CABS CHF, HF, Shock Flashcards
Phrenic nerve assists with sensory signalling from the
pericardium
Phrenic nerve innervates the
diaphragm to help with respiration
Cardiac innervation: _____ nerve innervates the efferent and afferent parasympathetic
vagus
Cardiac innervation: _____ and _____ ganglia innervates with efferent and afferent sympathetic
cervical and thoracic
Heart Failure is
syndrome of decreased cardiac output
(failure to meet its obligations)
Heart Failure presents with
fluid overload (large edematous legs/ pulm edema)
Classifications of HF
acute vs chronic
compensated vs decompensated
right sided vs left sided
systolic vs diastolic
Acute HF is
abrupt onset, more sudden/ severe sx
associated with acute heart disease
Chronic HF is
develops over months to years
more common
associated with cardiomegaly
hallmarked by fluid overload (peripheral edema, pulm edema)
Left sided HF is
most common type
left ventricular failure - decreased CO
leading to HTN, tissue ischemia, pulmonary edema (backing up into the right side)
Right sided HF is
right ventricular failure
primary causes: pulm HTN, pulm valve stenosis, increased preload, decreased contractility
secondary: m/c cause Left sided heart failure
Compensated HF
body is able to compensate for the underlying heart disfunction - typically decribes someone’s chronic state
Compensatory mechanisms during HF
body will try and fix the strain on the heart and decrease CO, in turn leading to the renin-angiotensin-aldosterone system being activated (thus making it worse)
Systolic HF is
left ventricle can’t squeeze effectively (HFrEF)
Diastolic HF is
cant dilate/ relax enough for the heart to properly fill (HFpEF)
How to measure EF?
ECHO
Causes of systolic HF
MI (m/c)
Dilated cardiomyopathy
tachyarrhythmia
Causes of diastolic HF
decreased preload
restrictive cardiomyopathy
pericarditis
increased afterload
Preload is
volume of blood in the ventricles at the end of diastole (end diastolic pressure)
Afterload is
resistance the left ventricle must overcome to circulate blood
increase afterload = increased cardiac workload
Presentation of HF includes
S3 heart sound
crackles (pulm edema)
elevated JVD
hepatojugular reflux
peripheral edema
SOB, orthopnea, PND
Ascites
Edema is
excess interstitial fluid volume, increased Na+ retention typically increases in edema
m/c in LE
Anasarca is
diffuse edema (everywhere)
Pitting vs non pitting edema
pitting - more common, typical underlying pathophysiology
non pitting - more reflective of lymphatic obstruction
Shock is
a life-threatening condition characterized by inadequate delivery of oxygen and nutrients to vital organs relative to their metabolic demand (inadequate O2 delivery/ nutrient supply) - resulting in end-organ dysfunction
Shock index =
HR / systolic BP
If shock index is greater than ___ this indicates
1
LV dysfunction, higher mortality rate
shock =
hypoprofusion
Cardiogenic shock results from
decreased cardiac function, typically LV
resulting in decreased perfusion to peripheral tissues
Cardiogenic shock is associated with
MI, arrhythmia, HF, valve dysfunction
Positive inotropic medications cause
increase muscular contraction
Positive chronotropic medications cause
increases HR
Vasopressors cause
vasoconstriction
If the IV infiltrates when giving vasopressors what can happen
leaks out into the tissues from the vein and can cause necrosis of the limb
Hypovolemic shock results from
decreased intravascular volume
marked by decreased preload, increased vascular resistance and decreased CO
seen with hemorrhage, capillary leak, GI losses, thermal burns
Distributive shock results from
redistribution of blood volume
systemic vasodilation - decreased preload
marked by decreased preload, increased systemic vascular resistance, mixed CO
think septic shock**, neurogenic shock, anaphylactic shock
Neurogenic shock results from
disruption of the autonomic pathway (this includes parasympathetic and sympathetic)
most commonly seen in thoracic level trauma
Neurogenic shock presents with
hypotension, bradycardia, flushing below (LE)
Obstructive shock results from
decreased venous return or decreased cardiac compliance (squeezed and obstructed)
obstructive shock is associated with
PE
