pulmonary vascular disease Flashcards
how does a pulmonary embolism form?
a thrombus form in the venous system, usually in thj deep veins of the legs and embolises to the pulmonary arteries
what is the treatment for a minor pulmonary embolism?
anticoagulation
why do thrombi aften form in the deep veins of the leg?
they are low flow, low pressure vessels
what is the relationship between embolism size and and severity of condition?
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
what are some risk factors for venous thromboembolism?
- recent major trauma
- recent surgery
- cancer
- significant cardiopulmonary disease
- pregnancy
- inherited thrombophilia
why can recent trauma increase the risk of venous thromboembolism?
there are increased coagulation factors within the blood to clot the blood at the wound, however this will increase of blood clots elsewhere
why can recent surgery increase the risk of venous thromboembolism?
patient will be bead-ridden so blood clots will be more likely
why can cancer increase the risk of venous thromboembolism?
the cancer can release factors that increase blood clotting.
why can significant cardiopulmonary disease increase the risk of venous thromboembolism?
blood flow is reduced
why can pregnancy increase the risk of venous thromboembolism?
increased blood coagulation factors, and feotus compressing veins
why can inherited thrombophilia increase the risk of venous thromboembolism?
eg. in factor V Leiden
coagulation is increased as the coagulation factor V can’t be inhibited
what are the symptoms of pulmonary embolism?
Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope (temporary loss or consciousness) or cardiac arrest (massive PE)
what are the signs of pulmonary embolism?
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
- Tachycardia, tachpnoea, hypoxia
- Tachycardia, hypotension, tachypnoea, hypoxia
what are the two pre-test probability scoring methods for PE?
wells score
revised geneva score
what are the pros and cons of the Wells score?
pros- it is validated
cons- it it subjective
what are the pros and cons of the revised geneva score?
pros- it is not subjective
cons- it is not yet validated
what are the investigations for PE?
-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)
how can a full blood count, biochemistry and blood gas be a useful investigation for PE?
to look for clotting factors and if blood gases are affected by the PE
how can a chest x-ray be a useful investigation for PE?
can sometimes show the emolism
how can an ECG be a useful investigation for PE?
abnormalities such as a sinus tachycardia can be useful for diagnosing PE
how can D-dimer a useful investigation for PE?
it tests for a breakdown product of blood clots, if negative then PE can be ruled out
how can a CT pulmonary angiogram be a useful investigation for PE?
it is the most useful investigation and involves injecting a contrast agent into the blood to diagnose PE
how can a V/Q scan be a useful investigation for PE?
it will check for and V/Q imbalance that may be caused by a pulmonary embolism
how can echocardiography be a useful investigation for PE?
it can act as a easy, non invasive test for PE without complications
how can a CT scan of abdomen or a mammogram be useful investigations for PE?
they can be used to look for cancers that may have caused the embolism
how can thrombophilia testing be a useful investigation for PE?
to look for an inherited cause of PE
what is the prognosis of PE
mortality rate at 30 days is 0-25%
what are the treatments for PE?
- Oxygen
- Low molecular weight heparin e.g. dalteparin
- Warfarin
- Direct Oral Anticoagulants (DOAC) eg. rivaroxaban, apixaban
- Thrombolysis eg. Alteplase (rt-PA)
- Pulmonary Embolectomy
why is low molecular weight heparin eg. dalteparin useful for PE?
it is an anticoagulant
why is warfarin useful for PE?
it is an anticoagulant, whoever used less nowadays as it interacts with many other drugs and requires constant monitoring
what is the definition of pulmonary hypertension?
a mean pulmonary artery pressure of > 25 mmHg.
what are the causes of pulmonary hypertension?
idiopathic Secondary to chronic respiratory disease Secondary to left heart disease Chronic Thromboembolic PH (CTEPH) Miscellaneous
what are the miscellaneous causes of PH?
collagen vascular disease
portal hypertension
congenital heart disease (L to R shunt)
HIV infection
what are the symptoms of pulmonary hypertension?
exertional dyspnoea
chest tightness
exertional presyncope (light-headed) or syncope (loss of consciousness)
what are the signs of PH?
- Elevated JVP
- Right ventricular heave
- Loud pulmonary second heart sound
- Hepatomegaly
- Ankle oedema
what is the cause of primary PH?
idiopathic
what us a right ventricular heave?
precordial impulse over the left parasternal region (palpable pusation of chest)
what investigations should be carried out for pulmonary hypertension?
- ECG
- Lung function tests
- Chest X-Ray
- Echocariography
- V/Q scan
- CT pulmonary angiogram
- Right heart catheterisation
what does right heart catheterisation allow measurement of fo PH diagnosis
allows direct measure of pulmonary artery pressure
measurement of wedge pressure
measurement of cardiac output
what is the general treatment of PH?
Treat underlying condition
Oxygen
Anticoagulation
Diuretics
what are the first line specific treatments for PH?
endothelin receptor antagonists
phosphodiesterase inhibitors
which endothelin receptor antagonists are used to treat PH?
bosentan
ambrisentan
which Phosphodiesterase inhibitors are used to treat PH?
sildenafil
tadalafil
what are some surgical options for treating PH?
- thromoendarterectomy
- lung or heart lung transplant
