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resp Flashcards

1
Q

COPD: symptoms?

A

Suspect COPD in a long term smoker presenting with

  • chronic shortness of breath,
  • cough,
  • sputum production,
  • wheeze
  • dysponea
  • chest tightness
  • and recurrent respiratory infections, particularly in winter.

Associated with the development of both:

  • CHRONIC BRONCHITIS: Cough with sputum for 3 months for 2 or more years
    • cyanosed
  • EMPHYSEMA: Histologically its enlarged airspaces distal to terminal bronchioles, with destruction of alveolar walls
    difficulty breathing but are well perfused
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2
Q

COPD: investigations?

A

Diagnosis is based onclinical presentation plusspirometry

Spirometry = “obstructive picture

FEV1/FVC ratio <0.7 !!!

residual vol and total lung vol are reduced

Chest X-ray: TO EXCLUDE LUNG CANCER

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3
Q

COPD: Mx?

A

SMOKING CESSATION

  1. Pulmonary rehabilitation.
  2. SABA/LABA for symptom relief.
  3. SHORT-ACTING BRONCHODILATORS: EG BETA-2-AGONISTS
    1. EG SALBUTAMOL OR TERBUTALINE

IF NO asthmatic or steroid responsive features - they should have a combinedlong acting beta agonist(LABA)

  1. ICS.
    If they haveasthmatic or steroid responsive features
    they should have a combinedlong acting beta agonist
    (LABA ) plus aninhaled corticosteroid(ICS)
  2. Lung volume reduction surgery - quite rare.
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4
Q

CF: define (inheritance too?)

A

One of the most commonest lethal autosome RECESSIVE conditions in

  • *CAUCASIANS**,
  • *mutation in CFTR gene**
  • *25% condition and 50% carrier risk**
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5
Q

CF: pp?

A

Failure to excrete Cl- leads to Na+ retention. This then leads to H2O retention.

  • CFTR: aka cystic fibrosis transmembrane conductance regulator
    • Transport protein on membrane of epithelial cells that acts as a chloride channel and Na+ channel

Commonest mutation is the F508 deletion mutation on chromosome 7 and accounts for 70% of cases THUS CFTR PROTEIN WILL BE MISFOLDED

so bc theres loads of positive Na+ inside the cell now - water won’t be attracted to mucus to thin out - THUS mucus is abnormally thick and builds up and obstructs organs

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6
Q

CF: symptoms?

A

thick mucus
Meconium ileus - bowel obstruction due to thick meconium (earliest
stool) (a medical emergency bc can result in bowel perforation!! → can lead to septic shock!!! → organ failure and death!! wo proper Mx will die of cardioresp complications like pneumonia and bronchiectasis)
- distended and rigid abdomen
- mottled and lethargic
- billious vomiting

Pancreatic Insufficiency
THUS fat isn’t absorbed and → steatorrhoea → poor weight gain and failure to thrive
Weight loss and growth retardation.
Malnutrition due to malabsorption
recurrent pneumonia
- Respiratory failure and cor pulmonale.
- delayed puberty
- sinusitis
- breathlessness
- salty sweat
- Chronic Bacterial Infection and Inflammation
- sometimes mucus can get compacted and can lead to mucus plug → BRONCHIECTASIS → = permanent dilation of bronchi walls s cough w lots of sputum can lead to haemoptysis

  • Biological Females able to conceive but often develop secondary amenorrhea
    (absence of menstruation) as disease progresses - irregular ovulation
  • Biological Males - infertile due to atrophy of vas deferens and epididymis
  • digital clubbing
  • nasal polyps
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7
Q

CF: investigations?

A
  • Clinical history
  • Family history of disease
  • One or more of these:
    • Sweat test: will show high sodium & chloride concentrations greater
      than 60mmol/L (Cl- will be higher)

Genetic screening for known CF mutations

  • Nasal Potential Difference Test - INTRANASAL TEST - TO SEE whether there is a negative transepithelial potential difference
  • Meconium Ileus is diagnosed by clinical and xray findings
    • air fluid levels
    • dilated bowel loops
    • soap bubble appearance / ground glass appearance
  • pulmonary function tests - showing obstructive pattern so → FEV1
    • cf exacerbaion if FEV1 is 10-15% decrease
  • chest x rays
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8
Q

CF: Mx?

