random Flashcards
after DVT complications
CTEPH: chronic breathlessness, hypoxia and RHF due to obstruction of major pulmonary arteries
Post-thrombotic syndrome — a chronic venous hypertension causing limb pain, swelling, hyperpigmentation, dermatitis, ulcers, venous gangrene, and lipodermatosclerosis. It affects up to 50% of people usually within 2 years of DVT of the lower limbs and can be debilitating with significant impact on quality of life.
• Bleeding associated with anticoagulation treatment — most episodes are associated with a previously unknown pathological lesion (for example, duodenal ulcer). • Heparin-induced thrombocytopenia (HIT) — this may occur 5–7 days after initial exposure to heparin, but can occur in less than 1 day in people previously exposed to heparin. ○ The incidence is low in people treated with low molecular weight heparin (for example, dalteparin, enoxaparin, tinzaparin). ○ Fondaparinux-associated HIT is rare.
Thrombophilias
Antiphospholipid syndrome (this is the one to remember for your exams) Antithrombin deficiency Protein C or S deficiency Factor V Leiden Hyperhomocysteinaemia Prothombin gene variant Activated protein C resistance
calf sign for DVT
To examine for leg swelling measure the circumference of the calf 10cm below the tibial tuberosity. More than 3cm difference between calves is significant.
Always ask questions and examine with the suspicion of a potential pulmonary embolism as well.
secondary hypertension causes
hypothyroidism: increase in diastolic pressure
hyperthyroidism: increased in systolic pressure
BP aim to maintain
○ Adults aged under 80 years — clinic blood pressure below 140/90 mmHg.
○ Adults aged 80 years and over — clinic blood pressure below 150/90 mmHg.
People with frailty or multimorbidity — use clinical judgement.
○ Be aware that the corresponding measurements for ABPM and HBPM are 5 mmHg lower than for clinic measurements.
treat malignant hypertension
- IV to reduce CO/TPR: beta blockers (labetalol), nitroprusside, nicardipine (not often)
a. 25% reduction over 24-48 hours
Sudden drop can cause cerebral hypoperfusion as it can cause stroke
treat pre eclampsia
- IV to reduce CO/TPR: beta blockers (labetalol), nitroprusside, nicardipine (not often)
a. 25% reduction over 24-48 hours
Sudden drop can cause cerebral hypoperfusion as it can cause stroke
pulmonary hypertension treatment
Treatments include:
* anticoagulant medicines – such as warfarin to help prevent blood clots * diuretics (water tablets) – to remove excess fluid from the body caused by heart failure * oxygen treatment – this involves inhaling air that contains a higher concentration of oxygen than normal * digoxin – this can improve your symptoms by strengthening your heart muscle contractions and slowing down your heart rate * endothelin receptor antagonists – such as bosentan, ambrisentan and macitentan * phosphodiesterase 5 inhibitors – sildenafil and tadalafil * prostaglandins – epoprostenol, iloprost and treprostinil * soluble guanylate cyclase stimulators – such as riociguat * calcium channel blockers – nifedipine, diltiazem, nicardipine and amlodipine
pulmonary endarterectomy
balloon pulmonary angioplasty
atrial septostomy
transplant
5 types of PH
Group 1 – Primary pulmonary hypertension or connective tissue disease such as systemic lupus erythematous (SLE)
Group 2 – Left heart failure usually due to myocardial infarction or systemic hypertension
Group 3 – Chronic lung disease such as COPD
Group 4 – Pulmonary vascular disease such as pulmonary embolism
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders
• Group 1: as above • Group 2: if left side does not work properly, right side needs to work harder so increases pressure • Group 3: COPD, ILD, OSA. - pulmonary vasoconstriction • Group 4: CTEPH Group 5: mix of a cause
pericarditis
steroids should be avoided in post-MI pericarditis due to their impairment of scar formation and a consequently increased incidence of myocardial wall rupture.
Cardiac tamponade is a clinical diagnosis made by documenting one or more of the following in the presence pericardial effusion
tachycardia, pulsus paradoxus (>10 mmHg inspiratory decline in systolic BP), jugular venous distention, and muffled heart sounds.
becks triad
cardiac tamponade: hypotension, muffled heart sounds, JV distension
diagnose cardiac tamponade
echo
• Right heart catherization: The most typical finding on right heart catheterization is equalization of mean right atrial, right ventricular and pulmonary artery diastolic, and mean pulmonary capillary wedge pressures.
aortic regurgitation
if significant regurgitation means that the stroke volume is very high, there will be an ejection flow murmur too.
mitral regurg
repair is better than replacement
