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Resp JL > Pulmonary Vascular Disease Overview > Flashcards

Pulmonary Vascular Disease Overview Flashcards

1
Q

Give 6 causes of pulmonary arterial hypertension

A
  1. Hypoxia - COPD
  2. Multiple PE
  3. Pulmonary vasculitis e.g. SLE, systemic sclerosis
  4. Drugs (appetitie suppressants)
  5. Cardiac left to right shunt - ASD, VSD
  6. Primary pulmonary hypertension (only once excluded above)
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2
Q

What are central cyanosis if hypoxic, dependent oedema, raised JVP with V waves, right ventricular heave at left parasternal edge, murmur of tricuspid regurgitation, loud P2 and enlarged liver (pulsatile) all signs of?

A

Pulmonary hypertension and right heart failure

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3
Q

What is a raised JVP with V waves due to?

A

Secondary tricuspid regurgitation

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4
Q

Name some investigations used to investigate pulmonary hypertension?

A

ECG, CXR, SaO2 and arterial blood gases, pulmonary function including DLCO, Echocardiogram/cardiac catheterisation

CT pulmonary angiogram, cardiac MRI

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5
Q

What investigations would you choose if PE was a suspected cause of pulmonary hypertension?

A

D dimers and VQ scan

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6
Q

What investigation would you choose if vasculitis was a suspected cause of pulmonary hypertension?

A

Auto-antibodies

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7
Q

How is primary pulmonary hypertension diagnosed?

A

By exclusion of other secondary causese

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8
Q

What clinical features might be found in primary pulmonary hypertension?

A

SOB on exertion and signs of right heart failure

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9
Q

What three pharmacological treatments are used for primary pulmonary hypertension?

A

Prophylactic anticoagulation [warfarin]
O2 if hypoxic
Pulmonary vasodilators

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10
Q

Give 5 types of pulmonary vasodilators

A
  1. Calcium channel blockers (oral nifedipine, diltiazem)
  2. Endothelin antagonist (oral Bosentan, Macitentan)
  3. PDE5-inhibitor (oral Sildenafil)
  4. Prostanoids (IV Epoprostenol or inh Iloprost)
  5. Guanylate Cyclase stimulator (oral Riociguat)
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11
Q

What causes thromboembolic lung disease?

A

Pulmonary infarction - in situ, venous emboli

Virchow’s triad

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12
Q

What is Virchow’s triad?

A
  1. Stasis
  2. Vessel wall damage
  3. Hypercoagulability
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13
Q

What are the risk factors for DVT and PE?

A 
Thrombophilia - FH, freq, site, age
Contraceptive pill, HRT
Pregnancy
Pelvic obstruction (e.g. uterus, ovary, lymph nodes)
Trauma e.g. RTA
Surgery e.g. pelvic, hip, knee
Immobility e.g. bed rest, long haul flights
Malignancy
Myocardial infarction
Pulmonary hypertension/vasculitis
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14
Q

What are the two areas you can get DVTs?

A

Proximal (ileofemoral)

Distal (popliteal)

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15
Q

Which location of DVT is most likely to embolise and lead to chronic venous insufficiency and venous leg ulcers?

A

Proximal (ileofemoral)

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16
Q

Give three differential diagnoses of DVT?

A
  1. Popliteal synovial rupture [bakers cyst]
  2. Superficial thrombophlebitis
  3. Calf cellulitis
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17
Q

Describe a leg with a DVT?

A

Swollen, hot, red and tender

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18
Q

What are two methods of investigating a DVT?

A

Ultrasound leg scan (1st line)

CT scan of ileofemoral veins, IVC and pelvis

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19
Q

How will a patient with a large PE present?

A

Cardiovascular shock, low BP, central cyanosis and sudden death

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20
Q

How will a patient with a medium PE present?

A

Pleuritic pain, haemoptysis, breathless

21
Q

How will a patient with a small recurrent PE present?

A

Progressive dyspnoea, pulmonary hypertension and right heart failrue

22
Q

What is the heart rate, breathing, skin colour, temperature, blood pressure and lugns like in PE?

A 
Tachycardia
Tachypnoea
Cyanosis
Fever
Low BP
Crackles, rub, pleural effusion
23
Q

What are arterial blood gases like in a PE patient?

A

Decreased PaO2

Decreased SaO2

24
Q

In a patinet with a PE, what will be seen on teh CXR after infarction?

A

Basal atelectesis, consolidation and pleural effusion

25
Q

What would you see on an ECG in a patient with a PE?

A

Acute right heart strain pattern (S1, Q3, T3, T inversion in V1-3)

26
Q

What are the D dimer levels like in a patinet with a PE?

27
Q

What is another name for an isotope lung scan?

A

Ventialtion/perfusion: VQ scan

28
Q

What investigation only picks up larger clots in proximal vessels?

A

CT pulmonary angiogram - to image pulmonary artery filling defect

29
Q

How can silent DVT be detected?

A

Leg and pelvic ultrasound

30
Q

What does an Echocardiogram measure in PE?

A

pulmonary artery pressure and right ventricle size

31
Q

How can a perfusion defect be measured in a patient with PE?

A

Gas transfer factor (DLCO)

32
Q

How can an underlying cause of PE be detected?

A

Coagulation factor screen

Autoantibodies (SLE)

33
Q

What 2 autoantibodies are detected in underlying PE cause?

A

Antinuclear

Anticardiolipin Ab

34
Q

When investigating underlying causes of PE, what 3 substances will a coagulation factor screen be looking for?

A

Antithrombin-3
Protein C/S
Factor 5/8

35
Q

Name a direct thrombin inhibitor?

A

Dabigatran

36
Q

Name two direct inhibitors of activated factor Xa?

A

Rivaroxaban/apixaban

37
Q

In the treatment of DVT/PE - what does anticoagulation prevent?

A

Clot propagation - tips balance to thrombolysis - body dissovles clot

38
Q

What treatment is initiated first with DVT/PE treatment?

A

Parenteral heparin - fast acting via antithrombin 3

39
Q

What other drug can be started at the same time as low molecular weight heparin in treatment of DVT/PE?

40
Q

How long does oral warfarin take to work and how does it work?

A

Oral warfirin - takes 3 days - antagonises vitamin K1 dependent prothrombin

41
Q

What drug treatment in DVT/PE would you stop after 3-5 days?

A

Heparin when INR>2

42
Q

In the treatment of DVT/PE - what drug will you continue for 3-6 months?

43
Q

What is used to monitor wardarin?

A

INR target range 2.5 - 3.5

44
Q

What do alcohol, antibiotics, aspirin, NSAIDS, amiodarone, cimetidine, omeprazole all do?

A

Increase anticoagulation

45
Q

What treatment for DVT/PE would you use for life threatening PE?

A

Thrombolysis-Streptokinase or TPA

46
Q

For recurrent PEs, what can you use to prevent embolisation from large ileofemoral/IVC clot?

A

IVC filter

47
Q

How do you reverse warfarin?

A

With vitamin K1

48
Q

How do you reverse heparin?

A

With protamine

49
Q

Name three conditions that cause pulmonary venous hypertension

A
  1. LVF - ischaemic
  2. Mitral regurgitation/stenosis
  3. Cardiomyopathy e.g. alcohol, viral

Resp JL (27 decks)

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