Pearls from Dr. Kristin Burkart

56 y/o with progressive SOB found to have Pulm HTN

2016-07-25

  • Useful Facts:
    1. Venous Blood Gas: Useful to screen for hypercarbia (not hypoxemia). If elevated, will need an ABG.
    2. RVSP on TTE: Estimation is with large S.E. - need RHC to formally evaluate
    3. If RVSP >50 unlikely acute process since this degree of elevation in pressures acutely would cause RV failure and HD compromise
    4. Shunt Physiology: Increasing FiO2 will only result in minimal improvement in PaO2. With serial ABGs on different O2 settings can actually calculate shunt fraction.  
      • Intrapulmonary Shunt Examples:
        • Hepatopulmonary Shunt
        • Hereditary hemorrhagic telangiectasia

    Posted 07/25/16 02:16:36 PM by Adam Faye

  • Pulm HTN Groups:
    1. PAH (idiopathic, connective tissue disorders, drugs and toxins)
    2. Secondary to Left Heart Disease
    3. Secondary to chronic lung disease and/or hypoxemia
    4. CTEPH
    5. Multifactorial

    Posted 07/25/16 02:22:35 PM by Adam Faye

  • Vasoreactivity Test:

    CTEPH:

    Posted 07/25/16 02:24:34 PM by Adam Faye

  • Treatment of Pulmonary Arterial Hypertension

    Posted 07/25/16 02:31:07 PM by Adam Faye

  • 41 y/o with Hx of Sarcoid who p/w hemoptysis

    2016-11-10

  • Sarcoid - 2 potato sign on CXR (refers to hilar nodes)

    Posted 11/10/16 01:52:37 PM by Adam Faye

  • Pearls:

    Posted 11/10/16 02:07:52 PM by Adam Faye

  • Hemoptysis:

    Posted 11/10/16 02:15:48 PM by Adam Faye

  • Sarcoid Stages:
    1.  B/L hilar adenopathy (regression of nodes occurs in 75% of individuals)
    2.  B/L hilar adenopathy and reticular opacities (upper lobe predominant)
    3.  Reticular opacities with shrinking hilar nodes
    4.  Reticular opacities with evidence of volume loss
    Treatment:

    Posted 11/10/16 02:40:30 PM by Adam Faye


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