Vascular Disorder

Question 1

What is pulmonary emoblism?

Answer 1

a potential fatal complication when the thrombus formation from the deep venous circulation travels up into the pulmonary tree

Question 2

What is the MOST COMMON cx of PE?

Answer 2

proximal DVT (above the knee)

Question 3

What can cx PE (other)?

Answer 3

• air
• amniotic fluid (pregnancy)
• fat (getting into accident)
• FB (IV drug users)
• parasite eggs
• septic emboli
• tumor cells

Question 4

Where does DVT occur?

Answer 4

• calf (20%): usually stays there
• Proximal (50%): half of these pts are asymptomatic
• Lower DVT (50-70%): turns into PE

Question 5

RF of PE?

Answer 5

VIRCHOW TRIAD
1) hypercoagulabilit: protein C&S def, Factor V ledien
2) venous statis (not moving)
3) injury to vessel wall (surgery)
2,3: orthopedic surgery, cancer 
1: not taking anticoagulants 
*30+ yo WOMEN + OCPs + smokers!*
pregnancy

Question 6

Pathphysiology of PE?

Answer 6

proximal DVT –> travels UP (via IVC, RA, RV) –> travels into lung arteries –> STUCK –> dead space (mismatch V/Q) –> SHUNT –> HYPOXEMIA occurs

Question 7

What is V/Q mismatch?

Answer 7

upper lobe has higher ventilation b/c d/t force of gravity, blood that enters the lungs naturally go towards the lower lobe
upper lobe: more vent than perfusion
lower lobe: less vent than perfusion

Question 8

Why is V/Q mismatch bad in PE?

Answer 8

the clot in lung artery will cause –> increase the blood perfusion in other arteries –> not enough O2 to oxygenated the blood –> HYPOXEMIA (cx of PE)

Question 9

PE of PE?

Answer 9

• dyspnea
• pain w/inspiration
• tachypnea (hyperventilation) –> cxing acute respiratory alkalosis on ABG
• HYPOXEMIA
• normal CXR
• NO lung dz

Question 10

Labs for PE?

Answer 10

• ECG: may look like MI
• ABGs: acute respiratory alkalosis
• D-DIMER: rule OUT if less than 500 mcg/L
• HELICAL CT PULMONARY ANGIOGRAPHY
• normal CXR (PE COULD should westermark, hampton’s hump)
• venous US (if normal, you can’t rule OUT PE, only DVT b/c clot may have moved up to the lungs)

Question 11

Tx for PE?

Answer 11

• anticoagulants: heparin then warfarin for 6 mo –> cxs the blood to thin out and lyse the clot
• vena cava filter (looks like spider legs trying to catch the clot)
• embolectomy
• thrombolytic (alteplase 100mg IV for 2 hrs) but ONLY USE if pt is at HIGH RISK OF DEATH; but DO NOT USE if: active internal bleeding, had a stroke w/in 2 months; uncontrolled HTN; surgery/trauma in 6 wks

Question 12

What is pulmonary htn?

Answer 12

increase blood pressure in the pulmonary artery (from the right ventricle)

Question 13

What is happening in pulmonary htn?

Answer 13

the arteries are closing in: increase systolic pressure of 30 or MEAN pressure of 20

Question 14

PE of pulmonary htn?

Answer 14

• dyspnea during exertion AND at rest
• syncope
• jugular venous distention b/c pt is having a hard time breathing
• MURMUR
• accented pulmonary valve (s2)
• right venticular hypertrophy (d/t the pressure going into the lungs)

Question 15

How to dx pulmonary htn?

Answer 15

-RIGHT HEART CATHERIZATION

Question 16

What is the criteria for dx pulmonary htn?

Answer 16

• pulm arterial pressure: greater than 25 mm (rest)
• pulmonary cap wedge pressure: less than 15 mm
• rule out other cxs of hypoxemia
• NO PE
• NO OTHER dz that might be systemic, hematologic, or metabolic related

Question 17

Tx of pulmonary htn

Answer 17

• O2
• digoxin (for left heart failure)
• vasodilators
• diuretics