Test 7.3 Flashcards
Elevated pulmonary arterial pressure and secondary right ventricular failure
Pulmonary hypertension
What is primary pulmonary htn caused by?
idiopathic
What is secondary pulmonary htn caused by?
PE COPD CT d/o Sleep apnea Congenital heart defects Sickle cell anemia Cirrhosis AIDS living at high altitudes Cocaine Pulmonary fibrosis Left sided heart failure
What part of the heart fails secondary to pulmonary htn?
Right sided heart failure
Average time from sx onset to dx of pulmonary htn
2 years
Early symptoms of pulmonary htn
Dyspnea
Weakness
Recurrent syncope
When is an echo useful in pulmonary htn?
If the underlying problem is right and left ventricular dysfunction
When is high res CT and VQ scan helpful in pulmonary htn?
If underlying problem is interstitial or thromboembolic dz
When is pulm. angiography useful in pulm htn?
Thromboembolic dz, high risk procedure
Pulm htn treatment
Refer to a specialist
CCBs, vasodilators, PDE-5 inhibitors (smooth muscle relaxation), endothelial receptor antagonists, diuretics, anticoagulants, soluble guanylate cyclase (sGC)
Which of the following is NOT PH treatment?
PDE-5 inhibitors, sGC, epithelial receptor agonists, vasodilators
Epithelial receptor agonists
Correct would be ENDOTHELIAL receptor antagonists.
An alteration in the structure and function of the right ventricle secondary to dz of the lung, thorax, or pulmonary circulation
Cor pulmonale
Adaptive response to long term increase in pressure resulting in right ventricular hypertrophy
chronic cor pulmonale
Dilation in response to increased pressure from PE or ARDS
Acute cor pulmonale
Cor pulmonale effects on Pulmonary Vascular Resistance,
RV afterload, CO, RV failure
Pulm. Vascular Resistance: Inc.
RV afterload: Increased
CO: Decreased
RV function: decreased
Most common cause of PE death
RV failure
Most common cause of cor pulmonale
COPD
What murmur goes along with cor pulmonale?
Systolic ejection murmur with click, S3/S4 with systolic tricuspid regurg
What’s the most accurate test to diagnose cor pulmonale?
Right heart catheterization
Cor Pulmonale Tx
Treat the cause: Anticoagulation for PE, bronchodilation for COPD, Oxygen therapy if PaO2 is <88%
COPD pts who develop cor pulmonale have a ____% chance of surviving 5 years
30
An abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption
Pleural effusion
Most common manifestation of pleural disease
Pleural effusion
Most common cause of pleural effusion (then two next most common)
- CHF
- Cancer
- Pneumonia
Why does CHF cause pleural effusion?
Increased capillary hydrostatic pressure
Why does cirrhosis cause pleural effusion?
Reduced intravascular pressure
Why does malignancy or PE cause pleural effusion?
altered permeability of pleural membranes. Malignancy also decreases lymph drainage due to blockage
Why does mesothelioma cause pleural effusion?
Reduced pleural space pressure
Extravascular fluid with low protein from atelectasis or heart failure
Transudates
Extravascular fluid with high protein from vessel alteration during inflammation. Caused by malignancy, pneumonia, PE, TB, pancreatitis
Exudates
Pleural effusion presentation
Dyspnea, cough, CP, LE edema, orthopnea, paroxysmal nocturnal dyspnea, TB or pneumonia
Night sweats, fever, hemoptysis, weight loss
TB
Fever, purulent sputum
Pneumonia
How much effusion do you need to get physical findings on exam?
at least 300 mL
Percussion note and tactile fremitus of pleural effusion
Dull
Decreased tactile fremitus
Other PE findings of pleural effusion
Diminished respiratory expansion Tracheal displacement toward effusion Diminished breath sounds Egophony Pleural friction rub
How well do physical findings and CXR work for diagnosing pleural effusion?
not very helpful. Use thoracocentesis
Pleural effusion tx
Drain if 500-1000 mL Manage infx Pleurodesis Thoracostomy Vasodilators Diuretics Anticoag for PE
Most common exudative cause of pleural effusion
Parapneumonic
Collapsed lung. Occurs when air leaks into the pleural space causing lung to collapse
Pneumothorax
PTX symptoms
Chest pain (sharp on affected side) Dyspnea
