Cardiac - Class 3 - Alterations in Cardiovascular Function Flashcards
What does the prognosis of a MI depend on?
■ Extent of tissue death
■ Surrounding tissue
■ Location
● MI can occur in various regions of the heart wall: anterior, inferior, posterior, lateral, subendocardial, transmural
Causes of Angina?
1.) Obstruction
● Vessel spasm
● Atherosclerosis (stable plaques)
● Atherosclerosis (unstable plaques)
■ Other
● Hypotension
● Anemia
● Hypoxemia
● Increased demand for oxygen (Causes of increased demand for oxygen: tachycardia, exercise, hypertension (hypertrophy), valvular disease)
What happens if hypovolemic shock can’t resuscitate quickly?
systemic inflammation and multiple organ dysfunction
What is relative hypovolemia with neurogenic shock?
It is a loss of vascular tone
blood volume is same but Systemic Vascular Resistance decreases…by a lot (amount of space
containing blood has increased)
- Inadequate distribution of blood volume between the central and peripheral compartments – systemic vascular resistance is too low to get blood back to the heart
What does a decrease in preload result in?
decrease preload = decrease in stretch = decrease in contractility = decrease in cardiac output
What is cardiogenic shock?
It is defined as decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume.
Causes/process of two of the main reasons for myocardial Ischemia?
- decreased coronary blood flow due to atherosclerotic plaque – plaque can also cause ulceration or rupture – underlying tissue is exposed – thrombus formation – can block blood supply to heart muscle – if not reversed ischemia becomes infarct
- coronary spasm, hypotension dysrhythmias and decreased oxygen carrying capacity of blood
what are the 4 progression steps to acute coronary syndrome? what happens at each of the stages?
1.) Stable angina
-Angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardia demand.
2.) Unstable angina
-The plague ruptures and a thrombus forms around the ruptured plaque, causing partial occlusion of the vessel. Angina pain occurs at rest or progresses rapidly over a short period of time
3.) nSTEMI
-The plague ruptures and thrombus formation causes partial occlusion to the vessel that results in injury and infarct to the subendocardial myocardium
4.) STEMI
-A complete occlusion of the blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and rise in tropinins
What is CAD usually caused by?
Atheroclerosis
What is stable angina caused by?
Caused by:
■ Gradual luminal narrowing and hardening of arterial walls,
with associated inflammation, endothelial cell dysfunction, and decrease in endogenous vasodilators.
● More prevalent in those with diabetes, obesity, dyslipidemia
Causes of neurogenic shock?
1.) Can be caused by any factor that stimulates parasympathetic or inhibit sympathetic stimulation
2.) Trauma to the spinal cord (above T6)
3.) Interruption of O2 to the medulla
4.) Depressive medications,
5.) anesthetic agents,
6.) severe emotional stress and pain other causes
Sings and symptoms for angina and MI regarding Substernal Chest Discomfort?
Substernal chest discomfort:
-Sensation of heaviness or pressure
-May radiate to neck, lower jaw, left arm and shoulder
-Pallor, diaphoresis, dyspnea
-Women – atypical chest pain
Complications of MI?
○ Dysrhythmias (arrhythmias)
○ *Heart failure
○ *Cardiogenic shock
○ Sudden cardiac death
○ Aneurysm of heart wall
○ Rupture of ventricular wall
○ Rupture of papillary muscles
○ Rupture of interventricular septum
What is stable angina pectoris activated by? What relives it? What might the pain be mistaken for?
Activated by physical exertion or stress
Relieved by rest
-Pain may be mistaken for indigestion
Signs and symptoms of right sided heart failure? (Cor Pulmonale)
1.) Fatigue
2.) Ascites
3.) Enlarged liver and spleen
4.) Dependant edema
5.)Weight gain
6.)May be secondary to chronic pulmonary problems
7.) Increased peripheral venous pressure
8* Weight gain
9* Anorexia and complaints of GI distress
What does Decreasing contractility, increasing preload, and increasing afterload develop in left sided heart failure?
Decreasing contractility, increasing preload, and increasing afterload develops, causing progressive worsening of symptoms – pulmonary edema – fluid backing up into the lungs
What is Mitral stenosis? What is it most commonly seen in the from of?
It impaires the flow of blood from the left atrium to the left ventricle
It is most commonly seen in the form of rheumatic heart disease
Manifestations of left sided heart failure?
