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Respiratory System > Pulmonary Vascular Disease > Flashcards

Pulmonary Vascular Disease Flashcards

1
Q

Name two Thromboembolic diseases

A
  • Pulmonary embolism

- Deep venous thrombosis

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2
Q

From what thrombi do the majority of emboli originate from?

A

Thrombi in leg veins

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3
Q

Are thrombi more likely to embolise in smaller or bigger veins?

A

Bigger

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4
Q

Give another condition which might result in pulmonary embolism

A
  • cardiac thrombus
  • septic embolus
  • air embolus
  • amniotic fluid embolus
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5
Q

What is Virchow’s Triad?

A

3 broad categories of factors that are risk factors for pulmonary embolism and deep venous thrombosis

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6
Q

What risk factors are in Virchow’s Triad?

A
  • Decreased blood flow
  • abnormal vessels
  • hyper-coagulable states
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7
Q

Name a condition/state that could be considered a hyper-coagulable state

A
  • pregnancy
  • oral contraceptive pill/HRT
  • malignancy
  • surgery
  • genetic factors
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8
Q

Give a condition that might lead to decreased blood flow

A
  • immobility
  • travel
  • bed-bound
  • heart failure
  • obesity
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9
Q

What range of people does pulmonary thromboembolic disease affect?

A

Wide range - young and old, well and unwell

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10
Q

What would worsen the prognosis of a patient with pulmonary thromboembolic disease?

A

An underlying disease

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11
Q

Why is pulmonary embolism difficult to diagnose?

A

Patients with pulmonary embolism don’t always have symptoms

Pulmonary embolism can mimic other conditions

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12
Q

What is a deep venous thrombosis?

A

A deep vein clot

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13
Q

What are the symptoms of deep venous thrombosis?

A
  • leg swelling
  • redness
  • tenderness
  • oedema
  • tight calves
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14
Q

What does a Well’s score of more than 2 indicate?

A

A high risk of deep venous thrombosis

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15
Q

How many conditions are taken into account when calculating a patients Well’s score?

A

9

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16
Q

What three investigations would be done if there was a suspicion of deep venous thrombosis in a patient?

A
  • D-Dimer test
  • Ultrasound
  • Venography
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17
Q

Why is a positive D-Dimer test result not conclusive of DVT?

A

D-Dimer is non-specific, it can increase in almost any inflammatory condition

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18
Q

D-Dimer test results are most helpful when they are

A

negative

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19
Q

What is D-Dimer?

A

Product of fibrin degradation

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20
Q

What is a pulmonary embolism?

A

When a blood clot lodges in the pulmonary arterial circulation

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21
Q

What three factors do the consequences of pulmonary embolism depend on?

A
  • where the emboli lodge
  • whether there are single or multiple emboli
  • size of emboli
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22
Q

Are most pulmonary embolisms single or multiple?

A

Multiple

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23
Q

Would one large clot or multiple small clots be more likely to cause chronic pulmonary hypertension?

A

Multiple small clots

24
Q

A pulmonary embolism is most likely to be life threatening if there is

A

a large clot

25
Q

What are the 3 most common signs/symptoms of pulmonary embolism?

A
  • Breathlessness
  • Pleuritic chest pain
  • Tachypnoea
26
Q

What investigations may be done if there is a high index of suspicion that a patient has a pulmonary embolism?

A
  • Arterial Blood Gases
  • Troponin
  • D-Dimer
  • ECG
  • CXR
27
Q

What definitive radiology is commonly done to diagnose pulmonary embolism?

A

V/Q scan

28
Q

What does a V/Q scan involve?

A
  • patient inhaling radioactive gas
  • gamma camera looks at distribution of ventilation
  • looking for V/Q mismatch
29
Q

V/Q scan results are very useful if they are

A

positive or unequivocally negative

30
Q

Would treatment follow V/Q scan results that were positive or negative?

A

Positive

31
Q

Following a V/Q scan, in patients with a low or intermediate probability of pulmonary embolism, what further investigations could be done?

A
  • Doppler ultrasound of legs
  • CTPA
  • Echocardiogram
  • Pulmonary angiography
32
Q

Give a condition that needs to be ruled out before investigating further for pulmonary embolism

A
  • pneumonia

- exacerbation of COPD

33
Q

What respiratory support can be given to a patient with a pulmonary embolism?

A

Oxygen and/or ventilation

34
Q

What haemodynamic support can be given to a patient with a pulmonary embolism?

A
  • IV fluids

- inotropes

35
Q

Anticoagulation drugs do not treat the existing clot in a pulmonary embolism, but can reduce what?

A

Fatal recurrence

36
Q

Give an example of an anticoagulant that might be given to a patient with pulmonary embolism?

A

Rivaroxaban

37
Q

What features are present in a massive pulmonary embolism?

A

A systolic blood pressure 15 minutes (not otherwise explained by another condition)

38
Q

What symptoms characterise a massive pulmonary embolism?

A
  • sudden chest pain
  • shortness of breath
  • may be collapse/loss of consciousness
  • may be hypotensive
  • may have right heart failure
39
Q

An echocardiogram is useful in detecting a massive pulmonary embolism as it can exclude

A

a dissecting aortic aneurysm

40
Q

What is necessary in treating a massive pulmonary embolism if thrombolysis fails?

A

Surgery (embolectomy)

41
Q

What is thrombolysis?

A

The breakdown of blood clots by pharmacological means

42
Q

What is pulmonary hypertension?

A

High pressure in the pulmonary arterial circulation

43
Q

What is the definition of pulmonary hypertension, in terms of pressure?

A

A mean pulmonary artery pressure > 25mmHG at rest or > 30mmHg during exercise

44
Q

What is primary pulmonary hypertension?

A

Pulmonary hypertension which is idiopathic

45
Q

What are the 5 classifications of pulmonary hypertension?

A
  1. Pulmonary arterial hypertension
  2. PHT due to left heart disease
  3. PHT due to lung diseases and/or hypoxia
  4. Chronic thromboembolic PHT
  5. PH with unclear multifactorial mechanisms
46
Q

Give a mechanism of PHT?

A
  • Hypoxic vasoconstriction
  • decreased surface area of pulmonary vascular bed
  • cardiac disease
47
Q

What are the early signs of PHT?

A
  • unexplained SOB
  • fatigue
  • syncope
  • chest tightness
  • haemoptysis
48
Q

What are the late signs of PHT?

A
  • ankle swelling

- right upper quadrant pain

49
Q

Give a sign of pulmonary arterial hypertension

A
  • Right ventricular heave
  • pulmonary flow murmer
  • increased murmers by inspiration
  • low gas transfers
50
Q

Give a factor in a patient with pulmonary hypertension which would lead to a poor prognosis

A
  • Age >44
  • connective tissue death
  • poor functional status
  • failure to respond to trail of treatment epoprostenol
  • evidence of heart strain
51
Q

How might PHT show up on a CXR?

A

Enlarged pulmonary arteries visible

52
Q

PHT can show what on an ECG?

A

Right heart strain

53
Q

PHT should be considered in patients with what kind of symptoms?

A

Unresponsive respiratory symptoms

54
Q

Give an investigation which should be included in the evaluation of unexplained SOB

A
  • CXR
  • ECG
  • PFTs
  • V/Q scan
  • echocardiogram
  • HRCT chest scan
55
Q

In treatment of Primary PHT, vasodilator therapy follows what treatments?

A
  • Warfarin
  • Oxygen
  • Diuretics
56
Q

What tree options are there for surgical intervention in PHT?

A
  • Atrial Septostomy
  • Pulmonary endarterectomy
  • Transplantation

Respiratory System (17 decks)

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