Vascular Lung Diseases Flashcards
What is an embolus?
A detached intravascular mas carried by the blood to a site in the body distal from its point of origin
What are the types of emboli?
Thrombi fat gas tumour foreign bodies
What is the most common type of emboli in pulmonary circulation?
Thromboemboli
Where is the most common source of a PE
DVT in pelvic and lower limb region
Iliofemoral- most likely
Popliteal- least likely
What is virchows triad?
Vessel wall problems
Hypercoagulation
Abnormal blood flow eg stasis
Who is at risk of a PE?
Thrombophilia contraceptive pill pregnancy pelvic obsturction trauma surgery cancer patients post MI Po hypertension/vasculitis
What are the symptoms of a DVT?
May be asymptomatic
Swolen, hot, red, tender
What are the possible differentials for a DVT?
Popliteal synovial rupture (bakers cyst)
Superficial thrombophlebitis
Calf cellulitis
How do you investigate a DVT?
Dopplers leg scan
CT of ileofemoral arteries, IVC and pelvis
What are the clinical features of a small PE?
Asymptomatic
recurrent Po hypertension
cor pulmonale
progressive dyspnoea
What are the clinical features of a medium PE?
pleuritic pain
Haemoptysis
Breathless
What are the clinical features of a large PE?
Cardiovascular shock
low BP
central cyanosis
death
What are the signs of a PE?
fever cyanosis tachypnoea tachycardia hypotension raised jvp pleural rub pleural effusion crackles
What investigations are used to diagnose a PE?
ABG- decreased PaO2 and SaO2 CXR normal- basal aelectesis, consolidation, effusion post infarct ECG- t wave invertion V1-V4 D dimer raised VQ scan CT pulmonary angiogram Ultra sound leg and pelvis Echocardiogram- pulmonary arterial pressure and RV size TLCO
How can you try find the underlying cause of the PE?
autoantibodies
coagulation factor scan
How can you prevent DVTs?
Early post op movement Compression stockings Calf muscle exercises Heparin Dabigatran- thrombin inhibitor Rivaroxoban/Apixaban- factor x inhibitor
What are the complications of PE?
Pulmonary infarct- probably have bronchial artery damage too
Pulmonary hypertension
Death
What is the treatment for a PE?
Anticoagulate
Begin heparin and warfarin for 3-5 days
Stop heparin when INR is greater than two
Continue warfarin for 3-6 months
What treatment may be considered in serious cases?
Thrombolysis- streptokinase A inhibitor
IVC filter
Thrombo embolectomy- RARE
Asiprin no role as antiplatelet
What should be done in the event of overanticoagulation?
Address underlying cause eg drugs
Stop anticoagulation
Prothrombin complex or fresh frozen plasma given
Reverse warfarin with vitamen K1- esp if liver disease
Reverse heparin with protamine
What drugs can interact with and increase anticoagulation of warfarin?
Alcohol Antibiotics Asprin NSAIDS amioderone Cimetidine Omeprazole
What is pulmonary oedema?
Fluid in the lung- interstitium and alveolar spaces included
What pattern of disease does pulmonary oedema cause?
Restrictive
What are the causes of pulmonary oedema?
1.Haemodynamic circulation (increasd hydrostatic pressure)
2.Due to alveolar lining or endothelium cell injury
Pneumonia- localised
ARDS- generalised
