Pulmonary Vascular Disease Flashcards
How does a pulmonary embolism occur?
- A thrombus (clot) forms in the venous system (usually in the deep veins of the leg)
- It embolises through the veins through the heart and lodges in the pulmonary arteries
Whats the prognosis for a minor PE?
Very good if treated with anticoagulation
Whats the mortality rate for PE?
At 30 days mortality is between 0-25% (closer to 25% in a massive PE)
How do we determine the risk of mortality?
Using a PESI score based on:
- Age
- Sex
- Comorbidity
- Physiological Parameters
What are the Major Risk Factors for a Pulmonary Embolism?
- Recent Major Trauma
- Recent Surgery
- Cancer
- Significant cardiopulmonary disease e.g. MI
- Pregnancy
- Inherited Thrombophilia
What is a thrombophilila?
An inherited disorder with a predisposition to produce clotting factors (e.g. Factor V Leiden)
What happens if you get a small PE in a peripheral artery??
A section of the lung is infarcted.
This leads to local tissue inflammation, necosis and rubbing against the pleura
What are the signs and symptoms of a small Peripheral PE?
Symptoms:
Pleuritic Chest Pain (from rubbing)
Cough and Haemoptysis
Signs:
Pyrexia
Stony Dullness to percussion at base (due to pleural effusion)
What happens if there multiple small PEs?
Several areas are infarcted
This means perfusion of the lung in general becomes low
What are the signs and symptoms of multiple small PEs?
Symptoms:
pleuritic chest pain, cough, haemoptysis, isolated acute dyspnoea
Signs:
Tachycardia, Tachpnoea, Hypoxia
What happens during a massive PE?
A general lack of pulmonary blood flow leads to hypoxia and loss of blood pressure
What are the signs and symptoms of a massive PE?
The loss of blood pressure can lead to syncope or even cardiac arrest.
Signs:
Tachycardia, Hypotension, Tachypnoea, Hypoxia
How do we determine how likely someone is to get a PE?
By various scoring systems:
- Wells Score
- Revised Geneva Score
What early tests do we do when we suspect a PE?
- A full blood count, blood gases & biochemistry.
- A CXR (rules out other conditions)
- ECG (shows tachycardia)
- D-dimer (-ve indicates unlikely to have a PE)
What is the main test we use to determine a PE?
A CT pulmonary Angiogram (CTPA)
What test would we use to determine if the right ventricle is under strain?
An echocardiograph