Pulmonary vascular disease Flashcards
Where do the thrombi that embolise and cause pulmonary embolism arise from?
Venous system, usually the deep veins of the legs
What are the major risk factors for venous thromboembolism?
Recent major trauma
Recent surgery
Bed bound
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 Haemoptysis Isolated acute dyspnoea Syncope Cardiac arrest
What are the clinical signs of pulmonary embolism?
Pyrexia Pleural rub Stony dullness at base (pleural effusion) Tachycardia Tachypnoea Hypoxia Hypotension
What tests are used to assess probability of pulmonary embolism?
Wells score - symptoms, signs, previous VTE, risk factors
Revised Geneva score - risk factors, symptoms and signs
PESI risk score - age, sex, comorbidity, physiological parameters
What investigations are carried out for PTE?
Full blood count Arterial blood gases CXR D-dimer CT pulmonary angiogram V/Q scan Echocardiography Thrombophilia test CT of body for possible cancer
How do you treat PE?
Oxygen Low molecular weight heparin Warfarin Anticoagulants Thrombolysis Pulmonary embolectomy
How long is treatment carried on after PE?
3 months, though can be lifelong if risk of it happening again is high
Describe pulmonary hypertension
Elevated blood pressure in pulmonary tree, with a mean pulmonary artery pressure of >25mmHg
Can be primary or secondary (usually in elderly with preexisting medical conditions)
What causes pulmonary hypertension?
Idiopathic (primary hypertension) Secondary to chronic respiratory disease Secondary to left heart disease Chronic thromboembolic PH Collagen vascular disease Portal hypertension Congenital heart disease (L to R shunt) HIV
What are the symptoms of pulmonary hypertension?
Exertional dyspnoea
Chest tightness
Exertional pre syncope
Syncope
What are the signs of pulmonary hypertension?
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
What investigations are carried out for pulmonary hypertension?
ECG - high P waves, tall R waves (RV strain)
Lung function tests
CXR - large pulmonary arteries
ECHO - leaky tricuspid, enlarged atria etc
V/Q scan
CT pulmonary angiography
Right heart catheterisation - measure pressure
How do you treat hypertension?
Treat underlying condition in secondary Oxygen if hypoxic Anticoagulation if needed/at risk Diuretics for oedema Ca channel antagonists e.g. amlodipine Prostacyclin - relax SM of arteries Endothelin receptor antagonists Phosphodiesterase inhibitors
Thromoendarterectomy
Lung or heart transplant
Name some Endothelin receptor antagonists
Bosentan
Ambrisentan
