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OS 213 Respiratory Exam 2 > Pulmonary Vascular Diseases and Cor Pulmonale > Flashcards

Pulmonary Vascular Diseases and Cor Pulmonale Flashcards

1
Q

Major Role of Pulmonary Circulation:

A

Bring blood into close proximity with air so that gas exchange can occur

Consists of arteries, capillaries, and veins

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2
Q

It is a High Volume, Low Pressure System

A

Pulmonary Circulation

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3
Q

Major Role of bronchial circulation

A

Supply blood to airways

1/3 blood flow through the bronchial circulation empties into the azygos vein

2/3 of blood flow through the bronchial circulation empties into the pulmonary capillaries

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4
Q

Low Volume; High Pressure system

A

Bronchial Circulation

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5
Q

Venous Thromboembolic Disease

A

Includes deep vein thrombosis and pulmonary emboli

abrupt onset of dyspnea, Right pleuritic pain

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6
Q

Diagnosis of DVT

A

Venography
Impedance plethysmography
Compression ultrasonagrophy

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7
Q

Standard diagnostic tool, injection of dye

A

Venography

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8
Q

Non invasive, sensitive and specific

A

Impedence plethysmography

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9
Q

Non-invasive, sensitive and specific. Test of choice for diagnosis of DVT

A

Compression Ultasonography

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10
Q

Most common pulmonary disorder among hospitalized patients

A

Pulmonary Embolism

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11
Q

Pathogenesis of Pulmonary Embolism

A

Most often detached portions of venous thrombi that dislodge andbtravel through the central veins to the pulmonary arteries

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12
Q

Major sources of clinically imporatant pulmonary emboli (>50% originate below the knee)

A

Femoral, iliac, and pelvic veins

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13
Q

Virchows triad

A

Endothelial injury
Stasis of flow
Activation of clotting

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14
Q

Pulmonary embolism is most frequent in…..

A

Lower lobes, and right lung

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15
Q

Emboli obstruct blood flow

A 
Alveolar dead space
Bronchoconstriction
Decreased surfactant production
Hypoxemia
Pulmonary hypertension
Shock (saddle embolus)
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16
Q

VE

A

equal to the sum of alveolar ventilation and dead space ventilation

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17
Q

Clinical features of Pulmonary Embolism

A

No specific signs or symptoms

Anticoagulation is started on suspicion of PE and stopped only when PE is ruled out

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18
Q

Most common symptom of PE

A

Dyspnea

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19
Q

calf pain on dorsiflexion of foot

A

Homan’s sign

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20
Q

Effects of pulmonary Embolism

A

Increased pulmonary vascular resistance

Impaired gas exchange

alveolar hyperventilation

Increased airway resitance

Decreased pulmonary compliance

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21
Q

Increased pulmonary vascular resistance

A

vascular obstruction or neurohumoral agents like serotonin

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22
Q

Impaired gas exchange

A

increase alvolar dead space from vascular obstruction and hypoxemia from alveolar hypoventilation in non-obstructive lung

