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CR - Pul Path (iv) Vasc Lung Diseases (PE (risk factors (surgery, leg…
CR - Pul Path (iv) Vasc Lung Diseases
PE
Complication of DVT
over 95% arise from here
usually popliteal vein or higher
blockage of pul art or 1 of its branches
source = venous circulation or right heart
true incidence of non-fatal PE unknown (often undxed)
risk factors
surgery
leg injury/trauma
long haul flights
oral contraception
hypercoaguable genetic mutations (factor V leiden, protein C/S deficiency, antithrombin III deficiency, homocysteinuria, lupus anticoagulant aka antiphospholipid syndrome)
immobilisation
prolonged bed rest
CHF
pregnancy (increased pressure on LL veins)
malignancy
connective tissue disease
peripartum
IBD
nephrotic syndrome
sepsis
thrombophilia
prosthesis/devices
a fib
virchow's triad
symptoms + prognosis depend on site (size of occluded art)
consequences
if in major vessel sudden back pressure on heart -> diminished CO -> acute heart failure + sudden death
vasospasm (via neurogenic mechanisms + mediator release)
ischaemia of downstream pul parenchyma
if occluded vessel is small result is much less catastrophic, may be clinically silent
clinical manifestations
60-80% silent
mass removed by fibrinolytic activity
bronchial circulation sustains viability of lung parenchyma
5% sudden death - when >60% of vasculature obstructed
10-15% obstruct small-medium branches
pul infarct
dyspnoea
pleuritic chest pain - adjacent pleura covered in fibrinous exudate - risk of effusion
haemoptysis
usually peripheral - based @ pleural surface - closest to blood supply
wedge-shaped
early stage: hyperaemia, haemorrhage (raised red-blue areas)
3% recurrent
pul hypertension
chronic cor pulmonale
pul vasc sclerosis
classic presentation
sudden pleuritic chest pain
SOB
hypoxia
syncope (hypoxia to brain)
seizures
decreased consciousness
new onset A fib
haemoptysis
non-thrombotic emboli: air, fat, amniotic fluid, foreign body, BM, septic
Hx
assess risk
examine LL for DVT
investigations
D-dimers
ABG
VQ scan (ventilation present, perfusion dimihsed)
CTPA = gold-standard
duplex US of LL to look for DVT
ECHO to look for central PE
ECG: tachycardia + S1Q3T3
management
find underlying cause
o2
pain relief
thrombolysis
long term anticoag
surgery - embolectomy
prevention
mobilisation
vena cava filters
TED (thromboembolic deterrent aka compression) stockings
anticoag
haemorrhage