Pulmonary Vascular Disease Flashcards
What 2 topics does pulmonary vascular disease cover?
Thromboembolic disease
Pulmonary hypertension
What are the 2 main examples of thromboembolic disease?
Deep venous thrombosis (DVT) Pulmonary embolism (PE)
Where do the majority of thrombi originate
Veins in the legs
Are thrombi in bigger veins more or less likely to embolise?
More likely
What concept are the risk factors for thromboembolic disease related to?
Virchows Triad
Name at least 3 signs and symptoms of DVT?
Leg swelling
Redness
Tenderness
Oedema
What 3 investigations should you perform (in order) to confirm a DVT diagnosis?
D Dimer
Ultrasound
Venography
What does a negative D Dimer test tell us about DVT and PE diagnosis?
Negative test effectively excludes PE/DVT
What is a pulmonary embolism?
When a blood clot embolises in the pulmonary circulation
What are some of the symptoms of a large pulmonary embolism? (4)
Hypoxia
Hypotension
Pain
Collapse
What are the 3 main symptoms of a pulmonary embolism?
Dyspnoea
Pleuritic chest pain
Tachypnoea
What 3 scans can be performed to help identify PE?
V/Q scan
Doppler ultrasound
CT pulmonary angiography
What immediate supportive management should be given to a patient with PE?
Oxygen (either with or without ventilation)
What type of drug (and an example of this drug) could be used to prevent the recurrence of a clot?
Anticoagulant (i.e. Warfarin)
What 3 clinical measures should be taken in the case of a Massive Pulmonary Embolism?
Resuscitate (oxygen, careful fluids, analgesia)
IV Heparin
Thrombolysis
What is the pressure in:
Mild pulmonary hypertension
Moderate PH
Severe PH
25-45 mmHg
45-65mmHg
>65mmHg
Name at least 2 causes of pulmonary arterial hypertension?
Idiopathic HIV infection Connective tissue disease Portal hypertension Coronary heart disease Schistosomiasis Chronic haemolytic anaemia
What are the 5 groups of pulmonary hypertension?
1: Pulmonary arterial hypertension
2: Pulmonary hypertension due to L heart disease
3 Pulmonary hypertension due to lung diseases and/or hypoxia
4: Chromic thromboembolic pulmonary hypertension
5: Pulmonary hypertension with unclear multifactoral mechanisms
What are the 3 mechanisms of PE?
Hypoxia vasoconstriction
Reduced surface area of pulmonary vascular bed
Cardiac disease
What are they 5 early signs of PE?
Unexplained dyspnoea Fatigue Syncope Chest tightness Haemoptysis
What is a late sign of PE?
Ankle swelling
What 6 investigations should be performed if a patient has unexplained dyspnoea?
CXR ECG PFTs V/Q scan Echo High-res CT if chest
What is the first line treatment for primary pulmonary HT?
Warfarin
Diuretics
Oxygen
What us the second line treatment for PHT if the patient has an acute vasodilator response?
CCBs (amlodipine)
What 3 surgical treatments could be performed for PHT?
Atrial septostomy
Pulmonary endarterectomy
Lung transplant
