PVD Flashcards
the V shaped structure on a CT scan is
the pulmonary artery
aorta is always
larger than pulmonary artery
-could mean is pulmonary HTN if larger
in someone with a large pulmonary artery, what could cause shortness of breath?
primary pulmonary HTN
how to measure pulmonary HTN
cardiac catheterization
- insert small tube called a catheter, swan gaz catheter-> goes to SVC-> RA-> RV->pulmonary artery
- read pulmonary wedge pressure
what is PAH?
hemodynamic state of stained elevation of pulmonary arterial pressure to 25 mmHg at rest or 30mmHg with exercise
-PCWP <15mmHg
what mimics PPH?
CTD, liver disease, HIV
PAH causes?
- idiopathic
- familial
- connective tissue disease
- associated with significant venous or capillary involvement
- pul HTN with left heart disease
- pul HTN associated with lung disease and hypoxmia: COPD, emphysema, pulmonary fibrosis, sleep apnea
- Pul HTN due to chronic thrombotic and/or embolic diseases
leading cause of PAH
idiopathic PAH
-more common in women
-mean age of 52
no risk factors, family history or genetic mutation
genetic abnormalities in PAH
TGF-B receptor family
bone morphogentic protein receptor type II,
activin receptor like kinase 1
associated PAH
CTD: 15%, systemic sclerosis have worst prognosis
HIV 6%
shistosomiasis
sickle cell disease 20%, mild-moderate increase PAP
clinical findings of PAH
increased P2 parasternal lift TI murmur Graham steel murmur (diastolic PI) rS3 cyanosis (late) *see right heart failure process
physical exam on PAH
RS4 peripheral edema (ankles) prominent P2 (93%) pitting edema RS3 cyanosis TR
pathophysiology
-Mainly vascular change
-Vasoconstriction
-Smooth muscle cell and endothelial cell proliferation
thrombosis
-Pulmonary endothelial cell injury leading to an imbalance in:
*vasodilators/constrictors
*growth inhibitors/mitogens
*antithrombotic/pro thrombotic factors
cellular mechanism involved in development of PAH include
increased endothelin levels
-main factor
APAH
HIV (independent of CD4 counts)
CREST
Portal HTN
Drugs and toxin: anorexigens, meth, cocaine, L-tryptophan
IPAH
rare
female more prominent
mean age of 37
progressive obliteration of pulmonary vascular bed
embolic disease rare forms
septic embolic amniotic fluid embolism fat embolism parasitic embolism tumor foreign body
Pulmonary HTN left heart disease
left ventricular dysfunction
left sided valvular disease: MS/MR, AS
most common HF with pulmonary HTN?
diastolic
pulmonary HTN with lung disease/hypoxemia
COPD
CTEPH
prom
PAH
- loss of cross sectional area
- vascular remodeling:
- medial hypertrophy
- plexiform lesion
- intimal fibrosis - excessive vasoconstriction
diagnosis of PAH
diagnosis of exclusion
-parenchymal disease
alveolar hypoventilation
chronic hypoxemia
mechanisms of PAH
reduced prostacyclin availability caused by diminished prostacyclin synthesis
diagnostic studies for PAH
V/Q echo RHC sleep study PFT's
therapy for PTH
vasodilators
coumadin
diuretics?
transplant
symtpoms to suspect PAH
exercise intolerance fatigue CP palpitations NP cough syncope tachycardia prominent P2, TR, RHF, JVD hepatomegaly, edema, stasis
ECG findings
prominent P waves
RVH
all patients with evidence of PAH by echo should undergo?
Ventilation perfusion scan
-look for embolic process
what can confirm PAH
right heart catheterization
guide for treatment
acute vasodilator challenge
-is respond: will respond to treatment
kkk
mean fall in PA pressure >10mmHg to mean <40mmHg to cardiac output
pre-test used to see treatment response
6 minute walk test
-afterwards measure oxygen sat values
CCB are only given to
responders
