8.3 Pulmonary Vascular Diseases

Pulmonary hypertension and pulmonary embolism are serious conditions affecting lung blood flow. They strain the right heart, causing symptoms like shortness of breath and chest pain. Understanding their pathophysiology is crucial for effective management.

Diagnosis involves tests like CT scans and blood work. Treatment includes medications, oxygen therapy, and lifestyle changes. Nurses play a vital role in monitoring patients, administering treatments, and providing education on managing these complex pulmonary disorders.

Pulmonary Hypertension and Right Heart Impact

Pathophysiology of pulmonary hypertension

Top images from around the web for Pathophysiology of pulmonary hypertension

• 

  Frontiers | Pulmonary Hypertension in Aortic and Mitral Valve Disease View original

  Is this image relevant?

• 

  Pulmonary hypertension pathophysiology - wikidoc View original

  Is this image relevant?

• 

  Frontiers | Oxidative Stress and Its Implications in the Right Ventricular Remodeling Secondary ... View original

  Is this image relevant?

• 

  Frontiers | Pulmonary Hypertension in Aortic and Mitral Valve Disease View original

  Is this image relevant?

• 

  Pulmonary hypertension pathophysiology - wikidoc View original

  Is this image relevant?

1 of 3

Top images from around the web for Pathophysiology of pulmonary hypertension

• 

  Frontiers | Pulmonary Hypertension in Aortic and Mitral Valve Disease View original

  Is this image relevant?

• 

  Pulmonary hypertension pathophysiology - wikidoc View original

  Is this image relevant?

• 

  Frontiers | Oxidative Stress and Its Implications in the Right Ventricular Remodeling Secondary ... View original

  Is this image relevant?

• 

  Frontiers | Pulmonary Hypertension in Aortic and Mitral Valve Disease View original

  Is this image relevant?

• 

  Pulmonary hypertension pathophysiology - wikidoc View original

  Is this image relevant?

1 of 3

• Increased pulmonary vascular resistance constricts blood flow through lungs
• Elevated mean pulmonary arterial pressure (>25 mmHg at rest) strains right ventricle
• Vascular remodeling and narrowing of pulmonary arteries reduces blood flow capacity
• Endothelial dysfunction leads to imbalance of vasoconstrictors and vasodilators
• Platelet aggregation and in situ thrombosis further obstruct vessels

Pulmonary embolism: causes and diagnosis

• Pathogenesis
  1. Formation of thrombus, usually in deep veins of legs (deep vein thrombosis)
  2. Embolization of thrombus to pulmonary arteries
  3. Obstruction of pulmonary blood flow reduces gas exchange
  4. Releases inflammatory mediators causing bronchoconstriction
• Clinical manifestations
  • Sudden onset dyspnea often worsens with exertion
  • Chest pain (pleuritic) typically sharp and worsens with breathing
  • Tachypnea and tachycardia compensate for reduced oxygen
  • Hemoptysis indicates pulmonary infarction
  • Anxiety and restlessness result from hypoxemia and distress
• Diagnostic tests
  • D-dimer blood test screens for active clot formation
  • Computed tomography pulmonary angiography (CTPA) visualizes clots
  • Ventilation-perfusion (V/Q) scan assesses blood flow and air distribution
  • Pulmonary angiography gold standard but invasive
  • Echocardiography evaluates right heart strain

Management of pulmonary vascular diseases

• Pharmacological interventions
  • Anticoagulants for pulmonary embolism prevent clot propagation (heparin, warfarin)
  • Vasodilators for pulmonary hypertension
    • Prostacyclin analogs dilate vessels and inhibit platelet aggregation
    • Endothelin receptor antagonists block vasoconstriction
    • Phosphodiesterase-5 inhibitors enhance vasodilation
  • Diuretics for right heart failure reduce fluid overload
• Non-pharmacological interventions
  • Oxygen therapy improves tissue oxygenation and reduces pulmonary vasoconstriction
  • Pulmonary rehabilitation enhances exercise capacity and quality of life
  • Smoking cessation reduces further lung damage
  • Weight management decreases cardiovascular strain
  • Dietary modifications (low sodium diet) help manage fluid retention

Nursing care for pulmonary disorders

• Nursing considerations
  • Monitor vital signs and oxygenation status (pulse oximetry, arterial blood gases)
  • Assess for signs of right heart failure (jugular vein distension, peripheral edema)
  • Administer medications as prescribed, monitor for side effects
  • Position patient to optimize oxygenation (semi-Fowler's position)
  • Monitor for bleeding complications in anticoagulated patients (bruising, blood in stool)
• Patient education needs
  • Importance of medication adherence emphasize timing and dosage
  • Recognition of worsening symptoms (increased shortness of breath, chest pain)
  • Proper use of oxygen therapy equipment demonstrate and have patient return demonstration
  • Importance of follow-up appointments stress regular monitoring
  • Lifestyle modifications
    • Exercise recommendations tailored to individual capacity
    • Dietary restrictions explain rationale for sodium limitation
  • Smoking cessation strategies offer resources and support
  • Stress management techniques teach relaxation methods