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Respiratory > Pulmonary vascular disease (P. embolism & P. Hypertension) > Flashcards

Pulmonary vascular disease (P. embolism & P. Hypertension) Flashcards

1
Q

What is a pulmonary embolism?

A

Thrombus forms in the venous system, usually in deep veins of the legs and embolises to the pulmonary arterie

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2
Q

What is the prognosis of a pulmonary embolism?

A

Massive PE can be fatal, although minor PE treated with anticoagulation has a very good prognosis

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3
Q

What are the major risk factors/causes for venous thromboembolism?

A 
Recent major trauma 
Recent surgery 
Cancer 
Cardiopulmonary disease e.g. MI
Pregnancy 
Inherited thrombophilia e.g. Factor V Leiden
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4
Q

Why does major trauma increase risk of PE?

A

Increased coagulating factors in the blood to clot at the wound

This means clots can form more easily elsewhere

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5
Q

Why does surgery increase risk of PE?

A

Bed bound patient

Low blood flow in legs increases risk of clotting

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6
Q

Why does cancer increase the risk of PE?

A

The cancer can release factors that increase clotting

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7
Q

How does cardiopulmonary disease increase the risk of PE?

A

Reduced blood flow

Because heart function is impaired

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8
Q

Why does pregnancy increase risk of PE?

A

Increased blood coagulating factors and foetus compresses veins

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9
Q

Why is a patient with thrombophilia at risk of PE?

A

Large amount of coagulating factors in blood

Factor V Leiden - coagulation factor V cant be inhibited

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10
Q

What are the symptoms of Pulmonary embolism?

A

Pleuritic chest pain, cough and haemoptysis

Isolated acute dyspnoea

Syncope (fainting) or cardiac arrest

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11
Q

What are the signs of Pulmonary embolism?

A

Pyrexia, pleural rub, stony dullness to percussion at base (pleural effusion)

Tachycardia, tachpnoea, hypoxia

Tachycardia, HYPOtension, tachypnoea, hypoxia

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12
Q

What scoring methods rank the severity of a PE?

A

Wells score

Revised Geneva score

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13
Q

How does the Wells score work?

A

Includes symptoms and signs of VTE, previous VTE and risk factors

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14
Q

How does the Revised Geneva score work?

A

Based on risk factors, symptoms and signs (heart rate)

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15
Q

What are the investigations for Pulmonary embolism?

A 
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

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16
Q

What is the mortality rate for a pulmonary embolism?

A

Mortality at 30 days varies from 0 to 25%

17
Q

How is the prognosis of a pulmonary embolism scored, and what is the score based on?

A

PESI score

Based on age, sex, comorbidity and physiological parameters

18
Q

What is the treatment for pulmonary embolism?

A 
Oxygen
Low molecular weight heparin e.g. dalteparin
Warfarin
Direct Oral Anticoagulants (DOAC)
 - rivaroxaban, apixaban
Thrombolysis
 - Alteplase (rt-PA)
Pulmonary Embolectomy
19
Q

What is pulmonary hypertension?

A

Abnormally elevated blood pressure in the pulmonary arterial tree

Mean pulmonary artery pressure > 25 mmHg

20
Q

Describe the prevalence of pulmonary hypertension as a primary and/or secondary disease

A

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

21
Q

What are the main causes of Pulmonary hypertension?

A

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
22
Q

What are the symptoms of pulmonary hypertension?

A

Exertional dyspnoea

Chest tightness

Exertional presyncope or syncope

23
Q

What are the signs of pulmonary hypertension?

A 
Elevated JVP
Right ventricular heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema
24
Q

What are the investigations for pulmonary hypertension?

A 
ECG
Lung function tests
Chest X-Ray
Echocardiography
V/Q scan
CTPA
Right heart catheterisation
25
Q

Why is right heart catheterisation useful for investigating PH?

A

allows direct measure of pulmonary artery pressure

measurement of wedge pressure

measurement of cardiac output

26
Q

What is the general treatment route for pulmonary hypertension?

A

Treat underlying condition

Oxygen

Anticoagulation

Diuretics

27
Q

What drugs are used in the treatment of pulmonary hypertension?

A

Calcium channel antagonist e.g. amlodipine

Prostacyclin

Endothelin receptor antagonists:

  • bosentan
  • ambrisentan

Riociguat

Phosphodiesterase inhibitors:

  • sildenafil
  • tadalafil
28
Q

Give examples of endothelin receptor antagonists

A

Bosentan

Ambrisentan

29
Q

Give examples of Phosphodiesterase inhibitors

A

Tadalafil

Sildenafil

30
Q

What are the less common surgery based treatments for pulmonary hypertension?

A

Thromboendarterectomy (CTEPH)

Lung or heart lung transplant

Respiratory (32 decks)

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