Main ones:
Pale cool,
decreased capillary refill, weak pulses
Decreased urine output
OTHERS:
Dyspnea,
orthopnea,
cough of frothy sputum, fatigue,
decreased urine output, edema,
confusion,
restlessness,
tachycardia,
cyanosis,
crackles
Paroxysmal Nocturnal Dyspnea
Tachypnea
-S3 gallop, underlying CAD or hypertension
What is Preload?
stretching of the cardiac muscle at end diastole, right before contraction
What is a Transmural infarction?
■ If infarction extends through the myocardium all the way from endocardium to epicardium
■ Severe cardiac dysfunction
■ STEMI: acute ST-elevation myocardial infarction
What are the clinical manifestations of cariogenic shock caused by?
What do they include/what are they?
Clinical manifestations caused by a widespread impairment of cellular metabolism
1.) Impaired through process
2.) Dyspnea and tachypnea
3.) Systemic venous and pulmonary edema
4.)Dusky skin color
5.) Hypotension
6.)oliguria (scant urine),
7.) ileus (lack of movement in bowel)
What does high after load mean?
high afterload means a decrease in cardiac output
Blockage of coronary arteries is a common cause of?
Blockage of these arteries is a common cause of angina, heart disease, heart attacks and heart failure.
Risk factors for septic shock
Genetics – our reaction, chronic diseases, immune deficiency state, timeliness of intervention
What is a Subendocardial infarction?
■ Occurs when thrombosis disintegrates before complete distal tissue necrosis occurs
■ Infarction only in the myocardium directly beneath the endocardium
What causes heart failure?
Mostly because of LV dysfunction
○ RV failure (pulmonary disease)
○ High-output failure (inadequate perfusion despite normal/high cardiac output)
Patho for right sided heart failure with left ventricular failure?
(Class notes) increased left ventricular filling pressure is reflected back in to the pulmonary circulation
As the pressure in the pulmonary circulation rises there is increased resistance to the right ventricle emptying
(Will notes) Pressure in pulmonary circulation rises → resistance to RV emptying increases
■ RV will dilate and fail
■ Pressure will increase in systemic venous circulation, leading to
● Peripheral edema
● Hepatosplenomegaly
● If LV failure is absent, diffuse hypoxic pulmonary
diseases (such as COPD, cystic fibrosis, and ARDS) can be attributed to it
What is Ischemia?
A local state in which the cells are temporary deprived of blood supply
-Cells remain alive but cannot function properly
What is unstable angina?
It is the result of reversible myocardial ischemia and is harbinger of impending infarction
new onset angina, occurs at rest, or angina with increasing severity or frequency
Risk factors for aortic stenosis?
hypertension, smoking dyslipidemia
What is septic shock?
Shock that is caused mostly by bacteria, fungal, and viruses
-infectious organisms cause systemic inflammation, initiating a cascade of physiological responses
What is a STEMI?
Continued coronary occlusion leads to transmural infarction extending from endocardium to pericardium
○ ST elevation
Why is it important to recognize unstable angina?
Because it signals that the athersclortic plague has become complicated, and infarction may soon follow
Non-modifable risk factors for CAD?
Age
Gender – assigned male at birth are at greater risk – after menopause – women increased risk
Family history – environment, genetics
Risk factors to heart failure?
Main ones: ischemic heart disease and hypertension
Age, obesity, diabetes, renal failure, valvular heart disease, cardiomyopathies, myocarditis, congenital heart disease, excessive alcohol use
Onset of anaphylactic shock?
Sudden onset – death imminent without intervention
What kind of substernal chest discomfort may accompany stable angina pectoris?
Substernal chest discomfort:
-Sensation of heaviness or pressure
May radiate to neck, lower jaw, left arm and shoulder
-Pallor, diaphoresis, dyspnea
Women – atypical chest pain – (microvascular angina – vasoconstriction of small coronary arteries)
Mortality rate of cariogenic shock?
70%
In early septic shock what does tachycardia do?
Early – tachycardia – CO remains normal
It causes cardiac output to remain normal or become elevated, although myocardial contractility is reduce
What do extra heart sounds (murmurs or gallops) represent?
Impaired left ventricular function
What ultimately happens in shock?
Ultimately Anaerobic metabolism, acidosis, sodium-potassium pump fails, cell membrane permeability, cellular edema, cell death
Whatcan prinzmetal angina result from?
Decreased vagal activity, hyperactivity of the SNS, or decreased nitric oxide activity
Risk factors for stable angina pectoris?
