Pulmonary vascular disease Flashcards
What is two examples of pulmonary vascular diseases
Pulmonary embolism
Pulmonary hypertension
Define pulmonary embolism
Blood clot traveling from one part of the body to antother part
What is pulmonary embolism medically treated with
anti coagulation
Where does the blood clot lodge in a pulmonary embolism
Peripheral pulmonary artery
Major risk factors of pulmonary embolism
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
Inherited thrombophilia e.g Factor V Leiden
What is thrombophilia
A genetic disorder that means you have a predisposition to blood clots
How can surgery cause blood clotting
In bed after operation, immobility results in clot
Surgery stimulates blood clotting
What are the symptoms of small blood clots to the lungs
Pleuritic chest pain
Cough and haemoptysis
Define pleuritic chest pain
burning or dull pain in the right or the left side of the heart during breathing
Define Isolated acute dyspnoea, and what causes this in a pulmonary embolism
Difficulty in breathing, caused by the blood being ventilated but not perfused
In a massive pulmonary embolism what is the symptom
Cardiac arrest
syncope - loss of consciences
What are the signs of a small pulmonary embolism
Pleural rub - scrunching sound
Pleural effusion - fluid around the lung
Pyrexia - increased temp
What are the signs of a major pulmonary embolism
Tachycardia - increased heart rate
hypotension - low BP
tachypnoea - rapid breathing
hypoxia
How can you test the probability that someone has a pulmonary embolism
Symptoms and signs present
Previous history
Has risk factors
List the different investigations to diagnose pulmonary embolism
Full blood count, biochemistry, blood gases Chest X-Ray ECG D-dimer CT Pulmonary Angiogram (CTPA) V/Q scan Echocardiography Consider CT abdomen and mammography Consider thrombophilia testing
What is the purpose of a D-dimer test?
D-dimer is the product of blood clotting, if D-dimer is negative means unlikely have pulmonary embolism
What does a V/Q scan show
The ventilation and perfusion in the lungs
What does an ECG measure and what is it checking for?
Heart rhythms, checking for tachycardia
When is a Echocardiography taken?
When a large pulmonary embolism is suspected
Why would a CT abdomen and mammogram be taken
to rule out any other possibilities e.g. cancer
For the prognosis what factors need to be taken into account
How many disease and conditions you have
the state of your health
Age
Sex
What tablets are given to treat pulmonary embolism
antocoagulants:
Warfarin
apixaban
rivaroxaban
What treatment is given to treat major pulmonary embolism
thrombolysis
What works immediately to relive a pulmonary embolism
oxygen
What treatment is Pulmonary Embolectomy
A cardiac surgeon opening up and removing embolism
What is the definition for pulmonary hypertension
Elevated blood pressure in the pulmonary arterial tree
What arterial pressure above is counted as hypertension
> 25mmHg
What is characteristics of primary hypertension
Rare
Common amount young groups
rapid and progressive if left untreated
What is the characteristics of secondary hypertension
Stems from other conditions
Common in older age group
More common
What can arise from left heart disease
pulmonar venous hypertension
What are causes of pulmonary hypertension
idiopathic - spontaneous
secondary:
chronic repiratory disease left heart disease collagen vascular disease portal hypertension congenital heart disease (L to R shunt) HIV infection chronic thromboembolic
What is chronic thromboembolic
A pulmonary hypertension caused by blockages in the blood vessels to the lungs due to scar tissue. The scars are the result of blood clots that the body has not properly cleared
What are the symptoms of pulmonary hypertension
Chest tightness
Exertional presyncope - feeling light headed (blacking out)
Exertional dyspnoea - shortness of breathe on exertion
What are signs of pulmonary hypertension
Elevated jugular venous pressure Right ventricular heave Loud pulmonary second heart sound Hepatomegaly (congested liver) Ankle oedema
What are the two signs that show advanced pulmonary hypertension
Hepatomegaly
Ankle oedema
What investigation are used to diagnose pulmonary hypertension
ECG Lung function tests Chest X-Ray Echocariography V/Q scan CTPA Right heart catheterisation
What does a tricuspid valve leaks allow us to measure
an indirect measurement to estimate pulmonary artery pressure
What does a Echocardiography allow measurement of
Direct pulmonary artery pressure
Indirect pressure on the capillaries
What does a right-heart catheterization measure
how well or poorly your heart is pumping, and to measure the pressures in your heart and lungs
Where is catheter passed in a right-heart catheterization
Pulmonary artery
What else does a right-heart catheterization allow indirect measurement of
measurement of wedge pressure
measurement of cardiac output
What is the general treatment of pulmonary hypertension
Treat underlying condition Oxygen Anticoagulation Diuretics Lung or heart transplant Thromoendarterectomy - specialised surgery
What is specific anticoagulant and diuretics treatments for pulmonary hypertension
Calcium channel antagonist e.g. amlodipine Prostacyclin Endothelin receptor antagonists: bosentan ambrisentan Phosphodiesterase inhibitors: sildenafil tadalafil
