Pulmonary vascular disease (P. embolism & P. Hypertension) Flashcards
What is a pulmonary embolism?
Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arterie
What is the prognosis of a pulmonary embolism?
Massive PE can be fatal, although minor PE treated with anticoagulation has a very good prognosis
What are the major risk factors/causes for venous thromboembolism?
Recent major trauma Recent surgery Cancer Cardiopulmonary disease e.g. MI Pregnancy Inherited thrombophilia e.g. Factor V Leiden
Why does major trauma increase risk of PE?
Increased coagulating factors in the blood to clot at the wound
This means clots can form more easily elsewhere
Why does surgery increase risk of PE?
Bed bound patient
Low blood flow in legs increases risk of clotting
Why does cancer increase the risk of PE?
The cancer can release factors that increase clotting
How does cardiopulmonary disease increase the risk of PE?
Reduced blood flow
Because heart function is impaired
Why does pregnancy increase risk of PE?
Increased blood coagulating factors and foetus compresses veins
Why is a patient with thrombophilia at risk of PE?
Large amount of coagulating factors in blood
Factor V Leiden - coagulation factor V cant be inhibited
What are the symptoms of Pulmonary embolism?
Pleuritic chest pain, cough and haemoptysis
Isolated acute dyspnoea
Syncope (fainting) or cardiac arrest
What are the signs of Pulmonary embolism?
Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)
Tachycardia, tachpnoea, hypoxia
Tachycardia, HYPOtension, tachypnoea, hypoxia
What scoring methods rank the severity of a PE?
Wells score
Revised Geneva score
How does the Wells score work?
Includes symptoms and signs of VTE, previous VTE and risk factors
How does the Revised Geneva score work?
Based on risk factors, symptoms and signs (heart rate)
What are the investigations for Pulmonary embolism?
Full blood count, biochemistry, blood gases Chest X-Ray ECG D-dimer CT Pulmonary Angiogram (CTPA) V/Q scan Echocardiography
Consider CT abdomen and mammography
Consider thrombophilia testing
What is the mortality rate for a pulmonary embolism?
Mortality at 30 days varies from 0 to 25%
How is the prognosis of a pulmonary embolism scored, and what is the score based on?
PESI score
Based on age, sex, comorbidity and physiological parameters
What is the treatment for pulmonary embolism?
Oxygen Low molecular weight heparin e.g. dalteparin Warfarin Direct Oral Anticoagulants (DOAC) - rivaroxaban, apixaban Thrombolysis - Alteplase (rt-PA) Pulmonary Embolectomy
What is pulmonary hypertension?
Abnormally elevated blood pressure in the pulmonary arterial tree
Mean pulmonary artery pressure > 25 mmHg
Describe the prevalence of pulmonary hypertension as a primary and/or secondary disease
Primary pulmonary hypertension is rare and has an incidence of 1-2 per million population
Secondary pulmonary hypertension is more common and tends to occur in an older age group
What are the main causes of Pulmonary hypertension?
Idiopathic
Secondary to chronic respiratory disease
Secondary to left heart disease
Chronic Thromboembolic PH (CTEPH)
Miscellaneous:
- collagen vascular disease
- portal hypertension
- congenital heart disease (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 are the investigations for pulmonary hypertension?
ECG Lung function tests Chest X-Ray Echocardiography V/Q scan CTPA Right heart catheterisation
