sudden onset of unexplained dyspnoea, hameoptysis?, pleural pain? - massive PE: syncope, central chest pain, shocked - chronic PE: progressive dyspnoea, weakness, PH, cor pulmonale

Vascular Diseases Flashcards by Costanza Cascio

True/False:

Frequent flyers are more likely to have a PE?

True

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classes of PE?

massive, chronic

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What is a PE?

a thrombus that forms in the peripheral veins which may dislodge and embolize in the pulmonary arterial system

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What is a big risk of PE?

pulmonary hypertension & pulmonary infarction

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What is pulmonary infarction?

when an embolus blocks bronchial arterial supply

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what is the pathophysiology of PE?

lung tissue is ventilated but not perfused resulting in dead-space. the area of affected lung no longer produces surfactant hence alveolar collapse occurs

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True/False:

Proximal embolus is worse than a distal embolus?

False:

distal is worse- it can cause alveolar haemorrhage (haemoptysis) and pleural inflammation with pleural effusion

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What causes a PE?

DVT, septic emboli

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Give an overview of DVT…

class: distal/proximal
symptoms: swollen, tender, red leg
ix: leg USS, CT
Ddx: baker’s cyst, thrombophlebitis, calf cellulitis
Rx: compression stockings, LMWH, DOACs

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What Triad is associated to formation of an embolus?

Virchow’ Triad:

blood stasis
local injury
hypercoagulability

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Main causes of DVT…

Travel
Hypercoagulability
Recreational drugs
Old (>60)
Malignancy
Birth control pills
Obstetrics/ obesity
Surgery 
Immobilisation
Smoking

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symptoms of PE..

sudden onset of unexplained dyspnoea, hameoptysis?, pleural pain?

massive PE: syncope, central chest pain, shocked
chronic PE: progressive dyspnoea, weakness, PH, cor pulmonale

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Signs of PE…

tachypnoea, hypotension, tachycardia, crackles over area, cyanosis, pleural effusion

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Ix for PE…

CXR: blunting of costophrenic angle
ECG: right ventricular hypertrophy 
ABG: dec PaO2
PESI: pesi score
V/Q: shows perfusion defects
CTPA: CT Pulmonary angiogram 
D-Dimer: if -ve, very likely patient has PE/DVT

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Which Ix is gold standard for PE?

CTPA

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Tx for acute PE?

O2 (60-100%), initial anticoagulation (LMWH), fluids, thrombolysis, surgical embolectomy

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Tx for chronic PE?

intra vena cava filter

- prophylaxis: LMWH, vit K antagonists (warfarin), DOACs

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length of treatment for PE?

unprovoked 1st PE: 6 months 
provoked 1st PE: 3 months 
unprovoked low risk distal DVT: 3 months 
high risk proximal DVT: 6 months 
Chronic: life-long

What is pulmonary oedema (PO)?

accumulation of fluid in the lung (interstitium or alveolar space)

What is the pathophysiology of PO?

cellular injury in alveolar lining cells or alveolar endothelium

True/False:

PO has an obstructive pattern of disease

False:

Has restrictive pattern of disease

What are the classes of PO?

Localised or general, acute

What is ix for PO?

CXR- indistinctness of hilarious fields

What is tx for PO?

diuretics, haemofiltration

What is the pathogenesis of Adult Respiratory Distress Syndrome (ARDS)?

infiltration of inflammatory cells which causes injury to cell membrane

What is the first sign of ARDS?

non-cardiac PO

What is the pathology of ARDS?

fibrosing of alveolar walls, inflammation, cellular regeneration

What is the presentation of ARDS?

PH & Cor Pulmonale, tachypnoea, central cyanosis, hypoxia, crackles

what is the Ix for ARDS?

CXR- diffuse shadowing

What is the Tx/Outcome for ARDS?

resolution & fibrosis mechanical ventilation NO

causes of ARDS?

Sepsis*, pneumonia, aspiration

What are the 5 causes of Pulmonary Hypertension (PH)?

1. Pulmonary Arterial HT (1y) 2. Left Heart Disease (2y) 3. Right Heart Disease (2y) 4. Pulmonary Vascular Changes (2y) 5. Miscellaneous (2y)

What are 2 classes of PH?

primary, secondary

What is PH?

mPAP> 25mmHg. results from high flow in a low pressure system. CP often associated

What is the pathophysiology of PH?

hypertrophy/fibrotic changes to distal pulmonary arteries (thickening of tunica intima- often due to atheroma).

Causes of PH...

Pulmonary system offers a low resistance pathway hence favourited for blood flow if cardiac disease present often leading to pulmonary artery remodelling at hence PH e.g. PE, emphysema, idiopathic, familial, drug and toxins, autoimmune rheumatic disease, congenital heart disease, HIV, portal HT

presenting symptoms of PH & Cor Pulmonale...

dyspnoea, fatigue, weakness, angina, syncope

signs of PH & cor pulmonale

central cyanosis, oedema, raised JVP, abdominal distension, murmur of tricuspid regurgitation, enlarged liver

Ix of PH...

FBC, CXR (enlargement of pulmonary arteries), ECG*, Echo*, right heart catherization

What is the gold standard Ix for PH?

Right heart catherixation

Tx for 1y PH?

IV Prostanoids, endothelia receptor antagonists, phosphodiesterase-5 inhibitors

2y PH Tx?

treat underlying cause e.g. PE

Give an overview of Cor Pulmonale?

what is it: right ventricular hypertrophy what is a common result: right heart failure symptoms: dyspnoea, fatigue, syncope signs: raised JVP, fluid retention e.g. Oedema Ix: ABG, CXR, ECG Tx: underlying condition, reduce pulmonary vascular resistance (O2), treat heart failure (diuretics etc)