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Part 2 book “Revision Notes for the respiratory medicine specialty certificate examination” has contents: Eosinophilic lung disease, sleep disorders, disorders of the mediastinum and pleura, occupational and environmental lung disease, lung transplantation, invasive and non-invasive ventilation, and other contents. | Chapter PULMONARY VASCULAR DISEASE 8 Pulmonary embolism (PE) Risk factors Major (relative risk 5–20): recent surgery (abdominal/orthopaedic), postoperative ITU, late pregnancy/puerperium, Caesarean section, lower limb fracture, varicose veins, malignancy (abdominal/pelvic/metastatic), previous thromboembolism, immobility. Minor (relative risk 2–4): congenital heart disease, cardiac failure, hypertension, oestrogen supplementation, neurological disability, occult malignancy, thrombotic disorders, long distance travel, raised BMI. Clinical findings (in order of decreasing prevalence) Symptoms: dyspnoea, pleuritic pain, subcostal pain, cough, haemoptysis, syncope. Signs: tachypnoea (≥20/min), tachycardia (>100/min), clinical deep vein thrombosis (DVT), fever (>38.5°C), cyanosis. Investigation Assess probability of PE using a clinical scoring system, e.g. Wells score, Geneva score (see Chapter 16: Respiratory scoring systems and statistics). D-dimer: Perform only if low or intermediate clinical probability of PE: If negative, PE is reliably excluded. False positives with sepsis, neoplasia, inflammation, trauma, pregnancy, etc. Imaging: CT pulmonary angiogram (CTPA) recommended for initial imaging; if negative, PE is reliably excluded. Isotope lung scanning may be used for initial imaging if: facilities are available on site, CXR is normal, there is no concurrent cardiopulmonary disease, standardized reporting criteria are used, a non-diagnostic result is always followed by further imaging if negative, PE is reliably excluded. ECHO will confirm right ventricular (RV) strain/failure. The BTS recommend screening for thrombophilia (present in 25–50% with DVT/PE) in those aged 3 Woods units. PULMONARY VASCULAR DISEASE Classification 1: Pulmonary arterial hypertension (PAH): Idiopathic. Familial: defects in BMPR2/ALK 1. Drug/toxin induced: e.g. fenfluramine, dexfenfluramine, toxic rapeseed oil, .
