pulmonary Vascular Disease Flashcards
Where do Pulmonary Embolisms originate from
DVT in the legs which travel ot the lungs
Where do Pulmonary Embolisms originate from
DVT in the legs which travel ot the lungs
What do PEs do
Obstruct the pulmonary vasculature
Who are vulnerable to DVTs
Patients who are immobilised in the community or in hospital
What is Virchow’s triad?
Venous stasis
Damage to the wall of the vein
hypercoagulable state
How does venous stasis occur
As a result of immobility, local pressure, venous obstruction, congestive cardiac failure and dehydration
How does damage to a vein occur
Local trauma to the vein, previous thrombosis and inflammation
How do hypercoagulable states arise?
As part of the body’s response to surgery, trauma and childbirth.
In association with malignancy and use of oral oestrogen contraceptives.
What are the classic signs of DVT
Oedema of the leg with tenderness
erythema and pain on flexing the ankle (Homan’s sign)
What is the usual investgation used to confirm or exclude DVT
Compression ultrasound of the leg veins
What happens when there is an occlusion of a large part of the pulmonary circulation
A catastrophic drop in cardiac output and the patient collapses with hypotension, cyanosism tachypnoea and engorged neck veins
What happens when there is an occlusion of a large part of the pulmonary circulation
A catastrophic drop in cardiac output and the patient collapses with hypotension, cyanosism tachypnoea and engorged neck veins
What are the 3 main clinical symptoms of a pulmonary embolism
Dyspnoea
Tachyphnoea (>20)
Pleuritic chest pain
What is the purpose of the CXR during investigations
To rule out any other causes
Is a CXR is usually normal in a PE. True or false
True
An ECG is often normal in a PE. True or false
True
What does an ECG do for investigating PE
Rules out an MI and cardiac arrhythmias
ABGs are normal in a PE. True or False
False.
What are the main changes in the ABGs for a PE
Low PCO2 and low PO2 due to underperfused areas of lung resultin in hypoxaemia and hyperventilation
D dimers are reduced in thromboembolism. True or false
False. They are elevated
What are D dimers
A breakdown product of cross-linked fibrin
Can D Dimers exclude PE
No - other causes
What is the definitive test for diagnosing PE
Pulmonary angiography
What is the problem with pulmonary angiography
They are invasive and require specialist expertise and equipment that are not widely available
What is the definitive initial non-invasive investigation for PE
CTPA - computed tomography pulmonary angiography
What is injected IV before a VQ scan
Famma emitting radio isotope
What do the cold areas on the VQ scan suggest
There is defective blood flow
What is the treatment for PEs
Anti-coagulatant therapy - Low molecular weight heparin
How is the dose for low molecular weight heparin determined
Based on the patients weight
What are some of the adverse effects of heparin
Haemorrhage, bruising and thrombocytopenia
Once there is supportive subsequent investigations, what should be given
Oral anti-coagulation as warfarin
Once there is supportive subsequent investigations, what should be given
Oral anti-coagulation as warfarin
Can warfarin and heparin be used together
Yes - when warfarin is just newly introduced to the body - 48-72 hours
What is the aim of thrombolytic therapy
To actively dissolbe clots
When is thrombolytic therapy used
In patients with acute massive pulmonary embolism who remain in severe haemodynamic collapse
What are 3 contraindications of thrombolytic therapy
Active haemorrhage
Recent major surgery
Trauma
What is used to correct hypoxaemia
High flow oxygen
In patients who are contraindicative of thrombolytic therapy, what could be used
A venous filter into the inferior vena cava
What is cor pulmonale
The development of pulmonary hypertension and right ventricular hypertrophy secondary to disease of the lungs.
What is cor pulmonale
The development of pulmonary hypertension and right ventricular hypertrophy secondary to disease of the lungs.
What is Wegener’s granulomatosis characterised by
Necrotising granulomatous inflammation and vasculitis affecting in particular the upper airways, the lungs and kidneys
What is usually present in the serum of Wegener’s granulomatosis
Anti-neutrophil cytoplasmic antibodies
How is Wegener’s granulomatosis treated
Combination of corticosteroids and also cyclophosphamide
How is Wegener’s granulomatosis treated
Combination of corticosteroids and also cyclophosphamide
What is Goodpasture’s syndrome
It consists of a combination of glomerulonephritis and alveolar haemorrhage in association with circulating anti-basement membrane antibody that binds to the lung and renal tissue
What is the treatment of Goodpasture’s syndrome?
Corticosteroids and cyclophosphamide with plasmapheresis to remove circulating antibodies
What are the values of pulmonary hypertension
Mean pressure of more than 25mmHg
