The NCCPA™ PANCE Pulmonary Content Blueprint addresses three types of pulmonary circulation disorders
| Cor pulmonale | Patient will present as → 65 y/o with 3 days of progressive dyspnea and purulent sputum production. The patient takes albuterol and tiotropium bromide for moderate COPD. His PMH is relevant for a 40 pack-year smoking history, type II DM, hyperlipidemia, and coronary artery stenting 2 years ago. PE shows barrel-shaped chest, inspiratory crackles, hepatojugular reflux, pulsus paradoxus, and ventricular gallop. His temperature is 38.1°C (100.5°F), the pulse is 130/min, respirations are 28/min, blood pressure is 130/84 mmHg, and pulse oximetry on room air shows an oxygen saturation of 86%. Right ventricular enlargement and eventually failure secondary to lung disorder that causes pulmonary artery HTN
DX: EKG: S1Q3T3
TX: Diagnose and treat the underlying condition before cardiac structure change becomes irreversible
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| Pulmonary embolism (ReelDx) | Patient will present as → 68 y/o F who underwent hip replacement surgery two weeks ago. The postoperative period was complicated by pneumonia, and the patient has been bed-ridden ever since. A nurse calls you to the patient’s room due to vital sign abnormalities and complaints of chest pain. The patient’s HR is 105 bpm, BP is 90/60 mmHg, RR is 35 rpm, and T is 100.2F. You note jugular venous distension and profound dyspnea. Upon auscultation, you notice tachypnea and crackles. Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs
Diagnosis: Well’s Score is used to assess the probability of pulmonary embolism
Tx: Heparin is the anticoagulant of choice for the acute phase with factor Xa inhibitors (eg, rivaroxaban, apixaban, edoxaban) and oral direct thrombin inhibitors (dabigatran) thereafter |
| Pulmonary hypertension | Patient will present as → 43 y/o F with a history of COPD presents to the office with worsening dyspnea, especially at rest. She also complains of dull, retrosternal chest pain. On examination, she has persistent widened splitting of S2. Radiographic findings (seen here) demonstrate peripheral “pruning” of the large pulmonary arteries. Blood pressure in the lungs is usually very low 15/5. In pulmonary hypertension, the pressure increases > 25 mmHg at rest
Diagnose with a right heart catheterization (gold standard) → most accurate measure of pressures
TX: identify and treat the underlying cause |
