tension pneumothorax - air continues to enter thorax - through tear in lung (tear forms a 1-way valve.
Boivin
pulmonary hypertension (PHTN) = mean pulmonary artery pressure > 25 mm Hg (mean = 2/3 diastolic + 1/3 systolic)
direct sign of PHTN = palpable P2
echo measures velocity of tricuspid regurgitation "jet" indirect measure of pressure in right ventricle. also measures RV volume
Swan Ganz = gold standard
etiology PHTN P=QR
increased Q increased R
pneumonectomy - all Q goes through remaining lung but P does not increase since R decreases. P = 2Q x 0.5R
Pulmonary embolism
S1Q3T3 (inverted T wave lead III)
Paul
pulmonary edema -
hemodynamic
protein loss; e.g., GI diseases with diarrhea
microvascular damage
undetermined cause; e.g., high altitude; neurogenic (head trauma)
hemosideren laden macrophages in chronic pulmonary edema (stress fracture of capillaries leaks RBCs into interstitium.
causes of sudden death
central pontine hemorrhage
v fib
saddle pulmonary embolism (obstructs both right and left PA)
primary (idiopathic) pulmonary hypertension = death sentence - due to inactivating mutations of BMPR2
secondary PHTN inc P = inc Q or inc R e.g., VSD, MS, thromboemboli,
thrombin cleaves fibrinogen into fibrin. thrombin also activates platelets.
fibrin monomers polymerize into clot.
hemophilia A,B, C
Fibrinolytic pathway - activates plasminogen
natural anti-coagulants and therapeutic anticoagulants (thrombin inhibitors; heparin which potentiates antithrombin). low molecular weight inhibits factor X.
Warfarin (coumadin) in vitamin K antagonist. (active ingredient of D-con rat poison)
INR measures extrinsic pathway
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