A

Regular chest physiotherapy (postural drainage, forced expiratory
techniques)

  • BRONCHODILATORS
    • B2 adrenergic agonists (eg ALBUTEROL OR salbutamol) & inhaled corticosteroids (beclometasone) -purely for symptomatic relief
  • MUCOLYTICS
    • LIKE NEBULIZES n-ACETYLCYSTEINE
    • DORNASE ALPHA - these are to clear airways of mucus
  • anti-inflammatory agents
    • ibuprofen
    • glucocorticoids
    • antibiotc - azithromycin
  • Pancreatic enzyme replacement - ezyme supplements for pancreatic insufficency
  • Anti-pseudomonal antibiotic therapy.

Pseudomonal & flu vaccine

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9
Q

TB: primary TB pp?

A

Once inhaled into the lung, alveolar macrophages ingest the bacteria

  • MOST asymptomatic
  • some have flu-like symptoms

about 3 WKS AFTER INFECTION - cell-mediated immunity kicks in and GRANULOMA forms

→ try to wall of bacteria and bacteria in middle die → THUS = CASEOUS NECROSIS aka ghon focus!!!

→ travels to lymph nodes - ghon focuses in hilar lymph nodes!! = GHON COMPLEX (usually subpleural and lower lobes)

→ tissues that has granuloma in undergoes calcification and fibrosis AKA RANKE COMPLEX
miliary tuberculosis whereby TB spreads to other organs

Bacilli settle in lung apex. Macrophages and lymphocytes mount an effective immune response that encapsulates and contains the organism forever.

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10
Q

TB: define latent Tb?

A

In the majority of people who are infected, the immune system contains the infection and the patient develops cell-mediated immunity memory to the bacteria

This is latent TB

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11
Q

TB: symptoms?

on xray what do u see?

A 
Systemic features:
• Weight loss (most predictive of TB)
• Low grade fever
• Anorexia
• Night sweats (most predictive of TB)
• Malaise

Pulmonary TB

  • Can be asymptomatic
    • Productive cough with occasional haemoptysis
    • Chest pain
    • Breathlessness
  • Associated with on xray!!!:
    • Consolidation on CXR
    • Pleural effusion
    • Pulmonary collapse caused by compression of a lobar bronchus by enlarged nodes
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12
Q

TB: Mx?

- Compliance in taking TB medication is critical. Why?

A

RIPE!!!!!

Rifampicin (6 months).

Isoniazid (6 months).

Pyrazinamide (2 months).

Ethambutol (2 months).

Resistance and relapse may be likely if the patient is non-compliant.
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13
Q
  • Why does TB cause hypercalcaemia?
A

Granulomatous diseases -> increased vitamin D production and so increased bone resorption, increased absorption from gut and increased re-absorption from kidney.

This is also seen in sarcoidosis.
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14
Q
  • A special culture medium is needed to grow TB. What is the medium called?
A

Lowenstein Jensen Slope.

this medium: 

1. It contains growth factors that promote mycobacterial growth.
2. It contains small amounts of penicillin that prevent pyogenic bacteria growth.
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15
Q

Bronchiolitis: define and aetiology?

A

Bronchiolitis describes inflammation and infection in thebronchioles, the small airways of the lungs.

usually caused by avirus.

Respiratory syncytial virus (RSV) is the most common cause.

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16
Q

bronchiolitis: symptoms and abnormal airway signs?

A
  • Coryzal symptoms. These are the typical symptoms of a****viral upper respiratory tract infection: running or snotty nose, sneezing, mucus in throat and watery eyes.
  • Signs of respiratory distress

Tachypnoea(fast breathing)

Apnoeasare episodes where the child stops breathing\

Wheezeandcrackleson auscultation

  • Wheezingis a whistling sound caused by narrowed airways, typically heard during expiration
  • Gruntingis caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
  • Stridoris a high pitched inspiratory noise caused by obstruction of the upper airway, for example incroup
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17
Q

Bronchiolitis: Mx?

