Vascular Disease Flashcards
2 main features of pulm circulation
low pressure low resistance
mechs to prevent increased PVR
recruitment and distension of vessels
2 types of hypoxic vasoconstriction
focal alveolar hypoxia (pneumonia) vasoconstricts upstream of specific area
global alveolar hypoxia (lung disease, altitude)
cutoff for pulm HTN
mPAP over 25
3 states that could elevate mPAP
left atrial elevation- passive, from heart failure, mitral stenosis
CO elevation- hyperdynami, high flow states
PVR elevation- PE, tumor; PAH, emphysema, ILD; hypoxemia or hypercapnea
WHO group 1 PH
pulmonary arterial hypertension- constriction of smooth muscle w/ arterial wall thickening and small lumen, inflammation
WHO group 2 PH
from left heart disease, pressure buildup from LA
WHO group 3
lung disease- hypoxic constriction, sleep apnea, emphysema, fibrosis
WHO group 4
thromboembolic pulm HTN
WHO group 5
varied- like sarcoid, myeloproliferative disease, renal failure
physical exam signs of PH
loud P2, ejection murmur, parasternal heave
signs of RV failure maybe: JVD, edema, ascites
echo findings for PH
can see dilated RA, evidence of high PVR
dx of PH
need right heart cath- swan ganz
3 drug pathways for PAH tx
endothelin, NO, prostacyclin
target of prostacyclin drugs
GCPR in SMC, induce more cyclic AMP and vasodilaiton
target for endothelin drugs
antagonize ETA and ETB receptors in SMC- A causes vasoconstriciton and B dilaiton
want to be more selective for A
drug targets for NO, examples
sildenafil/tadalafil
inhibit PDE 5- causes buildup of cyclic GMP (messenger downstream of NO) leading to dilation
moa of riocuat
stimulate guanylyl cyclase in SMC, also raises cyclic GMP
PH managment (6)
- Ca blocker (group 1 PAH w/ response to vasodilator)
- diuretics
- O2
- anticoag
- surgery
- transplant
4 pulm pathophys consequences from PE
- increased alveolar dead space
- hypoxemia (V/Q mismatch, surfactant loss and atelectasis)
- hyperventilation
- pulm infarction
cardio consequences of PE
increased PVR leads to PH, right heart failure, hypotension, shock death
sx of acute PE
dyspnea, pleuritic pain,hemoptysis (last two w/ infarct), anxiety, syncope
4 main Dx tools for PE
D-dimer: to rule out in low likelihood pts, if below 500 can exclude
V/Q scanning (looking for discrepancy)
spiral or helical CT
*not for PE, but detection of DVT w/ echo is easy and same Tx
4 PE tx options
anticoag- heparin, warfarin (after heparin), DOACs
thrombolytics for massive PE w/ hemodynamic compromise
surgery- embolectomy
IVC filter
