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SEM 5: SAM 1 > Pulmonary Vascular Diseases > Flashcards

Pulmonary Vascular Diseases Flashcards

1
Q

Pulmonary hypertension refers to elevated pulmonary ________ (arterial/venous) pressure

A

arterial

Inc. pressure in pulmonary a.

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2
Q

List the 3 pathophysiologic mechanisms that cause pulmonary hypertension

A
  1. Increased pulmonary blood flow
  2. Increased pulmonary vascular resistance
  3. increased pulmonary venous pressure
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3
Q

List the 6 groups/classifications of pulmonary hypertension

A
  1. Pulmonary arterial hypertension
  2. PH secondary to L-CHF (Inc. PVP)
  3. PH secondary to respiratory dz and/or hypoxia
  4. Pulmonary emboli/thrombi/thromboemboli
  5. Parasitic dz (HW, lungworm)
  6. PH with multifactorial or unclear mechanisms
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4
Q

List the causes of pulmonary hypertension secondary to respiratory disease

A
  1. Tracheobronchial dz (Bronchitis)
  2. Pulmonary paranchymal disease (pulmonary fibrosis, pneumonia)
  3. Airway obstruction
  4. Low inspired O2 (hypoxia @ high altitude)
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5
Q

List heart disease causes that can result in pulmonary venous hypertension

A

L-sided heart dz (Increased pulmonary venous pressure)

  • DCM
  • DMVD
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6
Q

List heart disease causes that can result in pulmonary arterial hypertension

A
  • PDA
  • VSD
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7
Q

Pulmonary hypertension is more common in _________ (dogs/cats)

A

Dogs

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8
Q

Pulmonary hypertension is more common in ___________ (small breeds/large breeds)

A

Small breeds

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9
Q

What clinical signs might be observed in a patient with pulmonary hypertension?

A
  • Syncope, often exercise induced
  • Tachypnea, dyspnea
  • Cough
  • Exercise intolerance
  • Ascites if R-CHF present
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10
Q

PE findings on a patient with pulmonary hypertension?

A
  • Abnormal lung sounds
  • Cyanosis
  • Normothermic, normal to inc. HR

If severe PH:
- Murmur due to TV regurg
- Ascites, jug distension due to R-CHF
- Systemic hypotension

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11
Q

What findings can be seen on a thoracic radiograph of a patient with pulmonary hypertension?

A
  1. Enlarged pulmonary arteries
  2. +/- R-side cardiomegaly
  3. +/- Enlarged main pulmonary arter
  4. +/- Pulmonary infiltrates
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12
Q

What findings can be seen on an echo of a patient with pulmonary hypertension?

A
  1. Tricuspid valve regurg
  2. RV hypertrophy
  3. Dilated many pulmonary a. & branches
  4. RA dilation
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13
Q

Explain how pulmonary hypertension can result in systemic hypotension

A
  1. Increased resistance in pulmonary a
  2. RV can’t pump enough blood to L-side of the heart
  3. Volume underloaded LV resulting in dec. CO, SV, and systemic hypotension
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14
Q

What is the treatment protocol for a patient with pulmonary hypertension?

A
  • Tx not indicated unless moderate or severe PH
  • Tx of underlying cause is most IMPT
  • Give pulmonary vasodilators: Sildenafil
  • Supplemental O2 (helps dilate pulmonary a.)
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15
Q

What is the prognosis for a patient with pulmonary hypertension?

A
  • Severe PH: poor long term, guarded short term
  • Sudden death can occur with severe PH
  • Good to fair prognosis if underlying cause is treated
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16
Q

What diagnostics should be done on a patient with suspect pulmonary hypertension?

A
  1. HWT
  2. Thoracic rads
  3. Echo (gold standard)
17
Q

True or False: Most patients with pulmonary hypertension present with clinical signs

A

False

mild PH does not cause CS, Severe PH always causes CS

18
Q

What conditions are associated with PTE?

A
  • IMHA
  • PLN / PLE
  • Hyperadrenocorticism / Corticosteroids
  • Diabetes mellitus

and more

19
Q

If pulmonary hypertension is severe enough, a ____________ murmur can be heard

A

Right apical systolic murmur (due to TV regurg)

20
Q

List the more widely available tests that may provide evidence in support of or against PTE

A
  1. Thoracic rads (may be normal)
  2. Arterial blood gas
  3. D-dimers
  4. Coag panel (PT/PTT)
  5. Thromboelastography
21
Q

Which of the following tests, if normal, generally rules out acute signs of PTE?

A. D dimers
B. PT/PTT
C. Thoracic radiographs
D. Absent right apical systolic murmur

A

A. D dimers

22
Q

What is the acute vs chronic treatment protocol for a patient with PTE?

A

Acute:
- Heparin
- Supplemental O2
- IV fluids

Chronic: antithrombotic
- Anticoag
or
- AntiPLT (Clopidogrel, Aspirin)

23
Q

What is the prognosis for a patient with PTE?

A

Fair to guarded if mild-mod

Poor for severe PTE

24
Q

What are features and clinical consequences of HWD?

A
  • Pulmonary artery and parachymal injury
  • pulmonary hypertension
  • R- CHF
  • Glomerulonephritis
  • Thrombocytopenia
  • DIC
  • Caval syndrome
25
Q

HWD can cause _________ hypertrophy due to ________ overload

A

RV concentric, pressure

26
Q

What is the drug of choice for eliminating Wolbachia during HW treatment?

A

Doxycycline

27
Q

What is caval syndrome?

A

Mechanical obstruction (by worms) of blood flow in the R side of the heart and vena cava

Results in hemolytic anemia and cardiogenic shock

28
Q

Annual screening should be done on dogs > ______ of age for HWD

A

over 7 months

29
Q

What tests should be ran on dogs when screening for HWD?

A

Antigen test and microfilaria test

30
Q

What is the preferred treatment protocol for a dog with HWD?

A
  1. Macrocyclic lactone preventative
  2. Doxycycline
  3. Exercise restriction
  4. Adulticide therapy with 3-dose melarsomine (1-2 months after diagnosis of HW)
  5. +/- corticosteroids
31
Q

Why is exercise restriction an imperative measure taken when treating a patient with HWD?

A

Reduces risk of thromboembolic complications

32
Q

What MCL should be avoided in microfilaremic dogs if possible?

A

Milbemycin - can cause obstruction and anaphylaxis

33
Q

How is corticosteroid therapy beneficial in treating dogs with HWD?

A
  1. Anti-inflamm tx for symptomatic patients
  2. Prevention and tx of adverse rxns to microfilaricides
  3. TX of pneumonitis, pulmonary granulomas, or PTE
  4. Provides analgesic for melarsomine injections
  5. Mf + dogs should be pretreated with corticosteroids before 1st dose of MCL
34
Q

What is the treatment protocol for caval syndrome?

A

Emergency worm extraction via jug vein

(delay melarsomine tx for atleast 30 days)

35
Q

Differences in HWD in cats compared to dogs?

A
  • Never develop mature infection (no adult worms)
  • Pulmonary disease develops even tho mature adults never exist
  • Rarely mf+
  • Develop HARD (HW ass resp disease)
36
Q

What can develop as a consequence of HWD in cats?

A

HARD (HW ass resp disease)

(ashthma like symptoms)

37
Q

What tests should be ran in symptomatic cat with suspect HWD?

A
  • Antigen and Antibody test (BOTH!!)
38
Q
A

SEM 5: SAM 1 (35 decks)

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