Immediately from the ACCP Pulmonary drugs Board assessment 2009 direction, this article covers each subject in a concise, easy-to-use layout. Use as a self-study source to organize for the pulmonary medication subspecialty board exam.
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Examples include the elderly patient with congestive heart failure who sustains a hip fracture and the patient with a myeloproliferative disorder who is undergoing major surgery. Pathogenesis The Virchow triad of venous stasis, endothelial vascular injury, and hypercoagulability explains how various processes can interact to overcome antithrombotic defenses resulting in VTE. Vascular stasis predisposes the patient to VTE by allowing activated coagulation factors to remain undiluted and in contact with the vascular endothelium.
Country-specific regulatory agency approval status and functional class indications for PAH medications vary. From: Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest 2007; 131:1917−1928. increased serum B-type natriuretic peptide levels. Patients with persistent poor functional class or exercise capacity, severely reduced right heart function, a right atrial pressure Ͼ 15 mm Hg, or cardiac index Ͻ 2l/min/m2 should be considered for lung transplantation.
Imaging . study was the V/Q scan. A normal V/Q scan 24 Table 3. 0 Total score 0 to 3, low pretest probability 4 to 10, moderate pretest probability Ն 11, high pretest probability *Adapted from Tapson VF. Acute pulmonary embolism. N Engl J Med 2008; 358:1037–1052. finding provides compelling evidence against the diagnosis of PE. In one study of 515 consecutive patients with clinically suspected PE who had anticoagulation therapy withheld on the basis of a normal perfusion scan finding, only 3 patients had symptomatic VTE (PE, 1 patient) during a 3-month follow-up period.