Pulmonary Vascular Disease COPY Flashcards
How does a pulmonary embolism occur?
- thrombus (clot) forms in venous system (usually in deep leg veins)
- emboli moves through veins, heart and lodges in pulmonary arteries
Whats the prognosis for a minor PE?
Very good if treated with anticoagulation
Whats the mortality rate for PE?
At 30 days mortality is between 0-25% (closer to 25% in a massive PE)
How do we determine the risk of mortality?
Using a PESI score based on:
- Age
- Sex
- Comorbidity
- Physiological Parameters
What are the Major Risk Factors for a Pulmonary Embolism?
- Recent Major Trauma
- Recent Surgery
- Cancer
- Significant cardiopulmonary disease e.g. MI
- Pregnancy
- Inherited Thrombophilia
What is a thrombophilila?
inherited disorder with predisposition to produce clotting factors (e.g. Factor V Leiden)
What happens if you get a small PE in a peripheral artery?
section of lung is infarcted
leads to local tissue inflammation, necosis and rubbing against pleura
What are the signs and symptoms of a small Peripheral PE?
Symptoms:
Pleuritic Chest Pain (from rubbing)
Cough and Haemoptysis
Signs:
Pyrexia
Stony Dullness to percussion at base (due to pleural effusion)
What happens if there multiple small PEs?
Several areas are infarcted
perfusion of lung in general becomes low
What are the signs and symptoms of multiple small PEs?
Symptoms:
pleuritic chest pain, cough, haemoptysis, isolated acute dyspnoea
Signs:
Tachycardia, Tachpnoea, Hypoxia
What happens during a massive PE?
A general lack of pulmonary blood flow leads to hypoxia and loss of blood pressure
What are the signs and symptoms of a massive PE?
loss of bp can lead to syncope or cardiac arrest
Signs:
Tachycardia, Hypotension, Tachypnoea, Hypoxia
How do we determine how likely someone is to get a PE?
- Wells Score
- Revised Geneva Score
What early tests do we do when we suspect a PE?
- fbc, blood gases & biochemistry.
- CXR (rules out other conditions)
- ECG (shows tachycardia)
- D-dimer (-ve indicates unlikely to have a PE)
What is the main test we use to determine a PE?
A CT pulmonary Angiogram (CTPA)
What test would we use to determine if the right ventricle is under strain?
An echocardiograph
What is the use of a V/Q scan?
show areas of ventilation and perfusion
PE indicated by normal ventilation but parts/whole area of reduced perfusion
Why would we consider doing abdomen CTs and mammography?
PE in someone with little clinical risk
If cause is occult cancer.
When would we do thrombophilia testing?
PE with low clinical risk
Test for inherited disease
What treatments do we use for someone with a minor PE?
- Oxyegn
- Blood Thinners
- Direct Oral Anticoagulatants (DOAC)
What treatment would we add for a massive PE?
Thrombolysis
If contraindicated then pulmonary embolectomy is performed
Name some blood thinners?
- Low Molecular Weight Heperarin (e.g. dalteparin)
- Warfarin
Name some Direct Oral Anticoagulants (DOAC)?
- Rivaroxaban
- Apixaban
In what situation do we put someone on permanent anticoagulants?
IF they have a very high risk of future PE
