Pulmonary Vascular Disease ( Edema, Embolus, Hypertension)🦋 Flashcards
The dual supply the pulmonary circulation receives is from
Pulmonary arteries and bronchial arteries
The pulmonary system has what type of pressure system
Low pressure
What makes up the low pressure system of the pulmonary circulation
- thin walled vessels
- low incidence of atherosclerosis
What is pulmonary edema
It’s the accumulation of fluid in the lungs interstitium and alveolar spaces
Describe the development of pulmonary edema
- fluid builds up first in interstitial space (causing a stiff lung)
- the fluid eventually gets into alveolar space
What does pulmonary edema cause
- dyspnea
- if chronic can cause pulmonary hypertension
- hypoxia(blood isn’t fully oxygenated)
What can complicate pulmonary edema
An infection
What things can cause an increase in hydrostatic pressure
- heart failure
- mitral stenosis
- mitral competence
What causes a decrease in oncotic pressure
- malnutrition
- nephrotic syndrome
- liver disease
What causes microvascular injury (capillary permeability)
- infections
- aspiration
- drugs
- radiation
What are signs of pulmonary edema
- Dyspnea
- Tachypnea
- cyanosis
- pink or blood tinged frothy sputum
- restlessness
- agitation
- wheezing
- crackles
- sudden weight gain
- decreased urinary output
Pulmonary embolus can cause what effects
- Sudden death
- pulmonary hypertension
- pulmonary infarction
- severe chest pain/ dyspnea/haemoptysis
Most emboli are what
Thromboemboli
What’s an embolus
A detached intravascular mass carried by the blood to a site in the body distant from its point of origin
What is the source of most pulmonary emboli
Deep vein thrombosis of lower limbs
What are the risk factors for pulmonary embolus
- abnormal blood flow (venous stasis-which is where the blood moves slowly)
- hypercoaguable blood (cancer patients, post-MI, birth control pill)
- factors in vessel wall (endothelial hypoxia)
Effects of pulmonary embolus depend on what
- size of embolus/ location of embolus/ number of emboli
- cardiac function
- respiratory function
What are the effects of embolus size
Large emboli can cause- death,infarction, severe symptoms
Small emboli can cause- recurrent pulmonary hypertension and is clinically silent
What are the types of pulmonary hypertension
- primary (rare, young women)
- secondary
What causes pulmonary hypertension
- Left heart failure (which causes increased back pressure in the pulmonary vessels)
- left ventricular pump failure (heart attack,cardiomyopathy)
- left ventricular stiffness (hypertension,diabetes,metabolic syndrome)
- valve disease (mitral or aortic stenosis/regurgitation) - Disease affecting the whole lung (lung diseases obliterate blood vessels)
- chronic bronchitis and emphysema (results in loss of lung and hypoxia)
- interstitial lung diseases (pulmonary fibrosis, sarcoidosis) - Congenital heart disease
- left to right shunts ASD and VSD - Hypoxia which causes hypoxia induced vascular vasoconstriction
- high altitude dwelling
- sleep apnea and hypoventilation syndromes
- hypoxia of COPD - Pulmonary arterial hypertension (which results in changes in the structure and function of the pulmonary arteries)
- idiopathic
- heritable
- drug and toxin induces
- connective tissue diseases (scleroderma)
- hiv infection
What is the morphology of pulmonary hypertension
- there is medial hypertrophy of the arteries
- intimal thickening of artery (fibrosis)
- atheroma
- right ventricular hypertrophy
NB: narrowing of the pulmonary arterioles causes hypertension and hypertension causes more narrowing
What is Cor Pulmonale
- it results from pulmonary hypertension
- it involves right ventricular hypertrophy
- it involves right ventricular dilation
- it is right heart failure ( which can cause swollen legs,congested liver,pulmonary edema, pleural effusion,tiredness)
