Pulmonary Vascular Disease Flashcards
How much of hospital admissions are pulmonary embolism
1%
Major risk factors for pulmonary embolism
Recent major trauma or surgery (venoustasis), cancer or pregnancy (pressure on veins), heart attacks, inherited thrombophilia (factor V leiden)
Symptoms of pulmonary embolism
Pleuritic chest pains, cough and haemoptysis(infarction), isolated acute dyspnoea, syncope or cardiac arrest (massive)
Signs of pulmonary embolism with pleural effusion
Pyrexia, pleural rub, stony dullness to percussion at base
Signs of multiple small bilateral embolisms
Tachycardia, tachypnoea, hypoxia
Signs of a massive pulmonary embolism
Tachycardia, hypotension, tachypnoea, hypoxia
Pre test probability of having pulmonary embolism
Wells score and revised Geneva score
Investigations to diagnose PE
Full blood count and gases
CXR, ECG, d dimer (rules it out if negative)
CT pulmonary angiogram
V/Q scan
Echocardiography
Maybe CT abdomen and mammography or thermophilia
Prognosis for PE
30 day mortality 0-25%
PE treatment
Oxygen, direct oral anticoagulants (rivaroxaban or apixaban), if in shock thrombolysis (alteplase, can cause massive bleed), if required pulmonary embolectomy.
Definition of pulmonary hypertension
Mean pulmonary artery pressure of >25mmHg.
Elevated blood pressure in the pulmonary artery tree
Primary pulmonary hypertension epidemiology
Rare but a rapidly progressive condition that leads to premature death
Causes of secondary pulmonary hypertension
Chronic respiratory disease (COPD etc give hypoxia which leads to vasoconstriction)!
Left heart disease
Chronic thromboembolic PH
Misc eg collagen vascular disease, HIV, L to R shunt
Symptoms of pulmonary hypertension
Exertions dyspnoea, chest tightness, exertional syncope or presyncope
Signs of pulmonary hypertension
Elevated JVP (jugular vein to sternal angle), Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
