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35 Cards in this Set
- Front
- Back
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what is the definition of pulmonary hypertension?
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mean pulmonary arterial pressure greater than:
- 25 mmHg (rest) - 30 mmHg (active) |
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what is passive pulmonary HTN?
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no active disease in pulmonary vascular bed (problem is "further down")
- mitral stenosis - LV failure - atrial myxoma - pulmonary veno-occlusive disease |
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what is hyperkinetic pulmonary HTN?
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secondary to high pulmonary blood flow
- VSD - ASD - PDA |
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what is obstructive pulmonary HTN?
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secondary to resistance to flow through large pulmonary arteries
- PE - pulmonary a. stenosis |
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what is obliterative pulmonary HTN?
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secondary to resistance to flow through small pulmonary vessels due to parenchymal inflamm -> fibrosis
- primary pulmonary HTN (PPH) - collagen vascular diseases - CREST syndrome |
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what is CREST syndrome?
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systemic inflammatory rheumatic disease
- Calcinosis - Raynaud's syndrome - Esophageal dysmotility - Sclerodactyly - Telangiectasia |
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what is vasoconstrictive pulmonary HTN?
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secondary to resistance to flow due to hypoxia-induced vasoconstriction
- COPD - sleep apnea - chronic hypoxemia (many) |
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what blood problem can cause pulmonary HTN?
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polycythemia vera
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what are signs on PE that suggest pulmonary HTN?
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loud S2
sternal lift (RV dialation) |
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what are findings on ECG that suggest pulmonary HTN?
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things that suggest RVH:
R-axis deviation R-atrial abnormality |
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what are some findings on ECHO that suggest pulmonary HTN?
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dialated pulmonary artery
dialated/hypertrophied RA/RV abnl IV septum movement (incr pulm a. pressure on R-side cath) |
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what is primary pulmonary HTN?
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pulmonary HTN in the absence of disease of the heart or lung
"vicious cycle" - an abnl incr in pulmonary arteriolar resistance -> thickening of pulm arteriolar walls -> worsened pulmonary HTN -> thickening of the walls |
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how do you treat primary pulmonary HTN?
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pulmonary vasodialators (IV prostacyclins and CCBs)
anticoagulation (warfarin) lung transplant |
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what is the definition of cor pulmonale?
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RVH -> RV failure
secondary to pulmonary HTN (from pulmonary disease) |
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what is the mcc of cor pulmonale?
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COPD
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what does cor pulmonale look like on ECG?
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R-axis deviation
P pulmonale (peaked P waves) RVH |
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what are (2) radiographic signs of a PE seen on CXR?
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Hampton's hump: wedge shaped, pleural based consolidation associated with pulmonary infarction
Westermark's sign: dilation of the pulmonary a.s proximal to the embolus and collapse of the distal vasculature -> appearance of a sharp cut off (CXR's are usually nl) |
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what is the initial study of choice in an acute PE?
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helical CT
(V/Q scan if not available) |
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when should you order pulmonary angiography for a PE?
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if V/Q scan is negative but clinical suspicion is high
(however, make sure you do a duplex US of the LE's since a DVT will trigger txt) |
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what is the role of D-Dimer assays in PE diagnosis?
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a sensitive test (90-98%) if results are normal and clinical suspicion is low
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why is the specificity low for D-Dimer assays for PE diagnosis?
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it is also elevated in:
- MI - CHF - pneumonia - post-operative state |
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INR is a way of reporting __ in a standardized fashion
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PT
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Warfarin increases __ values
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INR (PT)
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therapeutic INR is ___
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2-3
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when is a a therapeutic INR of 2.5 to 3.5 recommended?
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prosthetic mechanical heart valves
prophylaxis of recurrent MI antiphospholipid antibody syndrome txt |
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how should acute anticoagulation therapy be given in the setting of a PE?
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bolus of heparin (unfraction/low-mw) followed by continuous infusion for 5-10 days
(goal: aPTT 1.5 to 2.5 times control) |
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what is the MOA of heparin?
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promotes the action of antithrombin III
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which type of heparin is better?
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low-molecular weight > unfractionated
(better bioavailability, just as effective) |
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when should warfarin therapy be started/ended in the setting of an acute PE?
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start on day 1 w/ heparin
(INR goal: 2 to 3) continue for 3 to 6 months |
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when should thrombolytic therapy be used for a PE?
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pts w/ massive PE and hemodynamically unstable
pts w/ RHF (streptokinase, tissue plasminogen activator/TPA) |
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how long after aspiration does it take for an aspiration pneumonia to start?
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2-4 days following aspiration
(in 40% of those who aspirate) |
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what are (2) steps to prevent aspiration?
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keep head of bed elevated
NG tube for stomach decompression |
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what is normal pulse oximetry?
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96-100%
(COPD pts usually have a low baseline) |
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what is a chronic CO2 retainer?
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common in COPD pts
- nl pH - incr HCO3 (if acute: low pH, nl HCO3) |
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what is the definition of massive hemoptysis?
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>600 mL of blood in 24 hrs
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