Pulmonary Circulation (PEARLS)
The NCCPA™ PANCE Pulmonary Content Blueprint addresses three types of pulmonary circulation disorders
| Cor pulmonale |
Right ventricular failure secondary to pulmonary hypertension
- Etiology: COPD (most common), pulmonary embolism, acute respiratory distress syndrome
- Physical Exam: Lower extremity edema, neck vein distention, hepatomegaly, parasternal lift, tricuspid/pulmonic insufficiency, loud S2
- EKG: S1Q3T3
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| Pulmonary embolism (ReelDx) |
Dyspnea (most common) and pleuritic chest pain
- Virchow’s triad: hypercoagulable state, venous stasis, vascular injury
- Risk factors: Cancer, surgery, oral contraceptive pills, pregnancy, long bone fracture (fat emboli)
- Homan’s sign: (Dorsiflexion of the foot causes pain in calf) indicative of deep vein thrombosis
- EKG: Tachycardia (most common), ST changes, S1Q3T3 (Indicates cor pulmonale)
Imaging:
- Spiral CT: Best initial test
- Gold Standard is pulmonary arteriography
- Chest radiograph: Westermark's sign and Hampton's Hump - triangular infiltrate secondary to intraparenchymal hemorrhage
- Treatment: Heparin to Coumadin bridge. 3-6 mo treatment
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| Pulmonary hypertension |
Mean pulmonary artery pressure is ≥ 25 mmHg at rest (8-20 mmHg at rest is considered normal)
- May cause right ventricular hypertrophy
- Presentation: Dyspnea on exertion, fatigue, chest pain, edema
- Diagnose with a right heart catheterization
- Physical Exam: Loud P2, systolic ejection click, parasternal lift
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Back to PANCE Blueprint Pulmonary (10%)
