Pulmonary Vascular Disease Flashcards
How does a pulmonary embolism form?
A thrombus form the in the venous system, usually in deep veins of the legs, and embolises to the pulmonary arteries
What is the treatment for a minor pulmonary embolism?
Anticoagulation
What is a pulmonary embolism?
Blockage of artery in the lungs, usually by a detached thrombus
Why do thrombi often 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, so the bigger the section of lung cut off from blood so the more serious
What are the risk factors for venous thromboembolism?
Recent major trauma or surgery Cancer Cardiopulmonary disease i.e. MI 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 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?
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?
Coagulation is increased as the coagulation factor V can’t be inhibited (Factor V Leiden)
What are the symptoms of pulmonary embolism?
Pleuritic chest pain
Cough
Haemoptysis
Dysnoea
Syncope 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 to determine if its a PE?
Wells score
Revised geneva score
What does the wells score consider?
Symptoms and signs of VTE
Previous VTE
Risk factors
What does the revised Geneva score consider?
Risk factors
Symptoms and signs
What investigations should be carried out for PE?
FBC Biochem - clotting factors ECG D-dimer CT pulmonary angiogram V/Q scan ECHO
What two investigations should be considered for PE?
CT abdomen and mammography
Thrombophilia testing
Tests to see if cancer is a risk factor
How can a CXR be a useful investigation for PE?
Usually normal
Atelectasis
Pul. oedema
How can an ECG be a useful investigation for PE?
Non specific:
T wave inversion
Sinus tachycardia
What is a D-dimer test and how is it useful in PE?
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
What is the main diagnosis method for PE?
CT angiogram (CTPA)
Why is a V/Q scan useful for PE?
Highlights areas that are ventilated, but not perfused due to PE
What scoring system is used to determine PE prognosis?
PESI score
Based on age, sex, comorbidity and physiological parameters
What is the treatment for PE?
Oxygen LMW Heparin Warfarin Direct oral anticoagulants (DOAC) Thrombolysis Pulmonary embolectomy
What is pulmonary hypertension?
Elevated blood pressure in the pulmonary arterial tree
Mean pul. artery pressure > 25mmHg
Primary or secondary to other conditions
What can PHT cause?
Thickening of pul. artery walls and smooth muscle, which further increases the pressure and can causes R sided hypertrophy
What are the causes of PHT?
Idiopathic Secondary to chronic respiratory disease Secondary to L heart disease Chronic Thromboembolic PH (CTEPH) Miscellaneous
What are miscellaneous causes of PHT?
Collagen vascular disease
Portal hypertension
Congenital heart disease (L to R shunt)
HIV infection
What are the symptoms of PHT?
Exertional dyspnoea
Chest tightness
Exertional pre syncope or syncope
What are the signs of pulmonary HPT?
Elevated JVP R ventricular heave Loud pulmonary S2 sound Hepatomegaly Ankle oedema
What investigation are used for PHT?
ECG LFT CXR ECHO V/Q scan CTPA R heart catheterisation
Why is an echo a useful investigation for PE?
RV strain
Dilatation in patients with suspected massive PE
Why is a CXR useful for PHT?
Cardiomegaly
Enlarged vessels
Why is a V/Q scan useful for PHT?
Chronic thromboembolic pulmonary hypertension (CTEPH)
Why is a CTPA useful for PHT?
Signs CTEPH
Vessel and chamber size
Why is a R heart catheterisation useful in PHT?
Allow diet measure of pul. arterial pressure
Measurement of wedge pressure
Measurement of CO
What is the general treatment for PHT?
Treat underlying condition
Oxygen (if related to hypoxia)
Anticoagulation (if related to PE)
Diuretics (to reduce oedema)
What is the specific treatment of PHT?
CCB
Prostcyclin
Endothelin receptor antagonists
Phosphodiesterase inhibitors
What are surgical treatment for PHT?
Thromoendarterectomy (CTEPH) - removes clot and webbing from arterial tree
Lung or heart transplant
