Notes in Pulmonary Vascular Disease

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Published	11/02/2023	Pulmonary {{c1::HTN}} rare but deadly so need to recognize it Pulmonary {{c2::embolism}} is one of the most common disease entities you will encounter…
Published	11/02/2023	pulmonary circulation pressures are very LOW ({{c1::25}}/{{c1::8}}), flow is still very high (100%)PVR - {{c2::pulmonary vascular resistance}} Q - {{c…
Published	11/02/2023	the pulmonary circulation is a high {{c1::flow}}, low {{c2::pressure}}, low {{c2::resistance}} circuit
Published	11/02/2023	- if issues are pre-pulmonary capillary bed, then issues with {{c1::right}} side of heart - if issues are post-pulmonary capillary bed, then…
Published	11/02/2023	Pulmonary Vascular Resistance = △{{c3::Pressure}} / {{c3::Flow}} (output)- {{c2::resistance}} is inversely proportional to the {{c1::radius}}^4 (…
Published	11/02/2023	Pulmonary {{c1::hypertension}} is when mean PA pressure > {{c2::20}} mmHg- {{c3::PCWP}} is what differentiates between pre-capillary and post-capil…
Published	11/02/2023	5 classes of pulmonary hypertension1. {{c4::Pulmonary arterial hypertension (PAH)}}2. PH due to {{c3::left}} heart disease3. PH due to lung disease an…
Published	11/02/2023	Cor Pulmonale- RV unlike LV is thin walled and used to {{c1::lower}} pressures- ↑ PVR can lead to cor pulmonale RV {{c2::hypertrophy}} → ultimate…
Published	11/02/2023	Group 1: Pulmonary {{c6::Arterial}} Hypertension (PAH)• {{c7::Idiopathic}}: cause not known, uncommon • Heritable • {{c1::Drug}} & {{c1:…
Published	11/02/2023	{{c3::Idiopathic}} Pulmonary Arterial Hypertension• Uncommon, but more common in {{c2::women}} • Mean age late 40’s, but it can happen younger in…
Published	11/02/2023	Mediators in Group 1 PAH• Reduced {{c2::Nitric Oxide (NO)}} and {{c2::Prostacyclin}} (both are vasodilators) → {{c1::vasoconstriction}}* {{c…
Published	11/02/2023	Heritable PAH*still part of Group 1 PAH • Germline mutations in {{c1::BMPR2}} gene in 75% of familial and 25% of sporadic disease→ {{c1…
Published	11/02/2023	Drugs/Toxins implicated in Group 1 PAH → {{c1::Methamphetamine}}→ {{c1::Fenfluramine}}→ {{c2::Dasatinib}}: tyrosine kinase inhibitor used to trea…
Published	11/02/2023	Prevalence of PAH in {{c1::Connective}} Tissue Diseases1. {{c2::Systemic lupus erythematosus (SLE)}}2. {{c2::Mixed connective tissue disease…
Published	11/02/2023	Clinical Presentation of PAH• {{c2::Shortness of breath}} (unexplained with anything else) • Atypical chest pain • Palpitations  • Cough • …
Published	11/02/2023	Work-Up for PAH1. {{c1::Echocardiogram}} is the single most important {{c2::screening}} test→ should show elevated RVSP, RV dilation, RV dysfunct…
Published	11/02/2023	Pulmonary Hypertension Radiology- CXR: enlarged pulmonary {{c2::arteries}}, prominent {{c2::RA}}, and clear lungs- CT Angio: main PA / {{c1::ascending…
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Published	11/02/2023	Treatment of PAH- optimize therapy for related diseases- {{c2::supportive}} (O2, anticoagulation, diuretics, digoxin)- vascular targeted medication th…
Published	11/02/2023	most impotant risk factor for pulmonary embolism is {{c1::immobility}}
Published	11/02/2023	Venous thromboembolic disease• Deep Venous {{c1::Thrombosis}} +/- Pulmonary {{c1::Embolism}}Epidemiology for Pulmonary {{c1::Embolism}}- approximately…
Published	11/02/2023	Virchow's Triad*factors that can promote venous thrombosis: 1. Venous {{c1::Stasis}} 2. Hyper{{c2::coagulability}} 3. {{c2::Endothelial}} DamageT…
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Published	11/02/2023	{{c1::Homans}} sign for DVTs: pain in the calf with dorsiflexion
Published	11/02/2023	{{c2::supporting}} tests for pulmonary embolism *NOT {{c5::diagnostic}} tests- ECG: → usually ST/T changes→ sinus nonspecific {{c3::tac…
Published	11/02/2023	Diagnosing a Pulmonary Embolism1. Estimate Clinical Pre-Test {{c2::Probability}}*Wells Score2. {{c1::D-Dimer}} testing if indicated3. {{c1::Imaging}} …
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Published	11/02/2023	D-Dimerprotein fragment that is a byproduct of endogenous {{c1::fibrinolysis}}can be elevated due to other reasons (pregnancy, surgery/trauma, live …
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Published	11/02/2023	Treatment of PE with Anticoagulation (for stable patinets)- to prevent {{c1::future}} clots from developing and is NOT targeting the {{c1::current}} c…
Published	11/02/2023	Treatment of PE with Anticoagulation for UNSTABLE patients- {{c2::IVC filter}}: for patients with contraindications to {{c1::anticoagulation}}*also us…
Published	11/02/2023	Five groups of pulmonary hypertension: Group {{c1::1}} and Group {{c1::4}} are the only ones with treatment options Symptoms of PH are that of progres…
Published	11/02/2023	PE most commonly from lower extremity {{c1::DVTs}} {{c2::above::above/below}} the knee
Published	11/02/2023	Pre-test probability using a scoring system such as the Well’s criteria along with {{c3::D-Dimer}} is helpful to guide who requires further imaging DV…
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