Pulmonary Vascular Disease Flashcards
What is Pulmonary Embolism?
Thrombus forms in venous system (usually deep leg) and embolises to the pulmonary artery
How can minor PE’s be treated?
anticoagulation
What are the major risk factors of Venous thromboembolism?
Recent major trauma or surgery Cancer Significant cardiopulmonary disease Pregnancy Inherited thrombophilia
What are the symptoms of PE?
Pleuritic chest pain, cough and haemoptysis
Isolated acute dyspnoea
Syncope or cardia arrest
Signs of a PE
- Pyrexia, pleural rub, stony dullness to percussion at base
- Tachycardia, tachpoena, hypoxia
- Tachycardia (rapid heart rate), hypotension (low BP), tachypnoea (rapid breathing), hypoxia
What are the 2 pre-test Probabilities?
Wells Score and Revised geneva score
What is Wells score based on?
Symptoms and signs of VTE, previous VTE and risk factors
What is the revised Geneva Score based on?
Based on risk factors, symptoms and signs
What are possible PE investigations?
Full-blood count, biochemistry, blood gases Chest X-ray ECG D-dimer CT pulmonary V/Q scan Echocardiography Consider CT abdomen and mammography and Thrombophilia testing
What is the percentage Mortality at 30 days?
Varies from 0-25%
What is the treatment of PE?
Oxygen
Low molecular weight heparin (dalteparin)
Warfarin
Direct Oral anticoagulants (rivaroxaban, apixaban)
Thrombolysis
Pulmonary Embolectomy
What is Pulmonary Hypertension?
Elevated blood pressure in the pulmonary arterial tree
What is the pulmonary artery pressure in PH?
> 25mmHg
What is the prevalence of Primary Pulmonary hypertension?
1-2 per million population
What happens is PH is left untreated?
Its a rapidly progressive condition that can leave to death
What is secondary pulmonary hypertension?
More common and tends to occur in an older age group
What are the causes of Pulmonary Hypertension?
- Idiopathic
- Secondary to chronic respiratory disease
- secondary to left heart disease
- chronic thromboembolic PH
- Miscellaneous
Symptoms of Pulmonary hypertension?
- Exertional dyspnoea
- chest tightness
- exertional presyncope or syncope
Signs of pulmonary hypertension?
- Elevated JVP
- Right ventricular heave
- Loud pulmonary second heart sound
- Hepatomegaly
- Ankle oedema
How can you investigate Pulmonary Hypertension?
- ECG
- Lung function tests
- Chest X-ray
- Echocardiography
- V/Q scan
- CTPA
- Right heart catheterisation
What is the general treatment of Pulmonary Hypertension
- Treat underlying condition
- Oxygen
- Anticoagulation
- Diuretics
Specific Treatment of Pulmonary Hypertension
- Calcium channel antagonist
- Prostacyclin
- Endothelium receptor antagonists
- Riociguat
- Phosphodiesterase
Other treatments of Pulmonary Hypertension
Lung or heart transplant
