Pulmonary Vascular Disease
Objectives - Identify facts and principles about pulmonary embolism, pulmonary hypertension, and idiopathic pulmonary arterial hypertension as listed in the source overview.
Pulmonary Embolism
Pulmonary embolism is a sudden blockage of a pulmonary artery, most often from a venous blood clot or embolus.
High-yield source points:
- 80% originate from deep veins of the lower extremities.
- Pulmonary emboli occur more often in the right lung.
- They occur more frequently in lower lobes.
- They cause ischemia and infarction of lung tissue distal to the embolism.
- A large enough embolus can result in death.
Embolus Origin
Sources listed in the material:
- Deep vein thrombosis
- Fat from the marrow of a broken long bone, such as femur or pelvis
- Collagen or other tissue
- Part of a tumor
- Air bubbles
Pulmonary Embolism Signs and Symptoms
Signs and symptoms include:
- Severe dyspnea with rapid onset over seconds to minutes
- Pleuritic chest pain
- Cough
- Hemoptysis
- Tachycardia
- Diaphoresis
- Anxiety
Pulmonary Embolism Risk Factors
Risk factors listed in the source include:
- Advanced age
- Post-operative state
- Previous DVT
- Trauma
- Oral contraceptive use
- Thrombocytosis
- Prolonged bed rest
- Long periods of travel
- Cancer
- Obesity
- Smoking
- CVA
Pulmonary Embolism Diagnosis
Diagnosis can include:
- Patient history and physical
- Chest x-ray
- ABG
- D-dimer ELISA, which detects emboli
- V/Q scan
- CT
- Pulmonary angiography
Pulmonary Embolism Treatment
Treatment options listed in the source:
| Treatment | Examples or Notes |
|---|---|
| Thrombolytics | Eminase/anistreplase, Retavase/reteplase, Streptase/streptokinase/kabikinase, t-PA class including Activase, TNKase/tenecteplase |
| Anticoagulants | Heparin, Eliquis, etc. |
| Embolectomy | Surgical or percutaneous pulmonary embolectomy |
Pulmonary Hypertension
Pulmonary hypertension is defined in the source as mean pulmonary artery pressure greater than 25 mmHg at rest.
Normal mean pulmonary artery pressure is listed as 8-20 mmHg.
Pulmonary Hypertension Classification
Classifications listed in the source:
- Pulmonary arterial hypertension
- Congenital heart defect
- Liver cirrhosis
- Viral infections
- Drugs and toxins
- Pulmonary hypertension from left heart disease
- Pulmonary hypertension from lung disease or hypoxemia
- Chronic thromboembolism
- Multifactorial mechanisms
Pulmonary Hypertension Signs and Symptoms
Signs and symptoms include:
- Dyspnea
- Angina
- Syncope
- Cough
- Hemoptysis
- Loud second heart sound
- Right-sided third or fourth heart sound
Pulmonary Hypertension Diagnosis
Diagnosis can include:
- CBC
- HIV testing
- Rheumatologic panel
- Liver function panel
- EKG
- PFT
- Echocardiogram
- Pulmonary artery catheterization
- V/Q scan
- CT angiography
- Swan-Ganz catheter/pulmonary artery catheter
Pulmonary Hypertension Treatment
The source emphasizes treating the cause.
Treatment options listed include:
- Oral anticoagulation with INR around 2
- Oxygen therapy to prevent pulmonary vasoconstriction
- Diuretics
- Calcium channel blockers
- Prostanoids such as Flolan
- Lung transplant
High-Yield Review
| Topic | High-yield point |
|---|---|
| PE definition | Sudden pulmonary artery blockage, usually from a venous clot |
| PE origin | 80% originate from deep veins of lower extremities |
| PE onset | Severe dyspnea can develop rapidly over seconds or minutes |
| PE diagnosis | History and physical, chest x-ray, ABG, D-dimer ELISA, V/Q scan, CT, pulmonary angiography |
| PH definition | Mean pulmonary artery pressure greater than 25 mmHg at rest |
| Normal mPAP | 8-20 mmHg |
| PH treatment theme | Treat the cause; oxygen helps prevent pulmonary vasoconstriction |