Pulmonary Vascular Disease COPY Flashcards
What is a pulmonary embolism?
A thrombus which forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arteries
What is the prognosis of pulmonary embolism?
- Massive PE can be fatal
- Minor PE treated with anticoagulation has a very good prognosis
- Mortality at 30 days varies from 0 to 25%
Describe the diagnosis of PE?
- Over diagnosed as it is often suspected when it isn’t there
- Underdiagnosed as true diagnosis of PE is often missed
What are the major risk factors for a venous thromboembolism?
- Recent major trauma
- Recent surgery
- Cancer
- Significant cardiopulmonary disease
- Pregnancy
- Inherited thrombophilia
Why are you at increased risk of developing a venous thromboembolism id you have recently had surgery or a major trauma?
Your clotting system will be active and therefore you are more likely to develop clots. You are also less likely to be active and so the blood supply to the legs slows.
What 3 sets of symptoms may you have with a a pulmonary embolism?
- Pleuritic chest pain, cough and haemoptysis
- Isolated acute dyspnoea
- Syncope or cardiac arrest
When would symptoms of pulmonary embolism include pleuritic chest pain, cough and haemoptysis?
- A small clot lodging in a small peripheral artery
- The part of the lung becomes infarcted and as a result haemoptysis
- The surface of the lung becomes inflamed and rubs across the chest wall
When would symptoms of pulmonary embolism include syncope or cardiac arrest?
- Large blood clot blocks the main pulmonary artery
- Reduction in cardiac output from heart reduces blood flow to the brain
What are the 3 sets of signs you may have with pulmonary embolism?
- Pyrexia, pleural rub, stony dullness to percussion at base (pleural perfusion)
- Tachycardia. tachpnoea, hypoxia
- Tachycardia, hypotension, tachpnoea, hypoxia
What investigations are carried out in diagnosing pulmonary embolism?
- Full blood count, biochemistry, blood gases
- Chest X-ray
- ECG
- D-dimer
- CT pulmonary angiogram
- V/Q scan
- Echocardiography
- Consider CT abdomen and mammography
- Consider thrombophilia testing
What pre-test probability tests are there?
- Wells score
- Revised Geneva score
What is included in the Wells score?
Symptoms and signs of VTE, previous VTE and risk factors
What is included in the Revised Geneva score?
Based on risk factors, symptoms and signs
What do you need to pay particular attention to in an echocardiogram?
Right ventricle
What is the D-dimer test?
Blood test of the product of clotting cascade of the blood
What test is used in the prognosis of PE?
PESI score
What is the PESI score based on?
Age, sex, comorbidity and physiological parameters
What are the treatments for pulmonary embolism?
-Oxygen
-Low molecular weight heparin
-Warfarin
-Direct oral anticoagulants
-Thrombolysis
Pulmonary embolectomy
How long is a patient usually treated for PE?
- Usually for 3 months
- If patient is at risk of reoccurrence then they might be put on lifelong anticoagulants
What is pulmonary hypertension?
Elevated blood pressure in the pulmonary artery or tree
How is pulmonary hypertension defined?
A mean pulmonary artery pressure of >25 mmHg
How can pulmonary hypertension occur?
Either primary or secondary to other conditions
What is the epidemiology of primary pulmonary hypertension?
- Rare
- Incidence of 1-2 million population
What happens if pulmonary hypertension is left untreated?
It is a rapidly progressive condition that leads to premature death
What is the epidemiology of secondary pulmonary hypertension?
- It is more common than primary
- 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 (Collagen vascular disease, Portal hypertension, Congenital heart disease with L to R shunt, HIV infection)
What are the symptoms of pulmonary hypertension?
- Exertional dyspnoea
- Chest tightness
- Exertional presyncope or syncope
What are the signs of pulmonary hypertension?
-Elevated JVP
-Right ventricular heave
-Loud pulmonary second heart sound
Hepatomegaly
-Ankle oedema
What investigations are carried out to diagnose pulmonary hypertension?
- ECG
- Lung function tests
- Chest X-ray
- Echocardiography
- V/Q scan
- CTPA
- Right heart catheterisation
What does right heart catheterisation allow the measurement of?
- Direct measurement of pulmonary artery pressure
- Measurement of wedge pressure
- Measurement of cardiac output
What is the general treatment for pulmonary hypertension?
- Treat underlying condition
- Oxygen
- Anticoagulation
- Diuretics
What are the specific treatments for pulmonary hypertension?
- Calcium channel antagonist
- Prostacyclin
- Endothelin receptor antagonists
- Phosphodiester inhibitors
What surgical treatments are there for pulmonary hypertension?
- Thromboendarterectomy
- Lung or heart lung transplant
