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63 Cards in this Set

  • Front
  • Back
Normal capillary wedge pressures:
6-12 mmHg
What type of catheter measures capillary wedge pressure?
Pulmonary artery (Swan-Gantz) catheter
Tall spiking wave forms on PA catheter indicate you are located in the ?
If you're in the PA, pressures you measure just behind the balloon reflect pressures in ?
10-15% of all hospital mortalities!
pulmonary embolism
3 Reasons for clot (Wirchow's triad):
1) stasis
2) vessel wall abnormalities
3) alterations in coagulation system
Four effects of PE on pulmonary fxn:
1) circulation - vessels constrict and blood is shifted to other areas of lung
2) ventilation - bronchoconstriction in obstructed area, shifting ventilation to better perfused areas
3) ventilation/perfusion mismatch
4) loss of surfactant
Risk factors for venous thromboembolism:
IMMOBILITY, hypercoaguable states (pregnancy, malignancy), CHF, trauma, burns, shock, lupus, prior VTE, high estrogen, protein deficiencies (protein C, protein S, AT3)
The ____the prevalence of underlying CV disease the ___ likely that you will survive an embolic event.
greater, less
Symptoms of PE:
dyspnea, pleuritic pain, cough, hemoptysis, palpitations, wheezing, leg swelling
Signs of PE:
tachypnea, crackles/rales, tachycardia, S4, increased P2, fever, RV lift, pleural rub, cyanosis, DVT
Alveolar arterial O2 gradient
non-specific tool to determine normality of pulmonary fxn
How do you calculate alveolar O2?
PAO2 = FiO2(Pbar - PH2O) - (PCO2/R)
How do you calculate arterial O2?
Normal A-a gradient:
8-10 mmHg
DDx for PE:
AMI, PEdema, Asthma, COPD exacerbation, atelectasis, pericarditis, dissecting aneurysm, pneumonia, pleurisy, PA thrombosis, pneumothorax
Gold standard for diagnosing PE
pulmonary angiography
Potential problems w/ pulmonary angiography:
1) cath in pulmonary circulation
2) renal dysfxn b/c dye is nephrotoxic
3) done by interventional radiologist
Why is CT better than pulmonary angiography?
1)no special technique
3)contrast through regular IV
Mainstay of treatment for PE
anticoagulation w/ heparin or warfarin
Used for patients w/ PE that can't tolerate anticoagulation.
Vena Cava Interruption (Filter)
Supportive measures for PE
fluids for BP, supplemental O2
What are some other things that can cause a PE besides a clot?
fat, bone marrow, amniotic fluid, foreign bodies, air, tumors
Pulmonary HTN is an increase in ?
Pulmonary Arterial Pressure
Pulmonary HTN defined as ?
sytolic P > 30 mmHg
diastolic P > 15 mmHg
mean P > 18-20 mmHg
w/ exercise systolic P > 35 w/ mean P > 30
Gradual PA pressure increases will cause RV to?
hypertrophy and dilate, ultimately failing
Sudden PA increases (above 40 mmHg) will cause RV to?
Three principal mechanisms for pulmonary HTN:
1) increase in LA pressure
2) increase in pulm blood flow/volume
3) increase in pulm vasculature resistance
Increases in pulm vasculature resistance can be caused by?
vasoconstriction (hypoxemia), obstruction (PE), or obliteraion processes (tumors, emphysema)
Precapillary pulm HTN is due to?
vascular mechanisms - left to right shunting, primary pulm HTN, PTE disease
Pleuropulmonary HTN is due to?
emphysema, pulmonary fibrosis, ARDS, severe air space disease, interstitial disease
alveolar hypoventilation by way of chronic hypoxemia
Postcapillary pulmonary HTN is due to?
LV failure, mitral valve disease
Pulmonary venous HTN is due to?
Pulmonary Occlusive Disease, mediastinal granulomas/neoplasms
Pulmonary HTN is ____ in general population.
very low
How does pulmonary HTN progress?
eventually CO will fall, pulmonary pressuress fall, leading to right heart failure
Primary PHTN is more common in?
pre-menopausal females
What is the initial symptom of primary PHTN?
What does primary PHTN look like histologically?
increase in smooth muscle of small pulmonary arterioles
What appetite suppressant was associated w/ PHTN?
Fen Phenylalanine
Right sided heart disease due to any pulmonary lung disease.
Cor Pulmonale
Pulmonary emboli that don't resolve or go away leading to scarring of pulmonary vasculature.
Chronic thromoboembolic PHTN
Treatment of Chronic Thromboembolic PHTN.
Manifestations of PHTN.
exertional dyspnea, chest pain, syncope, hemoptysis, hoarseness, precordial discomfort, cyanosis, increased P2, S4, RV heave
Treatemnt of PHTN:
modify factors leading to disease, Ca channel blockers, surgery
Surgical opttions for PHTN:
atrial septostomy
pulmonary thromboendoarterectomy
lung transplant
Classes of PHTN by NYHA
Class I - no symptoms, 58.6 months
Class II - 58.6 months
Class III - 31.5 months
Class IV - can't get out of bed, 6 months
Abnormal accumulation of liquid and solute in extravascular spaces and tissues in the lung.
pulmonary edema
Two stages of pulmonary edema:
interstitial edema - fluid invades interstitial space, widening of alveolar walls and lymphatic channels, impairment of gas exchange
alveolar edema - fluid and solute in alveolar spaces, gas exchange is further impaired
Pathogenesis of PEd often seen w/ heart disease.
increase capillary hydrostatic pressure
What can cause PEd due to decrease in interstitial pressure?
rapid evacuation of an effusion or pneumothorax
Pathophysiology involved with PEd caused by nephrotic syndrome
decrease in colloid osmotic pressure b/c of protein loss
HAPE stands for?
high altitude pulmonary edema
Consequences of PEd?
decreased lung compliance
increased airway resistance
shorter breaths
increased pulmonary vascular resistance
Symptoms of PEd due to cardiogenic dysfxn?
orthopnea, S3, paroxysmal nocturnal dyspnea, and increasd JVD, peripheral edema
Management of PEd?
treat underlying cause, diuretics, O2, morphine, bronchodilators, vasodilators, and inotropic support
Abnormal connection btwn artery and vein in lung.
Pulmonary arterio-venous malformation
Pulmonary AV malformations are usually?
congenital (half due to Hereditary Hemorrhagic Telangectasia, AKA Osler-Weber-Rendu Disease)
Inheritance of HHT/OWR disease?
Characteristics of HHT/OWR disease.
recurrent nose bleeds, telagectasia

Patients develop cyanosis, clubbing, and polycythemia due to chronic hypoxemia.
Complicationns of AV malformations?
paradoxical embolus, brain abscess, and hypoxemia
Why do AV malformations lead to infarcts, abscesses, etc?
b/c the capillary bed is bypassed where bacteria and clots are usually trapped
Causes of Pulmonary artery aneurysms?
congenital, infection, vasculitis
Treatment of pulmonary artery aneurysms?