Vascular Diseases

by Jeremy Brown, PhD

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    The subjects of this lecture are pulmonary vascular diseases. Pulmonary circulation problems are very important, its particular pulmonary emboli and cor pulmonale are both very common conditions many patients will present with and you need to know about. Less common problems are pulmonary hypertension in which independent cor pulmonale, i.e. not associated with chronic hypoxic lung disease. Rare inflammatory disease of the pulmonary circulation called pulmonary vasculitis and arteriovenous malformations, which is where an artery, a pulmonary artery is directly connected to a pulmonary vein, and this is a congenital abnormality, which is very rare and I'm not going to discuss in any more detail today. Major haemoptysis which might be considered a problem with pulmonary circulation is discussed in the lecture on respiratory airway's disease. Some general principles about pulmonary circulation. The first is that the symptoms are not specific when you have pulmonary artery problems. That makes it hard to diagnose or think about the condition clinically. There are very few signs, which make it even harder to identify clinically. And the chest X ray is actually usually not particularly helpful, again making the diagnosis difficult. Finally, the lung diseases in general would normally affect spirometry, the pulmonary vascular diseases are the exceptions, they do not affect lung volumes, or the spirometry values, the FEV1 or the FVC. They do affect the transfer factor, so when requesting lung function tests and thinking about pulmonary vascular disease, you need a transfer factor to be able to identify whether they are present or not. So diagnosis of pulmonary circulation problems requires some form of imaging of the pulmonary arteries, that's normally a CT scan, but could be an MRI scan, or could even be an invasive angiography. It requires some form of imaging of the consequences of pulmonary artery circulation...

    About the Lecture

    The lecture Vascular Diseases by Jeremy Brown, PhD is from the course Pulmonary Vascular Disease. It contains the following chapters:

    • Pulmonary vascular diseases
    • Pulmonary emboli
    • Diagnosis of acute PEs
    • Treatment of PEs
    • Pulmonary hypertension
    • Chronic PEs/primary pulmonary hypertension
    • Treatment of pulmonary hypertension
    • Cor pulmonale
    • Pulmonary vasculitis

    Included Quiz Questions

    1. Spirometry and lung volumes
    2. Echocardiogram
    3. Transfer factor
    4. Oxygen saturations
    1. Raised serum D dimer level
    2. Raised serum troponin level
    3. Right ventricular dilatation visible on echocardiogram
    4. A large filling defect visible in the right pulmonary artery on the CT pulmonary angiogram
    1. Pneumonia
    2. COPD
    3. Multiple small pulmonary emboli
    4. Mitral valve disease
    1. Diuresis aiming for a fluid imbalance (output minus input) of greater than a litre per day
    2. Diuresis aiming for a fluid imbalance (output minus input) of no more than 500mls per day
    3. Correction of hypoxia
    4. Restriction of dietary salt intake
    1. Mesothelioma
    2. Granulomatosis with polyangiitis
    3. Tuberculosis
    4. Lung cancer

    Author of lecture Vascular Diseases

     Jeremy Brown, PhD

    Jeremy Brown, PhD

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    Section of PE has serious ommissions
    By Hamed S. on 02. March 2017 for Vascular Diseases

    No mention of the Well's Criteria! No mention of algorithm for the diagnostic work up of patients with suspected PE. This is inadequate for step 2.