Vascular Disease

Question 1

2 main features of pulm circulation

Answer 1

low pressure low resistance

Question 2

mechs to prevent increased PVR

Answer 2

recruitment and distension of vessels

Question 3

2 types of hypoxic vasoconstriction

Answer 3

focal alveolar hypoxia (pneumonia) vasoconstricts upstream of specific area

global alveolar hypoxia (lung disease, altitude)

Question 4

cutoff for pulm HTN

Answer 4

mPAP over 25

Question 5

3 states that could elevate mPAP

Answer 5

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

Question 6

WHO group 1 PH

Answer 6

pulmonary arterial hypertension- constriction of smooth muscle w/ arterial wall thickening and small lumen, inflammation

Question 7

WHO group 2 PH

Answer 7

from left heart disease, pressure buildup from LA

Question 8

WHO group 3

Answer 8

lung disease- hypoxic constriction, sleep apnea, emphysema, fibrosis

Question 9

WHO group 4

Answer 9

thromboembolic pulm HTN

Question 10

WHO group 5

Answer 10

varied- like sarcoid, myeloproliferative disease, renal failure

Question 11

physical exam signs of PH

Answer 11

loud P2, ejection murmur, parasternal heave

signs of RV failure maybe: JVD, edema, ascites

Question 12

echo findings for PH

Answer 12

can see dilated RA, evidence of high PVR

Question 13

dx of PH

Answer 13

need right heart cath- swan ganz

Question 14

3 drug pathways for PAH tx

Answer 14

endothelin, NO, prostacyclin

Question 15

target of prostacyclin drugs

Answer 15

GCPR in SMC, induce more cyclic AMP and vasodilaiton

Question 16

target for endothelin drugs

Answer 16

antagonize ETA and ETB receptors in SMC- A causes vasoconstriciton and B dilaiton

want to be more selective for A

Question 17

drug targets for NO, examples

Answer 17

sildenafil/tadalafil

inhibit PDE 5- causes buildup of cyclic GMP (messenger downstream of NO) leading to dilation

Question 18

moa of riocuat

Answer 18

stimulate guanylyl cyclase in SMC, also raises cyclic GMP

Question 19

PH managment (6)

Answer 19

• Ca blocker (group 1 PAH w/ response to vasodilator)
• diuretics
• O2
• anticoag
• surgery
• transplant

Question 20

4 pulm pathophys consequences from PE

Answer 20

• increased alveolar dead space
• hypoxemia (V/Q mismatch, surfactant loss and atelectasis)
• hyperventilation
• pulm infarction

Question 21

cardio consequences of PE

Answer 21

increased PVR leads to PH, right heart failure, hypotension, shock death

Question 22

sx of acute PE

Answer 22

dyspnea, pleuritic pain,hemoptysis (last two w/ infarct), anxiety, syncope

Question 23

4 main Dx tools for PE

Answer 23

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

Question 24

4 PE tx options

Answer 24

anticoag- heparin, warfarin (after heparin), DOACs

thrombolytics for massive PE w/ hemodynamic compromise

surgery- embolectomy

IVC filter