Uncontrolled Diabetes, dyslipidemia, obesity
Hypertension
Increased LDLs (low density lipoproteins)
Decreased HDLs (High Density Lipoproteins )
Sedentary lifestyle
High BMI
Genetics
What is happening during aortic regurgitation?
During systole, blood is ejected from the left ventricle into the aorta. During diastole, some of the ejected blood flows back into the left ventricle through the leaking valves
Modifiable risk factors for CAD?
1.) Dyslipidemia – Low density lipoproteins (LDL) need to stay low and high density lipoproteins (HDL) need to stay high – LDL – cholesterol in arteries, HDL reverses LDL
Control
2.) hypertension – stress, medication compliance
3.) Cigarette smoking – generating free radicals – contribute to atherogenesis -formation of fatty plaques
- Stimulates epinephrine & norepinephrine which are going to increase our HR & peripheral vasoconstriction = HTN
4.) Diabetes mellitus – insulin won’t work property, increase inflammation & thrombosis, damage to endothelium, thickening of vessel walls
5.) Obesity & Sedentary lifestyle – causes metabolic syndrome – will look at again later
6.) Atherogenic diet – high in protein, cholesterol, & saturated fats and then low fruit and vegetables
How long can cardiac cells withstand ischemic conditions before hypo injury causes cellular death and tissue necrosis?
20 min
Manifestations of MI?
First symptom of acute MI = sudden, severe chest pain
○ Same as angina, perhaps more intense
○ Longer than angina (longer than 20-30 minutes)
○ “Heavy” or “crushing”
○ Sensation of unrelenting indigestion
○ Pain radiates to neck, jaw, back, shoulder, or left arm
○ Older adults/diabetics may experience no pain
○ Associated with:
■ Nausea
■ Vomiting
■ Diaphoresis
■ Pallor
■ Cool, clammy
■ Tachycardia
■ Dyspnea
■ Apprehension, feeling of doom
○ Early signs missed in 78% of women
What can Aortic or mitral valve regurgitation be secondary to?
-It can be secondary to chronic hypertension, rheumatic heart disease, bacterial endocarditis
What is Patent Ductus Arteriosus? What is happening/going on?
-It is a heart defect
-Failure of the fetal ductus arteriosus to close within 15 hours of birth -
The ductus allows blood to detour away from the lungs before birth.
Respirations - faster and harder than normal – audible murmur – fatigue – poor eating
What is heart failure? (simple/basic definition)?
Heart failure – decreased contractility – decreased ability for the muscle to snap back
What is anaphylactic/distributive shock?
Anaphylactic shock is a severe reaction to an allergen causing an acute multisystem allergic reaction. It causes arterial and venous vasodilation; increased capillary permeability and pulmonary vasoconstriction, which increase right ventricular afterload, reduce pulmonary blood flow, decrease left ventricular preload, and reduce CO.
-Exposure to antigen - immune and inflammatory response - sudden onset of reaction
What is right sided heart failure caused by?
Caused by pulmonary hypertension – hypertension in the pulmonary circulation
What is stable angina pectoris?
Chest pain caused by myocardial ischema
Right side heart failure can be an indicator of? Or lead to?
Can be an indicator of left sided heart failure and eventually lead to left sided heart failure
What is shock?
The cardiovascular system fails to perfuse tissues which results in widespread impairment of cellular metabolism
Cardiac output =?
What is normal stoke volume and heart rate?
Heart rate x Stroke volume = Cardiac Output
Normal stroke volume is 60-100 ml/beat
Normal heart rate is 70
70 X 60 = 4200 range up to 70 X 100 = 7000
Normal CO = 4.2 – 7 L/min
When does pain often occur in Prinzemteal (variant) angina?
-Often occurs at night during REM sleep and may have a cyclic pattern of occurrence
What is Hibernating Myocardium? What can restore a hibernating heart?
It describes tissue that is persistently ischemic and undergoes metabolic adaptation to prolong myocyte survival until profusion can be restored in a MI
-PC or CABG for reperfusion can restore a hibernating heart
What isn’t present in Prinzemtal angina? what are some of it’s basic characteristics?
It is a variant angina – There is no evidence of coronary artery disease
It is unstable, unpredictable, and can occur at rest
Causes of cariogenic shock?
Causes include myocardial infarct, congenital heart anomalies, cardiomyopathy, myocarditis, arrhythmias, drug toxicity.
Manifestations of shock?
