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).
Hemosiderin-laden macrophages (“heart failure cells”) are a sign of chronic ___ and would not be present acutely.
lung congestion
Acute pulmonary edema is a common consequence of acute LV MI
Elevated ____ pressure in the pulmonary venous system leads to ENGORGED alveolar capillaries with fluid in the alveoli, appearing as ____ material on microscopy.
hydrostatic
acellular pink
Pulmonary embolism classically presents with sudden-onset shortness of breath and pleuritic chest pain. It causes hypoxemia due to
ventilation/perfusion mismatch
__ scans are helpful in evaluating for PE in patients whom angiography is contraindicated (eg, contrast allergy, renal failure).
V/Q
Advanced hypoxic lung disease (COPD, interstitial lung disease, OBESITY hypoventilation syndrome) is a common cause of
pulmonary hypertension
Increased right ventricular afterload
Lung specimen shows multiple WEDGE-shaped HEMORRHAGIC infarcts in the periphery of the lung, which, given this patient’s IVDU history, are most likely due to
septic pulmonary emboli due to tricuspid valve endocarditis
PE typically presents with hypoxemia due to ventilation/perfusion mismatch and acute respiratory _____
alkalosis (hypocapnia) due to hyperventilation/tachypnea
*bicarb wnl in an acute PE
*low HCO3- indicates renal compensation, which is expected with chronic respiratory alkalosis but should not be present with acute PE.
Hypoxemia from Reduced PiO2 indicates a High altitude
A-a gradient is
Normal
Hypoxemia from Hypoventilation can be due to CNS depression, & morbid obesity
A-a gradient is
Normal
Hypoxemia from Diffusion limitation can be due to Emphysema, or ILD
A-a gradient is
Increased
Hypoxemia from V/Q mismatch can be due to pulmonary embolism, pneumonia
A-a gradient is
Increased
involves acute neutrophilic lung inflammation with widespread alveolar damage due to proteases and reactive oxygen species, leading to, interstitial Hyaline formation, collagen deposition from fibroblast, failure of the vascular barrier and exudative pulmonary edema.
Acute respiratory distress syndrome
Microaspiration of vomit/GERD
Nearly drowning to death
can cause
Acute respiratory distress syndrome
IL-1, IL-6, TNF-alpha
The origin of pulmonary edema in ARDS is abnormal _____ rather than hydrostatic congestion due to left ventricular dysfunction (noncardiogenic).
vascular permeability
Exudation of fibrinous proteinaceous fluid into the airspaces, resulting in pulmonary edema. Surfactant is depleted and dysfunctional, leading to alveolar collapse
characteristic of
Acute respiratory distress syndrome
IL-1, IL-6, TNF-alpha
characterized by lymphocyte-driven granuloma formation (granulomatous inflammation) in response to extrinsic antigens (mold, bird dander).
Hypersensitivity Pneumonitis
Transudative pleural effusion caused by
increased hydrostatic pressure OR
decreased oncotic pressure
Exudative pleural effusion caused by
Increased vascular permeability
from inflammation/infection/malignancy
Pleural effusion fluid is typically milky white in gross appearance due to high triglyceride (chylomicron) content
Chylothorax
Decreased thoracic lymphatic flow
Increased intrapleural ____ occurs in large-volume atelectasis (lung collapse) and can lead to a transudative pleural effusion.
negative pressure
Increased intrapleural negative pressure occurs in large-volume atelectasis (lung collapse) and can lead to a ____ pleural effusion.
transudative
This diffuse atelectasis results in the characteristic reticular or ground-glass opacities on chest x-ray. Unlike alveoli, larger airways remain patent and filled with air due to their cartilaginous walls, making them visible (air bronchograms) against the reticular background.
Neo-natal Respiratory distress syndrome from insufficient surfactant
(can happen even if baby is NOT pre-term)
Complications of High Altitudes
Acute mountain sickness: Headache, fatigue, nausea
Cerebral edema (↓ PaO2 → ↑ cerebral blood flow)
Lethargy, confusion, gait disturbance
&
Pulmonary edema (unbalanced hypoxic vasoconstriction)
Dyspnea, cough ± hemoptysis, respiratory distress
alveolar-capillary membrane disruption
Hyper-resonant percussion =
Pneumothorax
Trachea away
Increased breath sounds =
Bronchial breath sounds
Crackles
Consolidation
Edema
Increased Tactile fremitus
Egophany (loud whisper/ e to a sound)
Consolidation
Edema
Increased Tactile fremitus
Egophany (loud whisper/ e to a sound)
Consolidation
Edema
Trachea deviates TOWARDS lesion
Atelectasis
*only one that does this
Decreased or absent breath sounds
Pleural Effusion
Atelectasis
Pneumothorax
Disruption of gas diffusion across alveoli or Ventilation/perfusion mismatch cause an ____ A-a gradient
elevated
