Pulmonary vascular disease Flashcards
What are the major risk factors for venus thromboembolism?
-Recent major trauma
-Recent surgery- (not moving/bed ridden)
-Cancer - blood more coagulable
Significant cardiopulmonary disease e.g. MI
-Pregnancy
-Inherited thrombophilia e.g. Factor V Leiden
Where does a thrombus normally form?
Usually in deep veins of the legs
Where does a thrombus normally embolise?
Pulmonary arteries
How many hospital admissions are because of this?
Estimated 1%
What is an embolism?
A blood clot travelling from one part the body to another
What symptoms arise if there is an isolated small blood clot in a large peripheral artery?
Pleuritic chest pain, cough and haemoptysis
What happens when there is an isolated small blood clot in a large peripheral artery?
Part of the lung becomes infarcted= necrotic tissue. Surface of lung becomes inflammed pleura rubs against chest wall= pleurisy
What are the symptoms of 2 bilateral clots in the pulmonary arteries.
Isolated acute dyspnoea (breathlessness)
What are the symptoms of a massive pulmonary embolism
Syncope (black out) or cardiac arrest
What are the signs of an isolated small blood clot in a large peripheral artery?
Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
What are the signs of 2 bilateral clots in pulmonary arteries?
Tachycardia, tachpnoea and hypoxia
What are signs of a major pulmonary embolism?
Tachycardia, hypotension, tachypnoea (fast resp rate), hypoxia
What pre-test probability scores exist to determine likelyhood of developing a PE
- Wells score
- -Includes symtoms and sings of VTE
- Revised Geneva score
- -Based on risk factors , symptoms and signs
What Investigations are used to determine if some has a PE?
- Full blood count,biochemistry, blood gases
- Chest X-ray
- ECG
- D-dimer
- CT Pulmonary angiogram
- V/Q scan
- Echocardiography
- Consider CT abdomen and mammography
- Consider thrombophilia testing
What might show up in a chest X-ray when a patient has a PE?
Small pleural effusion
What is the most common ECG for someone with a PE?
Simple tachycardia
What is a D-dimer test?
Blood test clotting pathway in blood if high continue tests
What part of the heart should be specifically looked at when a suspected PE is present and how?
Right atrium with echocardiography
What is the prognosis of a PE and how is it determined?
- Mortality at 30 days varies from 0 to 25%
- PESI Score (based on age, sex, comorbidity and physiological parameters)
What is the treatment for PE?
- Oxygen
- Low molecular weight heparin e.g. dalteparin
- Warfarin
- Direct Oral anticoagulants (DOAC)
- Thrombolysis (If extreme)
- Pulmonary Embolectomy
Name 2 direct oral antocoagulant (DOAC)
- Rivaroxaban
- Apixaban
Name a drug used for thrombolysis?
Atlepase (rt-PA) recombinant tissue plasminogen activator
What is pulmonary hypertension?
-Elevated blood pressure in the pulmonary hypertension.
What is the pressure to define pulmonary hypertension?
> 25mmHg
What are the causes of pulmonary hyertension?
- Idiopathic
- Secondary to chronic respiratory disease
- Secondary to left heart disease
- Chronic Thromboembolic PH (CTEPH)
- Miscellaneous
What are the miscellaneous causes of pulmonary hypertension?
- Collagen vascular diease
- Portal hypertension- liver disease
- Congentital heart disease (SHUNT)
- HIV infection
What are the symptoms of pulmonary hypertension?
- Extertional dyspnoea
- Chest tightness
- Exertional presyncope or syncope
What are the signs of pulmonary hypertension?
- Elevated (jugular venous pressure)
- Right venticular heave
- Loud pulmonary second heart sound
- Hepatomegaly
- Ankle oedema- increased pressure of venous tissue
What investigation of pulmonary hypertension are there?
- ECG
- Lung function tests
- Chest x-ray
- Echocardigraphy
- V/Q scan
- CTPA (CT pulmonary angiogram)
- Right heart catherisation
Describe what right heart catheterisation
- Allows direct measure of pulmonary artery pressure
- measurement of wedge pressure
- measurement of cardiac output
What is the general treatment of pulmonary hypertension?
- Treatment of underlying condition
- Oxygen
- Anticoagulantion
- Diuretics
What is the specific treatment for pulmonary hypertension
- Calcium channel antagonist
- Prostacyclin
- Endothenlin receptor anatagonists
- Phosphodiesterase inhibitors
What is the function of prostacyclin?
Vasodilation
name 2 endothelial receptor antagonists?
- Bosentan
- Ambrisentan
Name 2 phosphodiesterase inhibitors
- Sidenafil-Viagra
- Tadalafil
What are the alternative treatments to Pulmonary Hypertension?
- Thromboendarterectomy
- Lung transplant/heart transplant
