Vascular Diseases of Lungs
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Transcript of Vascular Diseases of Lungs
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Vascular Diseases of Lungs
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Pulmonary Hypertension
It is the increase in blood pressure in pulmonary arteries, veins and capillaries .
It leads to shortness of breath, dizziness and faintingM:F ratio 1:3Prevalence 15/million
Primary vs secondary
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Presentation
Gradual onset of dyspnea and fatigue
Non productive cough
Syncope
Peripheral edema (ankle swelling)
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Types
Arterial
Venous
Capillary
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PathogenesisArterial: vasoconstriction due to vascular hyper-reactivity due to endothelial dysfunction (low PG, NO, high endothelin)– thickening and fibrosis of blood vessels – increase pulmonary arterial pressure – increase work load to the right side of the heart – right ventricular hypertrophy – RV failure – less blood to the left side of heart – hypoxemia – systemic congestion of blood (liver, lower ankle swelling, increased jugular veinous pressure)
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PathogenesisVenous: no obstruction of blood flow – Due to left side heart failure – pooling and congestion of blood in lungs – increase hydrostatic pressure in pulmonary veins – chronic process – pulmonary hypertension
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Pathogenesis
Capillary: due to lung disease eg. idiopathic pulmonary fibrosis.
There is generalized fibrosis of the alveolar walls – changes of the capillary network due to loss and fibrosis – arterialization of capillaries – increase resistance and pressue
Generalized hypoxia - vasoconstriction
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CausesWHO group I: pulmonary arterial hypertension: disease of arteries, idiopathic pulmonary arterial hypertension, vasculitis, autoimmune diseaseWHO group II: Pulmonary hypertension associated with heart diseaseWHO group III: Pulmonary hypertension associated with lung disease: COPD, interstitial pneumonia..
WHO group IV: Pulmonary hypertension due to multiple pulmonary thromboembolismWHO group V: Miscellaneous: others eg. Sarcoidosis
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Diagnosis
Dyspnea, syncope
Elevated jugular venous pressue
Congested liver
Ankle edema
Clubbing of fingers
High pulmonary arterial pressure
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Pulmonary Thromboembolism
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Pulmonary Thromboembolism
Common clinical problem
Can be fatal
Frequently missed
Difficult to diagnose
95% thromboembolism of DVT (popliteal veins and larger veins of lower limb)
Predisposing factors for thrombosis
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Risk factors:
Prolonged bed rest, following major surgery, severe trauma, congestive heart failure, contraceptive pills, cancer
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Presentation
60-80% are asymptomatic
5% cause sudden death
10-15% cause lung infarction, presenting as sudden dyspnea, severe chest pain
3% are multiple and cause pulmonary hypertension
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Consequences of pulmonary thromboembolism:
1 .Fatal if it is large (Saddle embolus)
2 .Infarction :
small emboli, distal occlusion of pulmonary arteries, can be multiple, wedge shape, hemorrhagic “red” infarct
3 .Pulmonary hypertension: multiple, chronic
4 .Cor pulmonale
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Diagnosis
Needs high index of suspicion
Presentation: pleuritic chest pain, severe, with sudden dyspnea, history of DVT or risk for thrombosis
Imaging: x ray, CT scan, V/Q scan