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Respiratory system > pulmonary vascular disease > Flashcards

pulmonary vascular disease Flashcards

1
Q

how does a pulmonary embolism form?

A

a thrombus form in the venous system, usually in thj deep veins of the legs and embolises to the pulmonary arteries

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2
Q

what is the treatment for a minor pulmonary embolism?

A

anticoagulation

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3
Q

why do thrombi aften form in the deep veins of the leg?

A

they are low flow, low pressure vessels

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4
Q

what is the relationship between embolism size and and severity of condition?

A

the larger the embolism the larger the pulmonary artery it will get lodged in do the bigger the section of lung cut off from blood so the more serious

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5
Q

what are some risk factors for venous thromboembolism?

A
  • recent major trauma
  • recent surgery
  • cancer
  • significant cardiopulmonary disease
  • pregnancy
  • inherited thrombophilia
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6
Q

why can recent trauma increase the risk of venous thromboembolism?

A

there are increased coagulation factors within the blood to clot the blood at the wound, however this will increase of blood clots elsewhere

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7
Q

why can recent surgery increase the risk of venous thromboembolism?

A

patient will be bead-ridden so blood clots will be more likely

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8
Q

why can cancer increase the risk of venous thromboembolism?

A

the cancer can release factors that increase blood clotting.

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9
Q

why can significant cardiopulmonary disease increase the risk of venous thromboembolism?

A

blood flow is reduced

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10
Q

why can pregnancy increase the risk of venous thromboembolism?

A

increased blood coagulation factors, and feotus compressing veins

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11
Q

why can inherited thrombophilia increase the risk of venous thromboembolism?

A

eg. in factor V Leiden

coagulation is increased as the coagulation factor V can’t be inhibited

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12
Q

what are the symptoms of pulmonary embolism?

A

Pleuritic chest pain, cough and haemoptysis

  1. Isolated acute dyspnoea
  2. Syncope (temporary loss or consciousness) or cardiac arrest (massive PE)
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13
Q

what are the signs of pulmonary embolism?

A
  1. Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
  2. Tachycardia, tachpnoea, hypoxia
  3. Tachycardia, hypotension, tachypnoea, hypoxia
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14
Q

what are the two pre-test probability scoring methods for PE?

A

wells score

revised geneva score

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15
Q

what are the pros and cons of the Wells score?

A

pros- it is validated

cons- it it subjective

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16
Q

what are the pros and cons of the revised geneva score?

A

pros- it is not subjective

cons- it is not yet validated

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17
Q

what are the investigations for PE?

A

-Full blood count, biochemistry, blood gases
-Chest X-Ray
-ECG
-D-dimer
-CT Pulmonary Angiogram (CTPA)
-V/Q scan
-Echocardiography
-Consider CT abdomen and mammography (for cancers)
-Consider thrombophilia testing
(for inherited disorder)

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18
Q

how can a full blood count, biochemistry and blood gas be a useful investigation for PE?

A

to look for clotting factors and if blood gases are affected by the PE

19
Q

how can a chest x-ray be a useful investigation for PE?

A

can sometimes show the emolism

20
Q

how can an ECG be a useful investigation for PE?

A

abnormalities such as a sinus tachycardia can be useful for diagnosing PE

21
Q

how can D-dimer a useful investigation for PE?

A

it tests for a breakdown product of blood clots, if negative then PE can be ruled out

22
Q

how can a CT pulmonary angiogram be a useful investigation for PE?

A

it is the most useful investigation and involves injecting a contrast agent into the blood to diagnose PE

23
Q

how can a V/Q scan be a useful investigation for PE?

A

it will check for and V/Q imbalance that may be caused by a pulmonary embolism

24
Q

how can echocardiography be a useful investigation for PE?

A

it can act as a easy, non invasive test for PE without complications

25
Q

how can a CT scan of abdomen or a mammogram be useful investigations for PE?

A

they can be used to look for cancers that may have caused the embolism

26
Q

how can thrombophilia testing be a useful investigation for PE?

A

to look for an inherited cause of PE

27
Q

what is the prognosis of PE

A

mortality rate at 30 days is 0-25%

28
Q

what are the treatments for PE?

A
  • Oxygen
  • Low molecular weight heparin e.g. dalteparin
  • Warfarin
  • Direct Oral Anticoagulants (DOAC) eg. rivaroxaban, apixaban
  • Thrombolysis eg. Alteplase (rt-PA)
  • Pulmonary Embolectomy
29
Q

why is low molecular weight heparin eg. dalteparin useful for PE?

A

it is an anticoagulant

30
Q

why is warfarin useful for PE?

A

it is an anticoagulant, whoever used less nowadays as it interacts with many other drugs and requires constant monitoring

31
Q

what is the definition of pulmonary hypertension?

A

a mean pulmonary artery pressure of > 25 mmHg.

32
Q

what are the causes of pulmonary hypertension?

A 
idiopathic
Secondary to chronic respiratory disease
Secondary to left heart disease
Chronic Thromboembolic PH (CTEPH)
Miscellaneous
33
Q

what are the miscellaneous causes of PH?

A

collagen vascular disease
portal hypertension
congenital heart disease (L to R shunt)
HIV infection

34
Q

what are the symptoms of pulmonary hypertension?

A

exertional dyspnoea
chest tightness
exertional presyncope (light-headed) or syncope (loss of consciousness)

35
Q

what are the signs of PH?

A
  • Elevated JVP
  • Right ventricular heave
  • Loud pulmonary second heart sound
  • Hepatomegaly
  • Ankle oedema
36
Q

what is the cause of primary PH?

A

idiopathic

37
Q

what us a right ventricular heave?

A

precordial impulse over the left parasternal region (palpable pusation of chest)

38
Q

what investigations should be carried out for pulmonary hypertension?

A
  • ECG
  • Lung function tests
  • Chest X-Ray
  • Echocariography
  • V/Q scan
  • CT pulmonary angiogram
  • Right heart catheterisation
39
Q

what does right heart catheterisation allow measurement of fo PH diagnosis

A

allows direct measure of pulmonary artery pressure
measurement of wedge pressure
measurement of cardiac output

40
Q

what is the general treatment of PH?

A

Treat underlying condition
Oxygen
Anticoagulation
Diuretics

41
Q

what are the first line specific treatments for PH?

A

endothelin receptor antagonists

phosphodiesterase inhibitors

42
Q

which endothelin receptor antagonists are used to treat PH?

A

bosentan

ambrisentan

43
Q

which Phosphodiesterase inhibitors are used to treat PH?

A

sildenafil

tadalafil

44
Q

what are some surgical options for treating PH?

A
  • thromoendarterectomy

- lung or heart lung transplant

Respiratory system (38 decks)

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