Pulmonary vascular disease Flashcards
What is a pulmonary embolism
Thrombus forms in the venous system, usually in deep veins of the legs at valves and embolises to the pulmonary arteries
Major risk factors for pulmonary embolism
Recent major trauma Recent surgery Cancer Significant cardiopulmonary disease eg MI Pregnancy Inherited thrombophilia
Symptoms of pulmonary embolism (small, medium, massive)
Small - pleuritic chest pain, haemoptysis, cough
Medium - isolated acute dyspnoea
Massive - syncope or cardiac arrest
Signs of pulmonary embolism (small, medium, massive)
Small - pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
Medium - tachycardia, tachpnoea, hypoxia
Massive - tachycardia, hypotension, tachypnoea, hypoxia
What are the 2 scoring systems called to establish the ‘pre-test probability’ of a pulmonary embolism by assessing sings, symptoms and risk factors?
Wells score
Revised Geneva Score
Investigations for pulmonary embolism
CT pulmonary angiogram Full blood count, biochemistry, blood gases CXR ECG D-dimer V/Q scan Echocardiography Consider CT abdomen and mammography Consider thrombophilia testing
What is a D-dimer
A product of the clotting cascade in the blood
High d-dimer = increased probability of PE
Pulmonary embolism treatment
Oxygen Low molecular weight heparin Warfarin Direct oral anticoagulants Thrombolysis Pulmonary embolectomy
An example of low molecular weight heparin (used when diagnosis still unclear)
dalteparin
Example of thrombolysis drug
Alteplase
What is pulmonary hypertension?
Elevated blood pressure in the pulmonary arterial or tree >25mmHg
What causes primary pulmonary hypertension?
Idiopathic
Often in young people
Leads to premature death
Causes of pulmonary hypertension
Idiopathic Secondary to chronic respiratory disease Secondary to left heart disease Chronic thromboembolic PH HIV infection Congenital heart disease
Symptoms of pulmonary hypertension
Exertional dyspnoea
Chest tightness
Exertional presyncope or syncope
Signs of pulmonary hypertension
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