A

Mostly supportive
- O2, fluids, ventilatory support

Also palivizumab - is a mca that targets the rSV - respiratory syncytial virus

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18
Q

Bronchiectasis: define and aetiology?

A

Chronic infection of the bronchi and bronchioles leading to permanent
dilatation of these airways

Ectasis =dilation!!!!!

Aetiology =Results from pulmonary CHRONIC inflammation and scarring due to infection,
bronchial obstruction or lung fibrosis (e.g. following radiotherapy)

  1. Often post-infective e.g. previous pneumonia, TB or whooping cough infection.
  2. Congenital causes e.g. primary ciliary dyskinesia.
  3. 50% idiopathic.
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19
Q

Bronchiectasis: symptoms?

A

productive cough with large amounts of discoloured/pussy aka purulent sputum

and dilated, thickened bronchi detected on CT

  • Dyspnoea AKA SOB
  • foul-smelling mucus
  • Finger clubbing especially in cystic fibrosis
  • Wheeze
  • recurrent chest infections
  • Haemoptysis
    Chest pain
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20
Q

Bronchiectasis: investigations?

A
  • High resolution CT scan.
  • Spirometry - would be obstructive.
  • Sputum culture.
  • CXR. - dilated bronchi
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21
Q

Bronchiectasis: Mx?

A

. Education.

  1. Smoking cessation.
  2. Annual influenza and pneumococcal vaccinations.
  3. Antibiotics.
  4. Anti-inflammatories.
  5. Bronchodilators.
  6. Improved mucus clearance e.g. physiotherapy.
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22
Q

Pleural effusion: define

A

A pleural effusion is the excessive accumulation of fluid in the pleural space

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23
Q

Pleural effusion: pp?

A

Too much fluid is produced: either due to

  • Transudative pleural effusion - transparent i.e. less protein:
    • When too much fluid starts to leave the capillaries
    Due to either:
    • increased hydrostatic pa
      • Eg due to HF (bc blood backs up into pulmonary vessels and inc pathus forcing fluid out of capillaries into pleural space)
    • Or decreased on oncotic pa
      • Due to solutes not being able to move across capillary eg due to cirrhosis and nephrotic syndrome
  • Exudative effusion - exudes proteins:
    • Due to inflammation of pul capillaries → thus makes them more leaky bc the larger spaces between endothelial cells = → allows fluid, immune cells, large proteins eg lactate dehydrogenase to leak out
    • Due to trauma, malignancy, inflammatory conditions eg lupus and infection eg pneumonia like an abscess
24
Q

Pleural effusion: investigations?

A
  1. Take a good history.
  2. Imaging.
  3. Thoracentesis - can tell you transudates v exudates.
  • decreased breath sounds
  • dullness to percussion
  • decreased tactile fremitus
  • Diagnostic aspiration:
    • Known as thoracentesis or pleural tap • Needle inserted under anaesthesia
    • Transudative fluid = clear
    • Exudative fluid = cloudy and full of immune cells and much more proteins
    • Lymphatic fluid = milky and filled w fats
25
Q

Pleural effusion: Mx?

A
  • Depends on the underlying cause
    • Exudates are usually drained if symptomatic
    • Transudates are managed by treatment of underlying cause - Malignant effusions usually reaccumulate after drainage
26
Q

Pneumothorax: define

A
  • Means air in the pleural space
  • Leads to partial or complete collapse of the lung
  • Can occur spontaneously OR secondary to other things like trauma, medical interventions (iatrogenic), lung pathology like infection, asthma, COPD
27
Q

pneumothorax: epidemiology?

