Pulmonary Vascular Disease Flashcards
What happens in pulmonary embolism?
Thrombus forms in venous system, usually in the deep veins of the legs and embolises to the pulmonary arteries
Major risk factors for VTE
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g.MI
Pregnancy
Inherited thrombophilia e.g. factor V Leiden
Presentation of PE
Pleuritic chest pain Cough Haemoptysis Isolated acute SOB Syncope or cardiac arrest (Massive PE)
Signs of PE
Pyrexia Plerual rub Stony dullness to percussion at base (pleural effusion) Tachycardia Tachypboea Hypoxia Hypotension
Pre test probability for PE
Wells score
Revised Geneva score
What does wells score look at?
Symptoms and signs of VTE
Previous VTE
RFs
What does the revised Geneva score look at?
Risk factors
Symptoms and signs (HR)
Investigations for PE
FBC, biochemisty, blood gases CXR ECG D-dimer CTPA V/Q scan ECHO CT of abdomen and mammography (consider) Thrombophilia testing (consider)
What score determines prognosis of PE
PESI score
What does PESI score look at?
Based on age, sex, comorbidity and physiological parameters
Treatment of PE
Oxygen LMWH (or fondaparinux) initially (continue for 5 days or INR >2) Warfarin given within 24 hours DOAC Thrombolysis (if massive PE) Pulmonary embolectomy
Example of LMWH
Dalteparin
Examples of DOAC
Rivaroxban
Apixaban
Examples of thrombolysis
Altepase (rt-PA)
What is pulmonary HTN?
Elevated BP in the pulmonary artery or tree
What PMAP is defined as pulmonary HTN?
Pulmonary arterial pressure > 25 mmHg
Causes of pulmonary HTN
Idiopathic Secondary to chronic resp disease Secondary to L heart disease Chronic thromboembolic PH (CTPH) Collagen vascular disease Portal HTN Congenital heart disease (L to R shunt) HIV infection
Presentation of Pulmonary HTN
Exertional SOB
Chest tightness
Exertional pre syncope or syncrope
Signs of Pulmonary HTN
Elevated JVP Right ventricular heave Loud pulmonary second heart sound Hepatomegaly Ankle oedema
Investigations of Pulmonary HTN
ECG LFTs CXR ECHO V/Q scan CTPA Right heart catheterisation
What does right heart catheterisation measure?
Pulmonary artery pressure
Wedge pressure
Cardiac output
Treatment of pulmonary HTN
Treat underlying condition Oxygen Anticoagulation Diuretics CCBs e.g. amlodipine Prostacyclin Endothelial receptor antagonists e.g. bosentan, ambrisentan Phosphodiesterase inhibitors - sildenafil, tadalafil Thromoendarterectomy (CTEPH) Lung or heart transplant
How long should warfarin be continued for after a PE?
3 months
How long should LMWH be continued for after a PE in people with cancer?
6 months
What is thrombolysis the gold standard for a PE treatment for?
Massive PE when there is circulatory failure (e.g. hypotension)
Patients who have repeated PEs, despite anticoagulation, may be considered for what?
Inferior vena cava filters
How does an IVC filter work?
Stop clots formed in the deep veins of the leg moving to the pulmonary arteries
