Pulmonary vascular Disease Flashcards
What is the UK incidence of pulmonary embolism?
UK incidence is 60-70 per 100 000
List 6 major risk factors linked to pulmonary embolism
- Recent major trauma
- Recent surgery
- Cancer
- Significant cardiopulmonary disease e.g. MI
- Pregnancy
- Inherited thrombophilia e.g Factor V Leiden
Name the two scoring systems that can be used to assess a pulmonary embolism
Wells
Revised Geneva
List the investigations that would be done in hospital if a patient is suspected to have a pulmonary embolism
- Full blood count, biochemistry, Troponin I (indicates cardiovascular damage; you would expect a moderate TpnI in cases of PE), arterial blood gases (if patient appears to be hypoxic)
- Chest X-Ray
- ECG
- D-dimer (reflects blood clotting in the body- it would be expected to be +ve in cases of PE)
- CT Pulmonary Angiogram (CTPA)- this is definitive! PEs are visible as a filling defect in the vessel (CT angiogram)
- V/Q scan. The white areas are the places in which there is no perfusion)
- Echocardiography
- Consider CT abdomen and mammography to look for any factors that may have caused the PE
- Consider thrombophilia testing
How is a PE treated?
- Give oxygen
- Low molecular weight heparin (if diagnosis is suspected) or warfarin (if the diagnosis is confirmed)
- DOAC
- IV thrombolysis
- Alteplase
- Surgical pulmonary embolectomy (in cases where thrombolysis is contraindicated)
What scoring system is used to work out the prognosis of a pulmonary embolism?
PESI score
Define pulmonary hypertension
Elevated blood pressure in the pulmonary arterial tree with a mean pulmonary artery pressure of > 25 mmHg.
Pulmonary hypertension is split into groups 1-5. Explain each group
Group 1- idiopathic , collagen vascular disease, portal hypertension, congenital heart disease & HIV infection
Group 2- Secondary to left heart disease
Group 3- Secondary to chronic respiratory disease
Group 4- Secondary to chronic Thromboembolic Pulmonary Hypertension
Group 5- Secondary to sarcoidosis
List the 4 symptoms of pulmonary hypertension
- Exertional dyspnoea
- Exertional chest tightness
- Exertional presyncope or syncope (dizziness)
- Haemoptysis
List the 5 clinical signs associated with pulmonary hypertension
- Elevated Jugular venous pressure
- Right ventricular heave
- Loud pulmonary second heart sound
- Hepatomegaly
- Ankle oedema
How should pulmonary hypertension be investigated?
- ECG
- Lung function tests
- CXR
- Echocardiography
- V/Q scan
- CTPA
- Right heart catheterisation
What does right heart catheterisation allow you to do?
- Allows direct measure of pulmonary artery pressure
- Allows measurement of wedge pressure
- Allows measurement of cardiac output
- Facilitates a vasodilator trial
How should pulmonary hypertension be managed?
- treat the underlying condition
- Oxygen if the PT is hypoxic
- Anticoagulation
- Diuretics
- Calcium Chanel antagonists
- prostaglandins (cause dilation of bronchial arterial tree)
- prostacyclin
- Phosphodiesterase inhibitors
