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S2 Respiratory System > Pulmonary vascular disease > Flashcards

Pulmonary vascular disease Flashcards

1
Q

what is a pulmonary embolism?

A

thrombus forming in the venous system (usually in deep veins of the legs) and embolisms to the pulmonary arteries

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2
Q

what percentage of all hospital admissions is pulmonary embolism?

A

1%

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3
Q

what is the prognosis of PE?

A

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)

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4
Q

what are the major risk factors for a venous thromboembolism?

A
  • recent major trauma
  • recent surgery
  • cancer
  • significant cardiopulmonary disease (e.g.: MI)
  • pregnancy
  • inherited thrombophilia (e.g.: factor V Leiden)
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5
Q

what are the symptoms of pulmonary embolism?

A
  • pleuritic chest pain, cough and haemoptysis
  • isolated acute dyspnoea
  • syncope or cardiac arrest (massive PE)
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6
Q

what are the signs of pulmonary embolism?

A
  • pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
  • tachycardia, tachypnoea, hypoxia
  • tachycardia, hypotension, tachypnoea, hypoxia
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7
Q

what tests do you run to assess a pre-test probability? (i.e.: probability of having the condition)

A
  • 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)
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8
Q

what tests do you run to investigate the PE?

A
  • 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
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9
Q

what factors do the PESI score rely on? (pulmonary embolism severity index)

A

age, sex, comorbidity and physiological parameters

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10
Q

how do you treat PE?

A
  • oxygen
  • low molecular weight heparin (e.g.: dalteparin)
  • warfarin
  • direct oral anticoagulants (DOAC) (eg: rivaroxaban, apixaban)
  • thrombolysis (e.g.: alteplase (rt-PA)
  • pulmonary embolectomy
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11
Q

what is pulmonary hypertension?

A
  • 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
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12
Q

how common is primary pulmonary hypertension?

A

rare, incidence of 1-2/ million people

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13
Q

what happens to patients with untreated primary pulmonary hypertension?

A

leads to premature death

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14
Q

how common is secondary pulmonary hypertension?

A

more common

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15
Q

what age group is affected by secondary pulmonary hypertension?

A

older age group

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16
Q

anatomy of the heart: where does the pulmonary vein go to?

A

left atrium

17
Q

anatomy of the heart: where does the pulmonary artery leave from?

A

right ventricle

18
Q

what does idiopathic mean?

A

spontaneous arrival and unknown aetiology

19
Q

can pulmonar hypertension be idiopathic?

A

yes

20
Q

what is pulmonary hypertension otherwise secondary to?

A
  • chronic respiratory disease
  • left heart disease
  • chronic thromboembolic PH (CTEPH)
  • collagen vascular disease, portal hypertension, congenital heart disease (L to R shunt), HIV infection
21
Q

what are the symptoms of pulmonary hypertension?

A

exertion dyspnoea, chest tightness, exertion presyncope or syncope

22
Q

what are the signs of pulmonary hypertension?

A
  • elevated JVP
  • right ventricular heave
  • loud pulmonary second heart sound
  • hepatomegaly
  • ankle oedema
23
Q

how do you investigate pulmonary hypertension?

A
  • ECG
  • lung function tests
  • chest xray
  • echocariography
  • V/Q scan
  • right heart catheterisation
24
Q

what does right heart catheterisation allow?

A
  • allows direct measure of pulmonary artery pressure
  • measurement of wedge pressure
  • measurement of cardiac output
25
Q

how do you treat pulmonary hypertension (general treatment) ?

A
  • treat underlying condition
  • oxygen
  • anticoagulation
  • diuretics
26
Q

how do you treat pulmonary hypertension (specific treatment) ?

A
  • calcium channel antagonist (e.g.: amlodipine)
  • prostacyclin
  • endothelia receptor antagonists (bosentan, ambrisentan)
  • phosphodiesterase inhibitors (sildenafil, tadalafil)
27
Q

how do you treat pulmonary hypertension (other treatment) ?

A
  • thromoendarterectomy (CTEPH)

- lung or heart lung transplant

S2 Respiratory System (43 decks)

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