Pulmonology Flashcards
normal right atrial pressure
0-7 (reflects venous return during systole and RV EDP during diastole)
normal right ventricular pressure
15-25/3-12 (measured during catheter insertion)
normal pulmonary artery pressure
15-25/8-15 (elevation associated w/ dx that increase pulm artery pressure and affect pulmonic valve)
normal L atrium pressure
3-12
ground glass opacities on CXR or chest CT indicate one of the following:
water, mucus, blood (think diffuse alveolar hemorrhage: which can be anything from infectious to drugs to connective tissue etiology) or pus. fibrosis around the alveoli can give ground glass opacities as well
causes of pulmonary HTN include:
group 1: pulmonary vascular dx (PAH)
group 2: L heart dx
group 3: lung dx or hypoxia
group 4: chromic thromboembolic dx
group 5: misc. (such as hemolytic anemia, sickle cell, sarcoid, etc…)
PCWP represents
an estimation of L atrial pressure
PCWP is measured by
patient in the supine position, and catheter insertion into zone 3 of the lung at the end of expiration
normal PCWP is
6-15 (mean of 9)
importantly, other than L atrium pressure, PCWP also estimates
LV EDP
lots of conditions cause high PCWP, a few causes of low PCWP include
hypovolemia (such as hemorrhagic shock), pulmonary venooclusive dx, obstructive shock due to large PE
normal cardiac index is
2.8-4.2 L/min/m^2
causes of low cardiac index include
systolic/diastiolic HF, severe mitral regurg, hypovolemia, pulmonary HTN, and RV failure
only clinically proven scenario where incentive spirometry is useful
acute chest syndrome
what are values you must check w/ inhalation injury from smoke
methemoglobin and carboxyHb
best way to read a CT chest
A - airway
I - interstitium
C - cavitation
first line for prevention of bronchospasm
albuterol
what should you do if a Pt has failed inhaler use and cannot pull medication very well?
should set that patient up for success and make sure to prescribe the nebulized version of that medication instead
PAH is defined as a resting mean pulm artery pressure of _____ or more
> 25 mmHg
mutations in ____ gene increase risk of heritable PAH
BMPR2 (type II bone morphogenetic protein receptor)
PAH vascular targeted medications
prostaglandins, PDE-5 inhibitors, endothelin receptor antagonists, and soluble guanylate cyclase stimulators
pre-capillary pulm HTN definition
> 3 woods units (mmHg/L per min) PVR on RHC and decreased PCWP pressure <15 (caused by PAH, chronic lung disease, chronic thromboembolism, or certain multi-factorial mech)
post-capillary pulm HTN definition
increased PCWP w/ typically normal PVR (most often caused by L heart dx)
right ventricular systolic pressure (an important indicator of PH when increased) is determined from doppler U/S by:
tricuspid regurg. jet flow + estimated R atrial pressure