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23
Q

Alveolar hyperventilation

A

reflex stimulation or irritant receptors

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24
Q

Increased airway resistance

A

Bronchoconstriction

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25
Decreased pulmonary compliance
Lung edema, lung hemorrhage or loss of surfactant
26
CXR of PE
Hampton's Hump Peripheral wedge-shaped opacification abutting the pleura. SIgnifying pulmonary infarction distal to a pulmonary embolism Westermark's sign -dilatation of pulmonary vessels proximal to embolism along with collapse of distal with a sharp cut-off
27
Ventilation Perfusion Scans
useful if Normal
28
Angiogram of PE
Pulmonary angiography is the gold standard
29
CT angiography
detect alternative pulmonary abnormalities that may explain the patient's symptoms and signs
30
Pulmonary Embolism ECG and ABG
ECG rules out other inflammatory lefe threathening conditions Tachycardia, ST depression most common ABG findings most commonly show hypoxemia and hypocapnia 15-25% have PO2 >80mmHg
31
D-dimers
Level <500 mg/L rules out PE
32
Physiologic Effects of Pulmonary Embolism
Hypoxemia | - INcreased blood flow through regions of physiologic shunt or poor V/Q matching
33
Landmark study in the clinical probability of venous thromboembolism occuring
PIOPED study
34
V/Q scan
IV push of radioisotope-tagged albumin and radio-labeled gas in inhaled Gamma radiation produced by radioisotopes show distribution of blood flow and ventilation
35
Pulmonary Embolism Management
Use Knee-high 30-400 mm elastic stocking on affected legs Prevents further clot formation and clot being brought further into the system
36
Pulmonary Embolism and DVT management
Continue injected anticoagulant and hospitalization until patient is saafely assured
37
Prophylaxis of DVT
Heparin or fondaparinux is most commonly used
38
What type of heparin is used?
unfractionated
39
Management DVT
Heparin | Thrombolytic Agents
40
Management of PE
Preserving oxygenation and circulation are paramount. If circulation is impaired, consider clot lysis, drug or mechanical Similar regimen to DVT -first line heparin followed by oral coumarin
41
Supportive measures include:
Oxygen therapy Analgesia Hypotension and shock are treated with vasopressors and fluids
42
If patients are stable within 3 days of PE
they can be safely transferred out, as long as the condition that led to clot formation has been resolved
43
Mean pulmonary artery pressure >25 mmHg at rest or MPAP >30mmHg with exercise, with increased pulmonary vascular resistance and normal left ventricular function
Pulmonary arterial hypertension
44
Associated with congenital heart disease, collagen vascular disease, liver cirrhosis
Pulmonary Hyertension
45
Increased BP in the pulmonary arteries
PAH
46
Increased BP in the pulmonary veins
PVH
47
A blood clot breaks off from a deep vein
PE
48
A progressive disorder, primarly affects small pulmonary arterioles, Proliferation and remodeling of endothelial and smooth muscle cells
PAH mPAP >25 mmHg mPAP >30 mmHg
49
Devolopment of IPAH
Genetic Predisposition probably required Follows insult to arterial endothelium Damage results in vasoconstriction Maybe caused by abnormal transport of potassium and calcium
50
Clinical Features of PAH
Dyspnea (60%) Angina (50%) Syncope (8%) Others: Cough, hemoptysis, hoarseness and reynaud's phenomenon
51
Management of PAH
Supplemental Oxygen (SaO2>90%)
52
Anticoagulation with coumadin
Adjust to keep INR-2
53
Vasodilators (Ca Channel Blockers)
May usedigoxin and diuretics to manage side effects NO is preferred Very short half life Does not affect CO Enhances V/Q mismatching
54
Pulmonary Hypertension COPD
Alveolar hypoxia causes vasoconstriction and eventually medial hypertrophy, fibrosis and lumen narrowing Leads to HPN Severity of COPD with severity of HPN
55
Symptoms of PAH
Slowly progressive shortness of breath As the condition worsens, chest pain or fainting (syncope) with exertion can occur
56
Pulmonary Venous Hypertension
Shortens of breath, due to the CHF - shortness of breath may be worse while lying flat, when BP is uncontrolled, or when extra fluid is present
57
Clinical Classification of Pulmonay Hypertension
Group 1: Pulmonary arterial hypertension Group 2: Pulmonary hypertension due to left heart disease Group 3: Pulmonary hypertension due to lung disease and/or hypoxia Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) Group 5: Pulmonary hypertension with unclear multifactorial mechanism
58
hypertrophy of the RV resulting from diseases affecting the function and or structure of the lung, except when these pulmonary alterations are the result of diseaealterations are the result of disease that primarily affect the left side of the heart or congenital heart disease
COR PULMONALE
59
Etiologies of PAH
Lungs and Airways Vascular Occlusion Abnormal Respiratory Control
60
Etiology of Cor pulmonale (Thoracic Cage)
Kyphosis >180 degrees Scoliosis >120 degrees Thoracoplasty Pleural fibrosis
61
Pathologic features of Cor Pulmonale
Lung: consistent with specific diseases Common feature: Microvascular hypertrophy Hallmark: RVH * 60-200 g>0.5 cm * RV/LV <2.5 LVH Carotid body hypertrophy
62
Diagnostic Tests for Cor Pulmonale
CXR: depends on underlying lung condition but usually shows enlarged main PA segment (>16mm) ECG: P pulmonale (peaked p wave), RA enlargement, RVH Doppler Echocardiography: RVH, poor RV contactility with low EF, evidences of moderate to severe PH
63
Cor Pulmonale: Differential Diagnosis
Cor pulmonale from primary underlying lung disease such as COPD, Sleep disordered breathing vs Cardiac Diseases such as RHD with MS, COngenital Heart disease with systemic-pulmonary shunt
64
Therapeutic Strategies for Cor Pulmonale
Diet and lifestyle Interventions
65
Interventions in cor pulmonale
Treat underlying cause Continuous oxygen 2-3L/mn Diuretics Phlebotomy Digoxin Pulmonary vasodilators beta adrenergic agents Reduce ventilation/perfusion imbalance

OS 213 Respiratory Exam 2 (15 decks)

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