Pulmonary Vascular Disease COPY 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
