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Respiratory Physiology > Pulmonary Vascular Disease > Flashcards

Pulmonary Vascular Disease Flashcards

1
Q

What is a pulmonary embolism?

A

An embolus in the lung

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2
Q

What vessels do PE’s come from?

A

Venous

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3
Q

What is the usual origin of a PE?

A

Deep Vein Thrombosis

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4
Q

Besides blood, what else can PE’s be?

A

Air embolisms

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5
Q

What percentage of hospital admissions are PE’s?

A

1%

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6
Q

Which of the great vessels does a PE travel through to reach the lung?

A

Vena Cava then pulmonary artery

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7
Q

What are the major risk factors of PE’s?

A
  • Recent major trauma - Surgery - Cancer - Massive cardiopulmonary disease - COPD - Pregnancy - Thrombophilia
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8
Q

Why does surgery increase the likelihood of PE?

A
  • Blood is more likely to clot when in venous stasis
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9
Q

Why can cancer cause a PE?

A
  • Cancer genesis increases clotting ability - Tumour can press on and narrow an organ
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10
Q

What is inherited thrombophilia?

A
  • Over/under ability to clot
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11
Q

What is an example of an inherited thrombophilia?

A

Factor V Leiden

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12
Q

What are the main symptoms of a small PE?

A
  • Pleuritic chest pain - Cough - Haemoptysis - Isolated acute breathlessness (dyspnoea)
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13
Q

Why does haemoptysis occur from a PE?

A
  • Necrotic part distal to the PE can be coughed up
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14
Q

How does pleurisy result from this haemoptysis?

A
  • Coughing up of the necrotic areas inflames the lung - Inflamed lung then rubs against the pleural cavity
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15
Q

Why does isolated acute dyspnoea occur from PE?

A
  • Some areas of the lung are ventilated but not perfused - V/Q mismatch
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16
Q

What can be a result from a large PE?

A
  • Syncope - Cardiac Arrest
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17
Q
  • Why are vessels white in this CT?
  • Where are the 2 pulmonary embolisms in the CT?
A
  • IV contrast
  • The small white circles with grey circles inside them
18
Q
  • Where is the PE in the CT?
  • What is the name given to this PE?
A
  • The large grey streak in the centre
  • Saddle embolism
19
Q

What are the two scoring systems used to indicate the liklihood of a patient having a PE?

A
  • Wells’ Score
  • Revised Geneva Score
20
Q

What are the investigative steps taken to diagnose a PE?

A
  • Full blood count
  • Blood gases
  • ECG
  • D-dimer
21
Q

What is a D-dimer?

A

Product of the clotting cascade?

22
Q

If the D-dimer comes back postive what is the next step?

A
  • CT pulmonary angiogram
  • V/Q sca
  • Echocardiogram
23
Q

What would the echocardiogram examine and how would it allow PE diagnosis?

A
  • Examine right ventricle
  • If it is under strain then PE likely
24
Q

Once a PE is diagnosed, BEFORE treatment what should the patient be started on?

A
  • Potentially oxygen in V/Q scan is poor
25
Q

What three treatment pathways are there for PE?

A
  • Direct oral anticoagulants
  • Thrombolysis
  • Pulmonary embolectomy
26
Q

What is thrombolysis and what agent is usually used to achieve it?

A
  • Direct lysis of the clot
  • Alteplase
27
Q

What is pulmonary hypertension?

A

Increased blood pressure in the pulmonary artery

28
Q

What pressure value is needed for a pulmonary hypertension diagnosis?

A

>25mmHg

29
Q

What happens if pulmonary hypertension is left untreated?

A

Rapidly progresses towards death

30
Q

What is the main reason for pulmonary hypertension?

A
  • We don’t know
  • Idiopathic
31
Q

What conditions can lead to pulmonary hypertension?

A
  • Chronic respiratory disease
  • Left heart disease
  • Chronic thromboembolic PH
  • Congenital heart disease
  • HIV
  • Collagen vascular disease
  • Portal hypertension
32
Q

How can left heart disease lead to pulmonary hypertension?

A
  • Increased venous pressure will feed into pulmonary circulation
33
Q

What are the early symptoms of pulmonary hypertension?

A
  • Exertional dyspnoea
  • Tight chest
  • Exertional syncope/presyncope
34
Q

What are some signs of pulmonary hypertension?

A
  • Elevated JVP (jugular venous pressure)
  • Right ventricular heave
  • Loud pulmonary second heart sound
  • Hepatomegaly
  • Ankle oedema
35
Q

How should you investigate pulmonary hypertension?

A
  • ECG
  • Lung function
  • Echocardiogram
36
Q

What would an ECG show in pulmonary hypertension?

A
  • High P wave
37
Q

What does a high P wave indicate?

A
  • Increased atrial size
38
Q

What valve leaks if there is pulmonary hypertension?

A

Tricuspid valve

39
Q

What technique will show a tricuspid valve leak?

A

Echocardiogram

40
Q

What general treatments are there for pulmonary hypertension?

A
  • To treat the underlying cause
  • Oxygen
  • Anticoagulation
  • Diuretics
41
Q

What are the specific treatments for pulmonary hypertension?

A
  • Calcium channel antagonists
  • Prostacyclin
  • Phosphodiesterase inhibitors such as viagra

Respiratory Physiology (16 decks)

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