Resp Vasc pathology Flashcards
increase physiologic dead space
Pulmonary embolism
Patients being weaned from mechanical ventilation typically breathe at ___ tidal volumes, with a compensatory ___ in respiratory rate
low
increase
Breathing at __ tidal volumes causes a higher proportion of each breath to be lost in dead space
low
*wasted ventilation (inefficient breathing).
Breathing at low tidal volumes causes a higher proportion of each breath to be lost in
dead space
*wasted ventilation (inefficient breathing).
Left-sided heart failure can cause secondary pulmonary hypertension via elevated left-sided diastolic filling pressures transmitting backward to the pulmonary veins, resulting in
pulmonary venous congestion/pressure
Hereditary pulmonary arterial hypertension is DIRECTLY caused by excessive vascular endothelial and _______ leading to vascular remodeling & increased pulmonary vascular resistance
smooth muscle cell proliferation
Typically affects young women and can be familial. It is characterized by luminal narrowing of the pulmonary arteries and arterioles, with medial hypertrophy, intimal fibrosis, and the eventual development of plexiform lesions.
Pulmonary arterial hypertension (PAH)
*treat with Bosentan (endothelin receptor antagonist)
Should be suspected in young (<40s ish) and otherwise healthy patients with fatigue, progressive dyspnea, atypical chest pain, or unexplained syncope.
Pulmonary hypertension
Long-standing pulmonary hypertension leads to hypertrophy and/or dilation of the right ventricle
aka ____
cor pulmonale
A (<40ish) y/o woman presents with progressive dyspnea and fatigue, sometimes with associated chest pain and exertional lightheadedness or syncope.
Pulmonary Hypertension
Due to right ventricular enlargement, a ____ is often present.
holosystolic murmur (due tp functional tricuspid regurgitation from annular stretching)
Large emboli lodge in the ______ (“saddle emboli”) and may cause severe hypotension or sudden cardiac death
pulmonary artery bifurcation
In most cases, pulmonary emboli are multiple, with the ___ lobes involved more often than the ___ lobes.
lower
upper
indicated in the treatment of massive PE complicated by hemodynamic instability.
Tissue plasminogen activator
*LMW Heparin (enoxaparin) for prophylaxis
dyspnea and fatigue and a loud pulmonic component of S2 suggestive of
Pulmonary arterial HTN
Pulmonary hypertension's effect on levels of endothelin NO/cGMP Prostacyclin/cAMP Thromboxane
↑
↓
↓
↑
The lungs are supplied by dual circulation from both the pulmonary and bronchial arteries. This ___ circulation can help protect against lung infarction due to pulmonary artery occlusion
collateral
*Patients with an underlying elevation in pulmonary venous pressure (decompensated HF) are likely to have lung infarction with PE due to the high pulm. venous pressure impairing collateral flow
Intrapulmonary shunting occurs when an area of the lung is adequately perfused but poorly ventilated. ___ causes intrapulmonary shunting
Pulmonary embolism
Pulmonary arterial hypertension is a common complication of ______ due to Intimal thickening of pulmonary ARTERIOLES
systemic sclerosis
This patient’s skin tightening on the fingers and Raynaud phenomenon are suggestive of CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia), which is strongly associated with systemic sclerosis. Vascular manifestations are common in systemic sclerosis, and some patients will develop
pulmonary arterial hypertension (PAH).