A

Spontaneous pneumothorax is most common in young males -

Generally a pneumothorax is MUCH MORE COMMON in MALES

  • Often patients are tall and thin
  • sudden shortness of breath
  • Maybe whilst playing sports
  • W pleuritic chest pain

Both lungs are affected with equal frequency i.e. can occur in any lung right or left equally

28
Q

Tension pneumothorax: define

A

When you have a one-way valve which LETS AIR IN but NOT AIR out

SO during inspiration - air is drawn into pleural space and during expiration - air is trapped in pleural space

This means → pneumothorax gets PROGRESSIVELY LARGER W EACH BREATH

→ THUS increased pa in thorax and pushes mediastinum across

→ THUS kinking big vessels in mediastinum and causing CARDIORESP arrest

  • A pleural tear creates a 1-way valve through which air passes in inspiration -> increased intra-pleural pressure -> respiratory distress, shock and cardiac rest.
29
Q

Tension pneumothorax: signs?

A
  • tracheal deviation away from affected side
  • Reduced air entry **
  • Increased resonance
  • Haemodynamic instability - tachycardia, hypotension
  • tachypnoea (rapid breathing),
  • Low O2
30
Q

Pneumothorax: investigations?

A
  • CXR:
    • DO NOT REQUEST IN TENSION PNEUMOTHORAX - WASTES TIME!!!!
    • Erect chest X-ray! - standing upright w lungs fully expanded
    • Look for area devoid of lung markings, peripheral to the edge of the collapsed lung
    • Measure the size of pneumothorax
  • CT Thorax
    • Can see small pneumothoraxes
  • Arterial Blood Gases (ABG):
    • In dyspnoeic patients check for hypoxia
31
Q

Pneumothorax and tension pneumothorax: : Mx?

A
  • NO SOB + <2CM
    • NO TREATMENT and follow up CXR bc usually spontaneously resolves
  • SOB and/or >2cm
    • aspirationBut if aspiration fails twice- have to do a chest drain to properly drain pneumothorax
  • Pneumothorax due to trauma, haemothorax or mechanical ventilation
    • requires a chest drain

For TENSION PNEUMOTHORAX: immediate needle decompression/aspiration

  • INSERT a large bore cannula into the 2nd intercostal space in the mid-clavicular line- Creates a way for air to get out - Needle aspiration to remove excess air
  • then chest drain inserted into triangle of safety (bc least likely to damage local structures) - 5th intercostal line, mid-axillary line, anterior axillary line - needle is inserted just above ribThen chest X-ray to check positioning

DO NOT WAIT FOR INVESTIGATIONS

  • do needle aspiration then chest drain!!!!! - NEEDLE ASPIRATION FIRST
32
Q

Whooping cough: define

A

Contagious infection caused by bacteria bordatella pertussis

Caused by Bordatella pertussis, a GRAM-NEGATIVE COCCOBACILLUS (ROD)

33
Q

Whooping cough: symptoms?

A
  • violent coughing spells or paroxysms
  • The swollen airways make whooping noise
  • Incubation period is 7-10 days
    • Bordatella pertussis is in resp tract and hasn’t multiplied enough to create damage
Catarrhal phase (1-2 weeks):
• Patient highly infectious/contagious
Rhinorhoea (nasal cavity congested with significant amount of mucus) 
- **cough**
- **Low grade fever**

Paroxysmal phase (1-6 weeks):
• Begins 1 week later from catarrhal phase
• Coughing spasms - machine gun bursts - uninterrupted fits of coughing - whopping noise
vomiting
• Cough for more than 14 days - collapsed lung, broken ribs, petechiae

34
Q

Whooping cough: investigations?

A

Best to diagnose during catarrhal phase so ab can kill bacteria and reduce damage

  • But culture of a nasopharyngeal swab remains necessary for definitive
    diagnosis
  • Identifying DNA of bacteria by PCR tests are rapid and highly sensitive
  • Direct fluorescent antibody - detects bordatella pertussis antigens
  • pertussis serology - looking for antibody response **
35
Q

Whooping cough: Mx?

