Pulmonary vascular disease Flashcards
what is a pulmonary embolism?
thrombus forming in the venous system (usually in deep veins of the legs) and embolisms to the pulmonary arteries
what percentage of all hospital admissions is pulmonary embolism?
1%
what is the prognosis of PE?
massive PE can be fatal (mortality at 30 days varies from 0 to 25%), minor PE treated with anticoagulation has a very good prognosis (depends on PESI score)
what are the major risk factors for a venous thromboembolism?
- recent major trauma
- recent surgery
- cancer
- significant cardiopulmonary disease (e.g.: MI)
- pregnancy
- inherited thrombophilia (e.g.: factor V Leiden)
what are the symptoms of pulmonary embolism?
- pleuritic chest pain, cough and haemoptysis
- isolated acute dyspnoea
- syncope or cardiac arrest (massive PE)
what are the signs of pulmonary embolism?
- pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- tachycardia, tachypnoea, hypoxia
- tachycardia, hypotension, tachypnoea, hypoxia
what tests do you run to assess a pre-test probability? (i.e.: probability of having the condition)
- Wells score (includes symptoms and signs of VTE, previous VTE and risk factors)
- revised Geneva score (based on risk factors, symptoms and signs (heart rate)
what tests do you run to investigate the PE?
- full blood count, biochemistry, blood gases
- chest xray
- ECG
- D-dimer
- CT pulmonary angiogram (CTPA)
- V/Q scan
- echocardiography
- consider CT abdomen and mammography
- consider thrombophilia testing
what factors do the PESI score rely on? (pulmonary embolism severity index)
age, sex, comorbidity and physiological parameters
how do you treat PE?
- oxygen
- low molecular weight heparin (e.g.: dalteparin)
- warfarin
- direct oral anticoagulants (DOAC) (eg: rivaroxaban, apixaban)
- thrombolysis (e.g.: alteplase (rt-PA)
- pulmonary embolectomy
what is pulmonary hypertension?
- elevated blood pressure in the pulmonary arterial or tree
- defined as a mean pulmonary artery pressure of > 25mmHg
- either primary or secondary to other conditions
how common is primary pulmonary hypertension?
rare, incidence of 1-2/ million people
what happens to patients with untreated primary pulmonary hypertension?
leads to premature death
how common is secondary pulmonary hypertension?
more common
what age group is affected by secondary pulmonary hypertension?
older age group
anatomy of the heart: where does the pulmonary vein go to?
left atrium
anatomy of the heart: where does the pulmonary artery leave from?
right ventricle
what does idiopathic mean?
spontaneous arrival and unknown aetiology
can pulmonar hypertension be idiopathic?
yes
what is pulmonary hypertension otherwise secondary to?
- chronic respiratory disease
- left heart disease
- chronic thromboembolic PH (CTEPH)
- collagen vascular disease, portal hypertension, congenital heart disease (L to R shunt), HIV infection
what are the symptoms of pulmonary hypertension?
exertion dyspnoea, chest tightness, exertion presyncope or syncope
what are the signs of pulmonary hypertension?
- elevated JVP
- right ventricular heave
- loud pulmonary second heart sound
- hepatomegaly
- ankle oedema
how do you investigate pulmonary hypertension?
- ECG
- lung function tests
- chest xray
- echocariography
- V/Q scan
- right heart catheterisation
what does right heart catheterisation allow?
- allows direct measure of pulmonary artery pressure
- measurement of wedge pressure
- measurement of cardiac output
how do you treat pulmonary hypertension (general treatment) ?
- treat underlying condition
- oxygen
- anticoagulation
- diuretics
how do you treat pulmonary hypertension (specific treatment) ?
- calcium channel antagonist (e.g.: amlodipine)
- prostacyclin
- endothelia receptor antagonists (bosentan, ambrisentan)
- phosphodiesterase inhibitors (sildenafil, tadalafil)
how do you treat pulmonary hypertension (other treatment) ?
- thromoendarterectomy (CTEPH)
- lung or heart lung transplant
