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21 Cards in this Set
- Front
- Back
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What is Pulmonary HTN?
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MPAP > 25mmHg or > 30mmHg during exercise
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How is Pulmonary HTN Classified?
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Groups 1 -5
1. PAH 2. PVH 3. Resp/hypoxeima 4. Thombotic/embolic 5. Inflammatory affecting pul vasu |
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Mechanisms of pulmonary HTN?
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A - Hypoxic vasoconstriction
B - Decreased area of pulmonary vascular bed C- Volume and Pressure overload |
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Presentation of Pulmonary HTN?
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Dyspnea
Fatigue Substernal Chest pain Syncope symptoms of underlying disease |
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Findings on Physical Exam in Pulmonary HTN?
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Loud (palpable) S2
RV heave Right sided S4 Systoli Murmur (TR) RV failure signs if severe |
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Ix for Pulmonary Htn?
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CXR
ECG Echo Cardiac Cath PFTs Spiral CT V/Q scan Serology - ANA |
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Treatment of Pulmonary HTN?
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O2
Treat underlying cause Anticoag vasodialors CCB PDE inhibitos |
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What is a PE?
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Blood clot in pulmonary arterial tree with subsequent increase in pul vasuclar resistance and obstruction of blood supplying the lung parenchyma
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What percentage of patients with a PE have clincal signs of a DVT?
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Less than 30%
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What does Virchow's triad consist of ?
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Stasis
Endothelial damage Hypercoagulable state |
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Presentation of PE?
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Dyspnea
pleuritic chest pain hemoptysis syncope leg sympotms (DVT?) |
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Findings on Physical Exam in a PE?
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Tachypneea
tacycardia SaO2 <92% pleural rub hypotension fever |
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What is the scoring symstem used for PE? What does it give you?
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Well's PE Score
Gives an indication based on 7 criteria of the probability of a PE (low, intermediate and High) |
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Ix for suspected PE?
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D-dimer
ABG ECG CXR Echo V/Q scan Spiral CT Venous duplex Ultrasound or doppler |
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What is a D-dimer? Is it useful in PE?
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D-dimer are products of thrombotic/fibrinolytic process.
Useful in testing low probabilty pts as test is sensitive. |
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Findings on ABG in PE?
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Respiratory Alkalosis (think of V/Q curve)
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ECG findings in PE?
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Sinus Tachycardia
R Axis Dev RBBB S1-Q3-T3 wave changes |
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CXR findings in PE?
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Most often is normal!!!!
Subsegmental atelectasis pleural effusion (small) Hampton's Hump - wedge shape infarcted area Westermark's Sign - dilated proximal pulmonary artery with distal decreased lung markings (i.e. abrupt tappering of vessels) |
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Findings of PE on V/Q scan? Is this a good test?
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V/Q segmental mismatch - give PE probability in low, indeterminant or high
Very Sensitive test - consider if pt has normal CXR and no COPD....if neg then PE ruled out. |
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Treatment of PE?
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Admit
O2 Analgesics if chest pain initial Anticoagulation: -Get baseline: FBC, INR, aPTT, renal fx and LFTs -SC LMWH or IV heparin (dalteparin 200U/kg or enoxaparin 1mg/kg) Long Term Anticoagulation: -Warfarin, start same day and overlap with LMWH until INR 2-3 IV Thrombolytic therapy - If massive PE with clincal signs (i.e hypotension, RHF) IVC Filter - Only if DVT and absolute contrainidcation to anticoag or woreseing of PE after anticoag. - |
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Thromboprophylaxis Indications?
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Low Thrombosis risk (mobile medical patients /surgery less 30 mins) - no prophylaxis but early ambulation
Moderate Thrombosis Risk (most general, gyn, urological surgery and sick medical patients) - LMWH High Thrombosis Risk( arthroplasty, hip fracture surgery, major trauma, spinal cord injury) - LMWH, Warfarin, Fondaparinux High Bleeding Risk ( neurosurgery, intracrainal bleed, active bleeding) TED stockings, pneumatic compression devices |