A
  • Antimicrobials such as macrolides e.g. AZITHROMYCIN OR CLARITHROMYCIN will eliminate carriage of bacteria and reduce symptoms in catarrhal stage and early paroxysmal stage
    In the paroxysmal stage, antibiotics have little role to play in altering the course of the illness
  • PREVENT transmission to other individuals by isolating infected individuals and giving AB prophylaxis to hosuehold contacts
  • Vaccination - Acellular pertussis as part of the dTap vaccine (diptheria, tetanus and acellular pertussis) at 2,3,4 months and 3-4 years -
36
Q

aspiration pneumonia: define?

A

develops as a result ofaspiration, meaning after inhaling foreign material such as food

37
Q

CAP and HAP pneumonia: aetiology?

A

Organism indicated in CAP:

  • Streptococcus pneumoniae (most common)!!! - Gram positive cocci chain. Alpha haemolytic and optochin sensitive.
  • Haemophilus influenzae
  • Atypical:
    • Mycoplasma pneumoniae
    • Chlamydophila pneumoniae
  • Organisms indicated in HAP:
    • GRAM-NEGATIVE BACTERIA:
      • Pseudomonas aeruginosa
      • E.coli
      • Klebsiella pneumoniae
    • Staphylococcus Aureus including MRSA
38
Q

Pneumonia: symptoms?

A

productive cough (pus or bloody sputum) so or haemoptysis

  • Fever +/- raised respiratory rate & heart rate and low BP
  • sweats
  • Rigors
  • Malaise
  • Delirium (acute confusion associated with infection)
  • Sepsis
  • Myalgia, headache, arthralgia suggests atypical pneumonia.

Dyspnoea and breathlessness

Pleuritic chest pain - (sharp chest pain worse on inspiration)

39
Q

Pneumonia: characteristic chest signs?

A
  • Bronchial breath sounds. These are harsh breath sounds equally loud on inspiration and expiration. These are caused by consolidation of the lung tissue around the airway.!!!!
  • Focal coarse crackles. These are air passing through sputum in the airways similar to using a straw to blow in to a drink.
  • Dullness to percussiondue to lung tissue collapse and/or consolidation.
  • Pleural effusion - stony dull percussion
  • Crackles and wheeze.
  • Abnormal vital signs.
40
Q

Pneumonia: investigations?

A

CXR: - look for air bronchogram in consolidated area.

  • dullness to percussion = consolidation
  • tactile vocal fremitus - when u can feel more vibrations from person’s back on repeating certain phrases
  • late inspiratory crackles
  • bronchial breath sounds
  • ESR & CRP are usually significantly elevated
  • Biochemistry:
    • For urea, electrolytes and LFTs
    Blood tests:
    • FBC
  • Microbiological tests:
    • Sputum culture and antibiotic sensitivities +/- Gram Stain
    • Blood culture (low sensitivity)
    • Serology - for viruses and atypical organisms
  • CURB-65 is used to assess severity of CAP!!!!: CRB-65 out of hospital and CURB-65 in hospital - One point each for:
    • Confusion
    • Urea (greater than 7mmol/L)
    • Respiratory rate greater than 30/min
    • BP less than 90mmHg systolic and/or 60mmHg diastolic
    • Age greater than 65
41
Q

Pneumonia: Mx?

A

Maintain O2 stats between 94-98%

  • First dose of antibiotics should be administered within 4 hours of presentation in hospital and treatment should not be delayed whilst investigations are awaited
    • Mild CAP: 5 day course of oral antibiotics (amoxicillin or macrolide)!!!!!
    • Moderate to severe CAP: 7-10 day course of dual antibiotics (amoxicillin and macrolide)!!!
    • severe pneumonia (a CURB65 score of >3) = IV co-amoxiclav and clarithromyocin.
    • severe pneumonia (a CURB65 score of >4) be treated = in hospital, consider admission to critical care.
42
Q

Pneumonia: prevention?

A
  • Polysaccharide Pneumococcal Vaccine (protects against 23 serotypes)
  • Influenza vaccine to those who are older than 65 years,
    immunocompromised or with medical co-morbidities
  • Smoking cessation
43
Q

asthma: 2 types?

