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25 Cards in this Set

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What are normal pressures in pulmonary circulation?
-RA is about 2 or less
-RV is 25/0
-LA is about 5
-LV is 120/0

-Pulmonary arteries is about 15-30/4-12
Why do venous thrombi occur?
Virchows Triad: Stasis of blood, vessel wall abnormalities, alterations in coagulation system
How does a thromboembolus affect circulation and ventilation
-Blood vessels beyond clot constrict.
-Can have atelectasis
-Lung bronchoconstricts in obstructed area
-Causes ventilation/perfusion mismatch
-Can cause a loss of surfactant
Some causes of PTE
-Malignancy and pregnancy cause hypercoagulable states
-CHF, Trauma, Burns
-Increased estrogen
-Some protein deficiencies
-Shock
What affects the prognosis of a PTE
The better the heart and lung function, the better survival chances are
Symptoms and signs of PTE
Symptoms: dyspnea, pleuritic pain (on inspiration), cough, hemoptysis, palpitations, wheezing, leg swelling

Signs: Tachypnea, Rales, Tachycardia, changes in cardiac sounds (S4, increased P2), Fever, RV lift, pleural rub, cyanosis, DVT
What about the As gradient
Abnormal in PTE

above 10 is abnormal
what would be on your differential for PTE
Acute MI, pulmonary edema, asthma/copd exacerbation, atelectasis, pericarditis, dissecting aneurysm, pneumonia, pleurisy, PA thrombosis, pneumothorax
How do you diagnose PTE?
-V/Q Lung Scan- inhale a substance and inject one and compare...
-Pulmonary Angiography- gold standard... it involves a catheter in pulmonary circulation, the dye is nephrotoxic and may cause renal dysfunction and has to be done by interventional radiologist

CT angiography is most often used now. Echocardiography and MRI/MRA are possible
How do you treat PTE?
Usually anticoagulants

You can put in a vena cava filter. You can use thrombolytics, give oxygen, or do surgery too.
Define pulmonary htn
Systolic greater than 30 or diastolic greater than 15 or mean pressure greater than about 18

A rapid increase in pulmonary htn like with a PTE can cause RV failure. If changes are gradual, the RV can accomodate by hypertrophying and dilating.
What are the principal mechanisms of pulmonary htn?
1. Increase LA pressure
2. Increase pulmonary blood flow
3. Increase pulmonary vasculature resistance
-can be vasoconstrictive (hypoxemia), obstructive (PE), or obliterative process (tumors, emphysema)
What can increase risk of pulmonary htn?
-connective tissue disease like RA, scleroderma, lupus, liver dz
-HIV
-familial
As PAP increase what else happens?
PVR also goes up... eventually CO goes down and this causes PAP to drop because you are in heart failure.
A young woman concerned about weight experiences dyspnea on exertion....
Think diet suppressants like Fen Fen. They are linked to primary pulmonary htn. There will be an increase in smooth muscle of small pulmonary arteries.
What is Cor Pulmonale?
Right sided heart disease due to any primary lung disease. It is commonly seen with pulmonary HTN. Symptoms of right heart failure.
Someone presents with symptoms like cor pulmonale
Could be chronic thromboembolic pulmary HTN. It is a from pulmonary emboli that don't go away. Consider going on anticoagulants, an IVC filter, and surgery. Thrombolytics won't work either.
What is the first symptom of pulmonary HTN?
1. exertional dyspnea

then chest pain, syncope, hemoptysis, hoarseness, precodial discomfort, cyanosis
Treatment for Pulmonary HTN?
-treat modifiable factors first
-Medications like calcium channel blockers
-can do surgery like atrial septostmy, pulmonary thromboendocarterectomy, lung transplant
What are the stages of pulmonary edema?
-first, interstitial edema. this will cause impairment of gas exchange
-alveolar edema occurs next.
What governs the formation of pulmonary edema?
Starling's Law
What other things can cause pulmonary edema?
-Altitude can cause it acutely
-Neurogenic pulmonary edema can occur
-Increased capillary permeability
-Decreased lymphatic drainage
What implies that pulmonary edema may be cardiogenic?
Orthopnea, S3, paroxysmal nocturnal dyspnea, increased JVD
How do you manage pulmonary edema?
Diuretics, Oxygen, Morphine, bronchodilators, vasodilators, inotropic support
Why would you get a paraxical emboli without an Atrial septal defect?
Pulmonary AV malformation can cause this. It is an abnormal connection between artery and vein. Most cases are congenital and up to half of these are due to Hereditary Hemorrhagic Telangectasia (Osler-Weber-Rendu Disease). People with this get nose bleeds, telangectasia, and have a positive family history. People with AV malformations get cyanosis, clubbing fingers, erythrocytosis, brain abscesses, and hypoxemia.