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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 the in the venous system, usually in 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

What is a pulmonary embolism?

A

Blockage of artery in the lungs, usually by a detached thrombus

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4
Q

Why do thrombi often form in the deep veins of the leg?

A

They are low flow, low pressure vessels

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5
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, so the bigger the section of lung cut off from blood so the more serious

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6
Q

What are the risk factors for venous thromboembolism?

A 
Recent major trauma or surgery 
Cancer 
Cardiopulmonary disease i.e. MI
Pregnancy 
Inherited thrombophilia
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7
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 blood clots elsewhere

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8
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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9
Q

Why can cancer increase the risk of venous thromboembolism?

A

Cancer can release factors that increase blood clotting

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10
Q

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

A

Blood flow is reduced

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11
Q

Why can pregnancy increase the risk of venous thromboembolism?

A

Increased blood coagulation factors, and feotus compressing veins

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12
Q

Why can inherited thrombophilia increase the risk of venous thromboembolism?

A

Coagulation is increased as the coagulation factor V can’t be inhibited (Factor V Leiden)

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13
Q

What are the symptoms of pulmonary embolism?

A

Pleuritic chest pain
Cough
Haemoptysis

Dysnoea
Syncope or cardiac arrest (massive PE)

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14
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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15
Q

What are the two pre-test probability scoring methods to determine if its a PE?

A

Wells score

Revised geneva score

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16
Q

What does the wells score consider?

A

Symptoms and signs of VTE
Previous VTE
Risk factors

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17
Q

What does the revised Geneva score consider?

A

Risk factors

Symptoms and signs

18
Q

What investigations should be carried out for PE?

A 
FBC 
Biochem - clotting factors
ECG 
D-dimer 
CT pulmonary angiogram
V/Q scan 
ECHO
19
Q

What two investigations should be considered for PE?

A

CT abdomen and mammography
Thrombophilia testing

Tests to see if cancer is a risk factor

20
Q

How can a CXR be a useful investigation for PE?

A

Usually normal
Atelectasis
Pul. oedema

21
Q

How can an ECG be a useful investigation for PE?

A

Non specific:
T wave inversion
Sinus tachycardia

22
Q

What is a D-dimer test and how is it useful in PE?

A

D-dimer is a type of protein your body produces to break down the blood clot
Test used to rule out probability of PE - higher the level of D-dimer indicates significant blood clot

23
Q

What is the main diagnosis method for PE?

A

CT angiogram (CTPA)

24
Q

Why is a V/Q scan useful for PE?

A

Highlights areas that are ventilated, but not perfused due to PE

25
Q

What scoring system is used to determine PE prognosis?

A

PESI score

Based on age, sex, comorbidity and physiological parameters

26
Q

What is the treatment for PE?

A 
Oxygen 
LMW Heparin 
Warfarin 
Direct oral anticoagulants (DOAC)
Thrombolysis 
Pulmonary embolectomy
27
Q

What is pulmonary hypertension?

A

Elevated blood pressure in the pulmonary arterial tree
Mean pul. artery pressure > 25mmHg
Primary or secondary to other conditions

28
Q

What can PHT cause?

A

Thickening of pul. artery walls and smooth muscle, which further increases the pressure and can causes R sided hypertrophy

29
Q

What are the causes of PHT?

A 
Idiopathic 
Secondary to chronic respiratory disease 
Secondary to L heart disease 
Chronic Thromboembolic PH (CTEPH)
Miscellaneous
30
Q

What are miscellaneous causes of PHT?

A

Collagen vascular disease
Portal hypertension
Congenital heart disease (L to R shunt)
HIV infection

31
Q

What are the symptoms of PHT?

A

Exertional dyspnoea
Chest tightness
Exertional pre syncope or syncope

32
Q

What are the signs of pulmonary HPT?

A 
Elevated JVP 
R ventricular heave 
Loud pulmonary S2 sound 
Hepatomegaly 
Ankle oedema
33
Q

What investigation are used for PHT?

A 
ECG 
LFT 
CXR
ECHO
V/Q scan 
CTPA 
R heart catheterisation
34
Q

Why is an echo a useful investigation for PE?

A

RV strain

Dilatation in patients with suspected massive PE

35
Q

Why is a CXR useful for PHT?

A

Cardiomegaly

Enlarged vessels

36
Q

Why is a V/Q scan useful for PHT?

A

Chronic thromboembolic pulmonary hypertension (CTEPH)

37
Q

Why is a CTPA useful for PHT?

A

Signs CTEPH

Vessel and chamber size

38
Q

Why is a R heart catheterisation useful in PHT?

A

Allow diet measure of pul. arterial pressure
Measurement of wedge pressure
Measurement of CO

39
Q

What is the general treatment for PHT?

A

Treat underlying condition
Oxygen (if related to hypoxia)
Anticoagulation (if related to PE)
Diuretics (to reduce oedema)

40
Q

What is the specific treatment of PHT?

A

CCB
Prostcyclin
Endothelin receptor antagonists
Phosphodiesterase inhibitors

41
Q

What are surgical treatment for PHT?

A

Thromoendarterectomy (CTEPH) - removes clot and webbing from arterial tree
Lung or heart transplant

Respiratory System (29 decks)

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