A
  • Allergic/eosinophilic asthma (70%):*
    → due to Allergens (e.g    . fungal allergens and pets etc**.) & atopythere’s 2 types within this:
  • Extrinsic (atopic):
    • Occurs most frequently in atopic individuals
    • Childhood asthma often accompanied by eczema
  • Intrinsic
    • allergens not relevant
    • Often starts in middle-aged
  • Non-allergic/non-eosinophilic (30%):
    • Exercise, cold air & stress
    • Smoking & non smoking associated
    • Obesity associated
44
Q

asthma: 3 cracteristics?

A

Three characteristics:

  • Airflow limitation - usually reversible spontaneously or with treatment
  • Airway hyper-responsiveness
  • Bronchial inflammation with T lymphocytes, mast cells, eosinophils
    with associated plasma exudation, oedema, smooth muscle hypertrophy, mucus plugging and epithelial damage
45
Q

asthma: smptoms?

A
  • Intermittent dysponea (difficulty breathing)
  • Wheeze or high pitched whistline
  • chest tightness
  • Cough (especially nocturnal) - frequent symptom in children
  • Sputum - may be curschmann spirals mucus plugs or casts from small bronchi OR charct-leyden crystals - small needle=shaped from breakdown of crystals
  • Diurnal variation - often worse in the morning
  • Symptoms worse at night
  • Episodic shortness of breath
46
Q

asthma: investigations?

A
  • RCP3 questions: used to assess the severity of asthma.
    • Recent nocturnal waking?
    • Usual asthma symptoms in day?
    • Interference with ADLs? (activity of daily living) - May also want to ask about whether the patient has used any rescue medications.
  • Lung function tests:
    • Peak expiratory flow rate (PEFR) - measurement on waking, prior to taking a bronchodilator and before bed, after a bronchodilator - variable

Spirometry - useful in assessing reversibility - should show an obstructive pattern; FEV1 < 80%, FEV1/FVC < 0.7, PEFR - variable

Test for atopy - RAST, Skin prick tests to help identify allergic trigger factors

  • Criteria for diagnosis
    • *1. RR > 25.**
    • *2. HR > 110.**
    • *3. PEFR 35-50% predicted.**
    • *4. Unable to complete a sentence in one breath.**
47
Q

asthma: mx?

A
  • SABA mild
  • SABA + ICS
  • SABA + LABA + ICS
  • SABA + LABA + ICS + 4th drug e.g. anti-IgE monoclonal etc. severe
  • Bronchodilators: so
    • Beta2-agonists: so SABAs like salbutamol or LABA Salmeterol Formoterol (full agonist)
  • Anti-inflammatory steroids so eg
    • • Inhaled corticosteroids (ICS):!!!!!!!!
      eg • Prednisolone
      • Beclomatasone
      • Budesonide

acute severe asthma = Nebulised salbutamol with oxygen. IV corticosteorids and abx if evidence of infectio

48
Q

sarcoidosis: symptoms?

A

OFGREN’S SYNDROME:

  • ERYTHEMA NODOSUM
  • bilateral hilar lymphadenopathy
  • polyarthralgia - joint pain in multiple joints

Typically presents with bilateral hilar lymphadenopathy, pulmonary infiltration and skin or eye lesions

cute sarcoidosis commonly presents with erythema nodusum (red lumps form on the shins and less commonly thighs and forearms)

Constitutional symptoms:
• Fever
• Weight loss
• Fatigue

• Dry cough
• Progressive dyspnoea/SOB
wheeze

Other symptoms:
• Lymphadenopathy also MEDIASTINAL lymphadenopathy (abnormally large lymph nodes in mediastinum) →
• Hepatomegaly and/or liver nodules and/or liver cirrhosis and/or cholestasis
• Deranged LFTs
• Splenomegaly
• Conjunctivitis
• Glaucoma
• Anterior uveitis (inflammation of the middle eye)!!!!!!!!!!!!!!!
Bell’s palsy
- pulmonary fibrosis
- pul nodules
- Lupus pernio - blueish-red/purple nodules and plaques over nose, cheek and ears
• Renal stones
• Cardiac arrhthmias
• Heart block or BBB

49
Q

sarcoidosis: investigations? gs?

