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1ST YEAR SYSTEMS: Respiratory > Pulmonary vascular disease > Flashcards

Pulmonary vascular disease Flashcards

1
Q

what is pulmonary embolism?

A

Thrombus that forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries.

the embolus not only prevents the exchange of O2 and CO2, but it also decreases blood supply to the lung tissue itself, potentially causing lung tissue to die

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2
Q

what is a minor PE treated with?

A

anticoagulation (drugs like warfarin)

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3
Q

what are the major risk factors of a venous thromboembolism (6)

A 
recent major trauma 
recent surgery
cancer
significant cardiopulmonary disease like MI
pregnancy
inherited thrombophilia
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4
Q

name an inherited thrombophilia

A

Factor V leiden

  • a variant (mutated form) of human factor V which causes an increase in blood clotting
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5
Q

symptoms of pulmonary embolism (3)

A

pleuritic chest pain, cough, haemoptysis (due to rupturing of pulmonary arteriole)

isolated acute dyspnoea (laboured breathing)

syncope or cardiac arrest (massive PE)

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6
Q

examples of pre-test probability ie tests to find out the probabilities of the presence of a condition (2)

A

wells score

revised geneva score

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7
Q

what is the wells score?

A

a score showing likelihood of having pulmonary embolism

includes symptoms and signs of Venous thromboembolism (VTE), previous VTE and risk factors

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8
Q

what is the revised geneva score based on?

A

risk factors, symptoms and signs (heart rate)

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9
Q

what investigations are done to determine a PE (9)

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

Consider thrombophilia testing

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10
Q

what is a V/Q scan?

A

scan that examines ventilation and perfusion of the lungs

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11
Q

mortality at 30 days from PE varies from 0 to X%?

A

25%

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12
Q

what is the PESI score

A

Pulmonary Embolism Severity Index

calculates risk based on age, sex, comorbidity and physiological parameters

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13
Q

treatment options for a PE (6)

A
  • Oxygen
  • Low molecular weight heparin e.g. dalteparin
  • Warfarin
  • Direct Oral Anticoagulants (DOAC)
    rivaroxaban, apixaban
  • Thrombolysis - use Alteplase (rt-PA) to do this
  • Pulmonary Embolectomy
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14
Q

what is pulmonary hypertension?

A

Elevated blood pressure in the pulmonary arterial tree

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15
Q

what is the mean pulmonary artery pressure during pulmonary hypertension

A

> 25 mmHg

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16
Q

Causes of pulmonary hypertension? main (4)

A

idiopathic (unknown)

secondary to chronic respiratory disease (arterioles constrict to find better ventilated alveoli)

secondary to left heart disease (or LHF can cause pulmonary hypertension- back log from heart to the lungs)

chronic thromboembolic PH

17
Q

secondary pulmonary hypertension is…?

A

more common and tends to occur in an older age group

secondary- caused by another disease

18
Q

miscellaneous causes of pulmonary hypertension

A

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

19
Q

symptoms of hypertension (3)

A 
exertional dyspnoea (occurs when engaged in a simple activity)
chest tightness 
exertional presyncope (feeling faint during exercise) or syncope
20
Q

signs of pulmonary hypertension (5)

A
  • elevated JVP - higher pressure, collapses higher up the neck (can also be sign of RV failure which can be linked with PH)
  • right ventricular heave - (murmur you can feel- lifting of chest) suggests RV hypertrophy due to narrowing of pulmonary arteries, pushing blood through is harder
  • loud pulmonary second heart sound (closing of the pulmonary and aortic valves- sound of the blood rushing back to the ventricle after the valves close- more blood-louder noise as it hits the closed valve)
  • Hepatomegaly - enlarged liver
  • Ankle oedema - increased pressure pushes fluid out of arterioles
21
Q

what is JVP

A

jugular venous pressure

blood pressure in the jugular vein

22
Q

what is a right ventricular heave

A

visible or palpable pulsations of the chest wall

a ‘lift’

23
Q

what investigations are undergone for pulmonary hypertension (7)

A

ECG
Lung function tests
Chest X-Ray
Echocardiography
V/Q scan
CTPA - CT pulmonary angiogram - shows pulmonary arteries
Right heart catheterisation - required to definitively diagnose pulmonary arterial hypertension (PAH)

24
Q

what is right heart catheterisation?

A

catheter inserted into right side of heart and then into the pulmonary artery
it measures blood flow and pressure

25
Q

what does a right heart catheterisation allow measurement of? (3)

A

pulmonary artery pressure

measurement of cardiac output

measurement of wedge pressure - pressure measured by catheter with an inflated balloon into a small pulmonary arterial branch. It estimates the LA pressure

26
Q

what is a CTPA

A

CT pulmonary angiography - CT scan of pulmonary artery

27
Q

what is an echocardiography test

A

sonogram of the heart

uses 2D, 3D and ultrasound to create image of heart

28
Q

what is an ECG

A

electrocardiogram

a test that shows electrical activity generated by the heart as it contracts

29
Q

general treatment of pulmonary hypertension

A

treat underlying condition
oxygen
anticoagulation
diuretics

30
Q

specific treatment of pulmonary hypertension

A

Calcium channel antagonist e.g. Prostacyclin

Endothelin receptor antagonists e.g. Riociguat

Phosphodiesterase inhibitors

31
Q

thromboendarterectomy CTEPH

A

surgery to remove thrombus from the pulmonary arteries

32
Q

name 2 phosphodiesterase inhibitors

A

sildenafil

tadalafil

33
Q

name 2 endothelin receptor antagonists

A

bosentan

ambrisentan

34
Q

what is a split S2 sound?

A

A split S2 is a finding upon auscultation of the S2 heart sound
causes of a fixed split S2 are pulmonary hypertension, right sided heart failure and atrial septal defect

35
Q

why is low molecular weight heparin the better option over warfarin for DVT

A

You need to be loaded with warfarin before it has a therapeutic effect therefore it would not be the immediate treatment

36
Q

direct oral anticoagulants have taken the place of which other drugs for treatment of DVT

A

warfarin and daltaparin (LMWH)

1ST YEAR SYSTEMS: Respiratory (38 decks)

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