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Respiratory System DO > Pulmonary Vascular Disease (Pulmonary Embolism) > Flashcards

Pulmonary Vascular Disease (Pulmonary Embolism) Flashcards

1
Q

Where will a thrombus normally form

A

In the venous system usually in deep veins of the legs

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2
Q

Where will a thrombus normmaly embolise

A

Pulmonary arteries

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3
Q

How many hospital admissions is a pulmonary embolism though to cause

A

1%

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4
Q

Why are blood clots able to form

A

Due to the low flow system

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5
Q

What can pulmonary embolisms (PE) range from

A

Minor to major

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6
Q

What is the prognosis of major and minor PE

A

Minor - treated with anti-coagulation and has a good prognosis
Major - fatal

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7
Q

What the risk factors of PE

A

Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease e.g. MI
Pregnancy
Inherited thrombophilia e.g. Factor V Leiden

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8
Q

Why is a recent major trauma a risk factor for PE

A

The body responds by producing procoagulant as a protective mechanism

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9
Q

Why is pregnancy a risk factor for PE

A

The foetus presses on veins in abdomen which slows system flow further

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10
Q

What are the symptoms of a PE

A

Pleuritic chest pain, cough and haemoptysis
Isolated acute dyspnoea (breathlessness)
Syncope or cardiac arrest

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11
Q

What causes the pleuritic chest pain, cough and haemoptysis

A

The clot breaks off and goes into artery causing that part to die and causes inflammation

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12
Q

What causes isolated acute dyspnoea

A

A V/Q mismatch causing the patient to feel breathless and become hypoxic

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13
Q

What type of PE can cause syncope or cardiac arrest

A

A massive PE

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14
Q

What are the signs of pleuritic chest pain, coughs and haemoptysis

A

Pyrexia
Pleural rub (sounds like someone walking in deep snow)
Stony dullness to percussion at base (pleural effusion)

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15
Q

What are the signs of isolated acute dyspnoea

A

Tachycardia
Tachpnoea
Hypoxia

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16
Q

What are the signs of syncope or cardiac arrest

A 
Tachycardia
Hypotension
Tachypnoea
Hypoxia
Patients look shocked and unwell
Sweating
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17
Q

How can a diagnosis of a PE be made

A

CT pulmonary-angiogram

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18
Q

What can be used to estimate the likelihood of the condition being a PE

A

Wells score

Revised Geneva score

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19
Q

What does the Wells score include

A

Symptoms and signs of VTE

Previous VTE and risk factors

20
Q

What is the revised Geneva score based on

A

Risk factors
Symptoms
Signs (heart rate)

21
Q

Which pre-test probability test is less subjective

A

Revised Geneva score

22
Q

What type of investigations can be conducted

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
23
Q

Is a chest X-Ray useful

A

It is not very useful as it looks normal to the untrained eye

24
Q

Why can a ECG be used

A

It will identify alternative causes of the patients sign and symptoms
It can produce a sinus tachycardia as a sign of PE

25
Q

What is a D-dimer

A

Breakdown product of coagulation

26
Q

When is a D-simer test useful

A

When the pre-test probability is low it can be used to rue out PE
If it comes back positive then more tests should be conducted

27
Q

What is the main investigation for a PE

A

CT pulmonary angiogram (CTPA)

it involves a CT contrast

28
Q

When should a V/Q scan be done

A

If there is a reason not to do CT pulmonary angiogram (CTPA)

29
Q

What part of the heart does the echocardiograph look at

A

Right side of the heart

30
Q

What does thrombophilia testing test for

A

Inherited PE

31
Q

What is the prognosis of PE dependent on

A

Size

32
Q

What is the mortality rate from a PE at 30 days

A

It can range from 0-25%

33
Q

What can be used to estimate the mortality rate

A

PESI score

34
Q

What is the PESI score based on

A

Age
Sex
Comorbidity
Physiological parameters

35
Q

What can the PESI score also help determine

A

How long someone should stay in hospital

36
Q

What is the treatment for PE

A 
Oxygen
Low molecular weight heparin e.g. dalteparin
Warfarin
Direct Oral Anticoagulants (DOAC) 
Thrombolysis
Pulmonary Embolectomy
37
Q

What is warfarin and what does it require

A

An anticoagulant

Requires constant blood tests

38
Q

What are the advantages and disadvantages of direct oral anticoagulants

A

Advantage: do not require constant blood tests
Disadvantage: No current antidotes

39
Q

What do direct oral anticoagulants block

A

Coagulation cascade

40
Q

Give examples of newer direct oral anticoagulants

A

Rivaroxaban

Apixaban

41
Q

Give an example of a thrombolysis agent

A

Alteplase (rt-PA)

42
Q

What is alteplase (rt-PA)

A

A recombinant form of fat which the body uses to break down clot

43
Q

How is alteplase (rt-PA) administered

A

IV injection over 30 minutes

44
Q

What does a • pulmonary embolectomy require and who should do it

A

Requires a bypass

Conducted by a cardiothoracic surgeon

45
Q

How long should treatment last

A

A patient with a known predisposing factor can be given treatment for 3 months
Patients with unknown predisposing factors are given lifelong treatment

Respiratory System DO (33 decks)

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