Pulmonary Vascular Diseases Flashcards
10 Risk factors for PE?
Same as risk factors for DVT
Contraceptive pill Pregnancy Pelvic obstruction Trauma Surgery Immobility Malignancy Obesity Pulmonary hypertension Vasculitis
Evidence of DVT?
Calf is swollen, hot, red and tender
Presentation of PE?
SOB most common symptom
If infarction will also have haemoptysis and pleuritic chest pain
On examination localised pleural rub and coarse crackles over involved area
May have fever
Also signs of DVT as this is most likely source of PE
When can pulmonary infarction happen?
If there is a pulmonary embolus and there the bronchial artery supply is compromised
How is PE treated?
High flow O2 to patients unless chronic lung disease
Anticoagulation with subcutaneous low molecular weight heparin
IV fluids
Thrombolysis therapy in unstable patients or stable patients with adverse features
Surgical embolectomy rarely necessary
Prevention of further emboli by….
anticoagulation with warfarin for 3-6 months
What should also be considered with PE?
Why patient had PE
Check for cancer
Test auto antibodies
Thrombophilia screen to check for inherited conditions
Pulmonary circulation is normally a ….
high flow, low pressure system
Normal mPAP is…
12-20 mmHg
Pulmonary hypertension is …
mPAP more than 25 mmHg
Signs of primary pulmonary hypertension?
Central cyanosis Dependent oedema Raised JVP Pulsatile liver Murmur of tricuspid regurgitation Right ventricular heave at parasternal edge Cardiomegaly on CXR
Treatment of primary pulmonary hypertension?
Riociguat (PA vasodilator)
Prophylactic anticoagulation
What is cor pulmonale?
Lung disease that causes right sided heart disease
It is a complication of COPD, fibrotic lung disease, chronic PE, obesity, kyphocoliosis
3 main groups that cause pulmonary hypertension?
1) Left sided heart failure that causes back pressure on pulmonary vessels
2) Pulmonary arterial hypertension caused by connective tissue diseases, infection, congenital heart defects etc.
3) lung disease that causes hypoxia and vasoconstriction of the pulmonary vessels meaning pressure has to be increased to get same flow of blood
