Pulmonary 1021 Pulmonary Vascular Disease

Front 1

What is hte most common cause of pulmonary vascular congestion?

Back 1

left heart disease, increased left atrial pressure, congestion of pulmonary veins and capillaries

Front 2

How is the arterial side of the pulmonary vascular system affected by left heart failure?

Back 2

strong regulation by pre-capillary arterioles, so it does not affect the arterial side of the lung capillaries

Front 3

What is the pathogenesis of pulmonary edema?

Back 3

increased pressure in veins and capillaries, pulmonary lymphatics push fluid out, fills lung interstitium, fluid makes lung tissue less compliant and impairs gas exchange

Front 4

How do heart failure cells form?

Back 4

chronic congestion leads to leakage of red cells from vessels, hemolyse, macrophages eat the hemosiderin

Front 5

What happens with acute left heart fialure?

Back 5

large quantities of fluid fill alveolar spaces, profound dyspnea, cough of frothy fluid

Front 6

What is the most common inciting cause of ARDS?

Back 6

septicemia

Front 7

What are the inciting causes of ARDS?

Back 7

severe pneumonia, massive aspiration, severe trauma, hypovolemia/hypotension, burns, pancreatitis, liver failure

Front 8

What happens in the early stage of ARDS?

Back 8

proteinaceous eosinophlic exudates form membranes along damaged alveolar walls

Front 9

What happens in the proliferative phase of ARDS?

Back 9

reparative metaplasia of alveolar epithelial cells and development of intra-alveolar and interstitial granulation tissue become more prominent

Front 10

What happens in the organization phase of ARDS?

Back 10

scars, local hypoxia and reflex hypoxic vasoconstrction, pulmonary hypertension

Front 11

What causes primary thormbosis of pulmonary arteries?

Back 11

chornically increased pulmonary arterial pressure or vasculitis

Front 12

What are the symptoms of pulmonary embolus?

Back 12

dyspnea, chest pain, circulatory compromise

Front 13

What causes death in pulmonary embolism?

Back 13

occlusion of pulmonary bed to critical degree, abrupt right heart failure with insuffficient forward flow to sustain left atrial return and forward left ventricular output to systemic vascular beds
lethal arrhythmia by abrupt right heart failure/pulmonary hypertension

Front 14

What do smaller pulmonary emboli cause?

Back 14

pulmonary hypertension, cor pulmonale

Front 15

What factors increase risk of pulmonary infarction following embolus?

Back 15

congested, inflamed, collapsed
oxygenation of pulmonary parenchyma

Front 16

Which vessels oxygenate the pulmonary parenchyma?

Back 16

bronchial arteries, pulmonary ventilation

Front 17

What does a pulmonary infarct look like on CXR?

Back 17

pneumonia, tumor, pleuritis

Front 18

What can cause secondary pulmonary hypertension?

Back 18

congenital heart disease, chronic recurrent pulmonary thromboembolism, collagen vascular/autoimmune diseases, living at high altitude

Front 19

What mutation causes primary pulmonary hypertension?

Back 19

mutation of BMPR2 (TGF-beta related gene)

Front 20

What are the histologic changes associated with chronic pulmonary hypertension?

Back 20

muscle in walls of peripheral arteries, increase in medial thickness of normally muscular arteries, intimal proliferation, intraluminal angiomatous proliferation

Front 21

What is the major gross change of pulmonary hypertension?

Back 21

secondary atheromas in larger pulmonary arteries

Front 22

What changes are associated with advanced chronic pulmonary hypertension?

Back 22

vascular changes, esp in smaller vessels, decreased volume of pulmonary vascular bed, decreased pulmonary blood flow, increased pulmonary artery pressure, pulmonary vascular resistance, right ventricular hypertrophy and dilation

Front 23

What happens when you have a parenchymal lung disease with hypoxia?

Back 23

chronic reflex hypoxic vasoconstriction, hypertrophy of vascular smooth muscle, increased vascular resistance, hypertension