Pulmonary Vascular Disease Flashcards
what is the mortality of PE if left untreated
up to 30% die
what is the mortality of PE once treatment has started
2-8% die
what are the signs and symptoms of deep vein thrombosis (DVT)
leg swelling
leg redness
tenderness
oedema
(note, signs and symptoms are not always present)
what are investigations that may identify a deep vein thrombosis
D Dimer test
ultrasound
Venography
what is a D Dimer test
a test that measures protein degradation that breaks off from a clot
what is a venography
radiography of a vein after injection of radiopaque fluid
what are weaknesses of D dimer test to diagnose DVT
non-specific can go up in any inflammatory condition
if a D dimer test is negative does the patient have a DVT
no, if negative it effectively excludes PE/DVT
what is a pulmonary embolism
a blood clot lodged in the pulmonary ARTERIAL circulation
what are the signs and symptoms of pulmonary embolism
breathlessness pleuritic chest pain cough haemoptysis cyanosis tachypnoea tachycardia fever
what investigations could you do for a pulmonary embolism
arterial blood gas troponin level D dimer ECG CXR definitive radiology
what is a V/Q scan
ventilation/perfusion scan
inhaled radioactive gas
inject radiolabelled albumin
gamma camera compares them both looking for a ventilation perfusion mismatch
what imaging is gold standard for diagnosis of acute PE
pulmonary angiography
what are the signs and symptoms of a massive pulmonary embolism
sudden chest pain
SOB
collapse/loss of conciousness
hypotensive
what is the treatment for DVT
anticoagulation therapy -LMWH
warfarin started after INR is in normal range.
what is the treatment for an acute minor pulmonary embolism
hypoxic-give high flow O2
bed rest and analgesia
anticoagulation with LMWH for 7 days
then start on warfarin
some patients will have a filter inserted into their vena cava why
if they have had an acute minor pulmonary embolism and are at high risk of a future emboli
how would you treat a massive pulmonary embolism
oxygen
fluids
analgesia
iv heparin -stop when giving thrombolysis
thrombolysis or embolectomy
what is mean pulmonary artery pressure at rest
25 mmHg
what is mean pulmonary artery pressure on exercise
30mmHg
what pressure is considered to be severe pulmonary hypertension
higher than 65mmHg
what pressure is considered to be moderate pulmonary hypertension
46-65 mmHg
Factor V Leiden is a mutated form of human factor V, what effect does it have
causes an increase in blood clotting
what can be cardiac signs of pulmonary hypertension
R ventricular heave
tricuspid regurgitation