A
  • Tissue biopsy OF SKIN : GOLD STANDARD
    • DIAGNOSITIC
    • Shows NON-CASEATING GRANULOMATA
    • Bronchoscopy OF mediastinal lymph nodes
    • histology will show non-caseating granulomas w epitheliod cells)
  • CXR:
  • Used for staging:
    • Stage 0 - normal
    • Stage 1 - Bilateral hilar lymphadenopathy (BHL)
  • high res CT - pul nodules
  • **MRI - cns involvement*
    *
  • PET scan - active areas of inflammation
- **Blood tests:**
• Raised ESR
• Lymphopenia
• Raised LFT
**• Raised Ca2+**
• Raised immunoglobulins
• **Serum ACE (angiotensin converting enzyme)**
• 24 hour urinary calcium if blood serum normal
    - **soluble IL-2 receptors**
    - **raised CRP**
    - **raised immunoglobulins**
50
Q

sarcoidosis: mx?

A
  1. no treatment for no/mild symptoms
  2. oral steroids (6-24mth course) - Prednisolone orally then gradually reduce dose • In severe illness give IV methylprednisolone
    1. bisphosphonates to protect bones whilst they’re on steroids
  3. immunosuppressants - methotrexate or azathioprine

in v severe lung disease = → lung transplant

  • Treat extra-organ complications
51
Q

pul htn: define

A

increased blood pa in pul circulation

  • Normal mean pulmonary artery pressure (mPAP) is 14 +/- 3 mmHg with an upper limit of normal of 20mmHg
    • Pulmonary hypertension is defined as an mPAP of above 25mmHg as measured at right heart catheterisation and secondary right ventricular failure
  • The lung circulation offers a low resistance to flow compared to the systemic circulation (about 90mmHg)
52
Q

pul htn:

A
  1. Hereditary.
  2. Idiopathic.
  3. Drug use.
  4. HIV infection.
  5. Pulmonary hypertension secondary to left heart disease (valvular, systolic/diastolic dysfunction

most commonly develops as a result of LEFT HD

chronic lung disease → typicall causes hypoxic vasoconstriction - when an area in lung is diseased and unable to deliver O2 to blood

chronic thromboembolic pul hypertension

53
Q

pul htn: symptoms?

A

Initial symptoms:

1. Dyspnoea on exertion.

  1. Lethargy.
  2. Fatigue.
  3. Syncope.

Symptoms as RV failure develops:

  1. Pulmonary oedema.

2. Abdominal pain.

  • Exertional dyspnoea, lethargy and fatigue are the initial features due to an inability to increase cardiac output with exercise
  • if LHS HF = orthopnoea - shortness of breath when lying flat
54
Q

pul htn: ix?

A
  • auscultation - Loud pulmonary secondary sound.
  • Right parasternal heave.
  • CXR:
    • Enlarged proximal pulmonary arteries which taper distally
    • Enlarged heart
    • May also reveal cause of pulmonary hypertension e.g. emphysema or calcified mitral valve
  • ECG:
    • Right ventricular hypertrophy and P pulmonale (tall & peaked P wave     in)
  • ECHO cardiogram:
    • Right ventricular dilatation and/or hypertrophy
    • Can show cause of pulmonary hypertension e.g. intra-cardiac shunt
  • Spirometry
  • In advanced disease there are signs of RHF, elevated JVP, hepatomegaly and pleural effusion etc.
  • LFTs to detect portal hypertension
  • Autoimmune screening
55
Q

pul htn: mx?

A
  • Treat underlying cause
    • is cardiogenic in nature → meds to boost heart’s performance or decrease BP
    • if pul arterial htn → Oral endothelin receptor antagonist e.g. bosenten OR prostacyclins
  • Oxygen
  • Warfarin - due to intrapulmonary thrombosis
  • Diuretics for oedema
  • Oral calcium channel blockers as pulmonary vasodilator

med 2a (13 decks)

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