary artery pressure
- measurement of wedge pressure
- measurement of cardiac output
- vasodilator trial with nitric oxide
