Pulmonary Vascular Disease

Question 1

what is the mortality of PE if left untreated

Answer 1

up to 30% die

Question 2

what is the mortality of PE once treatment has started

Answer 2

2-8% die

Question 3

what are the signs and symptoms of deep vein thrombosis (DVT)

Answer 3

leg swelling
leg redness
tenderness
oedema

(note, signs and symptoms are not always present)

Question 4

what are investigations that may identify a deep vein thrombosis

Answer 4

D Dimer test
ultrasound
Venography

Question 5

what is a D Dimer test

Answer 5

a test that measures protein degradation that breaks off from a clot

Question 6

what is a venography

Answer 6

radiography of a vein after injection of radiopaque fluid

Question 7

what are weaknesses of D dimer test to diagnose DVT

Answer 7

non-specific can go up in any inflammatory condition

Question 8

if a D dimer test is negative does the patient have a DVT

Answer 8

no, if negative it effectively excludes PE/DVT

Question 9

what is a pulmonary embolism

Answer 9

a blood clot lodged in the pulmonary ARTERIAL circulation

Question 10

what are the signs and symptoms of pulmonary embolism

Answer 10

breathlessness 
pleuritic chest pain 
cough
haemoptysis
cyanosis 
tachypnoea
tachycardia
fever

Question 11

what investigations could you do for a pulmonary embolism

Answer 11

arterial blood gas
troponin level
D dimer 
ECG
CXR
definitive radiology

Question 12

what is a V/Q scan

Answer 12

ventilation/perfusion scan

inhaled radioactive gas
inject radiolabelled albumin

gamma camera compares them both looking for a ventilation perfusion mismatch

Question 13

what imaging is gold standard for diagnosis of acute PE

Answer 13

pulmonary angiography

Question 14

what are the signs and symptoms of a massive pulmonary embolism

Answer 14

sudden chest pain
SOB
collapse/loss of conciousness
hypotensive

Question 15

what is the treatment for DVT

Answer 15

anticoagulation therapy -LMWH

warfarin started after INR is in normal range.

Question 16

what is the treatment for an acute minor pulmonary embolism

Answer 16

hypoxic-give high flow O2
bed rest and analgesia
anticoagulation with LMWH for 7 days
then start on warfarin

Question 17

some patients will have a filter inserted into their vena cava why

Answer 17

if they have had an acute minor pulmonary embolism and are at high risk of a future emboli

Question 18

how would you treat a massive pulmonary embolism

Answer 18

oxygen
fluids
analgesia
iv heparin -stop when giving thrombolysis

thrombolysis or embolectomy

Question 19

what is mean pulmonary artery pressure at rest

Answer 19

25 mmHg

Question 20

what is mean pulmonary artery pressure on exercise

Answer 20

30mmHg

Question 21

what pressure is considered to be severe pulmonary hypertension

Answer 21

higher than 65mmHg

Question 22

what pressure is considered to be moderate pulmonary hypertension

Answer 22

46-65 mmHg

Question 23

Factor V Leiden is a mutated form of human factor V, what effect does it have

Answer 23

causes an increase in blood clotting

Question 24

what can be cardiac signs of pulmonary hypertension

Answer 24

R ventricular heave

tricuspid regurgitation

Question 25

what are the ways pulmonary hypertension can develop

Answer 25

hypoxic vasoconstriction - e.g COPD

decrease in the surface area of the pulmonary vascular bed- e.g PE

cardiac disease resulting in RV volume/pressure overload

Question 26

what is the treatment for pulmonary hypertension

Answer 26

warfarin, oxygen, diuretics

then a choice of vasodilator therapies (see slides)