Subjective complaints are non-specific:
■ Individual may report feeling sick, weak, cold, hot, nauseated, dizzy, confused, afraid, thirsty, SOB
○ Hypotension is common (MAP less than 60mmHg)
■ Late sign of decreased tissue perfusion
○ Cardiac and urinary output decrease as shock progresses
○ Respiratory rate is increased
■ Respiratory alkalosis
Manifestations of hypovolemic shock?
High SVR (trying to keep low volume central), poor skin turgor, thirst, oliguria, low preloads, rapid heart rate, thread pulse, mental status deterioration
What is the chest pain in prinzmetal angina caused by?
Vasospasm of one or more major coronary arteries w/ or w/o associated atherosclerosis
Myocardial ischema in women may not present with typical angina pain, what are the common symptoms women would present with? (stable angina)
atypical chest pain, palpitations, sense of unease, and severe fatigue
-Estimated that half of the women with stable angina don’t have obstructive CAD
Patho for left sided heart failure?
1.) Contractility is decreased – can happen in a MI , myocarditis, cardiomyopathies
2.) When contractility is decreased, stroke volume fills and left ventricular end-diastolic
volume increase – dilation of the heart and an increase in preload
3.) Initially increases in LVEDV can actually improve cardiac output up to a certain point
4.) As preload continues to rise, it causes stretching of the myocardium that eventually leads to dysfunction an decreased contractility – Starling’s law of he heart
Increased afterload is a result of increased peripheral vascular resistance – seen with hypertension
Causes of hypovolemic shock?
(will notes) Caused by loss of large amounts of:
○ whole blood (hemorrhage)
○ Plasma (burns) or
○ interstitial fluid (diaphoresis, diabetes mellitus/insipidus, emesis, diarrhea, or diuresis)
Loss of whole blood – hemorrhage
Loss of plasma – burns
Loss of interstitial fluid – diarrhea, diuresis, diabetes mellitus, diabetes insipidus, emesis
Steps/patho for septic shock progression?
Infection → bacteremia (bacteria in blood) → systemic inflammatory response syndrome - sepsis → severe sepsis (organ dysfunction) → septic shock → multiple organ dysfunction syndrome (altered organ function homeostasis cannot be maintained without intervention
What is the most common cause of automatic dysfunction that leads to silent ischmia?
Diabetes mellitus
Other causes:
Surgical denervation during CABG
Cardiac transplant
Previous MI – local nerve injury
Mental stress
What is valvular regurgitation?
-The valve leaflets, or cups, fail to shit completely, permitting blood flow to continue even when the valve is presumably closed - during systole or diastole, some blood leaks back into the chamber proximal to the distend valve, which increases the volume of blood the heart must pump and increases the workload of both the atrium and ventricle
Regurgitation, the doorway doesn’t close properly so blood will leak back into the chamber it just left – door can’t stay close – if we have this and the door is not closing it means were supposed to be pumping it into the body but some of it is going into the right ventricle
What is valvular stenosis?
-Valve orifice is constricted and narrowed, so blood cannot flow forward and the workload of the cardiac chamber proximal to the diseased valve increases
Stenosis the doorway isn’t all the way open so it is hard to get blood past – valve is not opening – like a door that is not able to open – no pressure in the filling stage – Not going to be filling up the ventricle – CANT GET THROUGH – higher afterload and youre not going to get a lot of blood flow through – low BP
- Chronic hypertension
- Genetic defect in valve
What is neurogenic shock?
It is the result of widespread vasodilation that results from parasympathetic over stimulation and sympathetic under stimulation
Caused by any factor that could stimulate parasympathetic or inhibits sympathetic stimulation of smooth muscle
Small ventricular septal defect (VSD) sound Vs Large ventricular septal defect (VSD) sound?
Small VSDs - Loud murmur – may close on their own
Large VSD – pulmonary artery banding – relieve pressure & blood flow to the lungs – when older can have open heart surgery to close the hole
What is Car Pulmonale?
enlargement, dilatation hypertrophy or failure of the right ventricle with right sided heart failure
What is myocardial remodelling?
It is a process that causes myocyte hypertrophy & loss of contractility in areas of the heart distant from the site of infarction
Signs and symptoms of anaphylactic shock?
Anxiety, dizziness, difficulty breathing, stridor, wheezing pruritus with hives, swollen lips and tongue, abdominal cramping
What does microvascular angina effect?
Microvascular angina - Intramyocardial arterioles – not as responsive to nitrate vasodialtors
What does the frank starling law state about stroke volume of the left ventricle?
TheFrank-Starling Lawstates that the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.
What can be the primary cause of aortic regurgitation?
Can be primarily caused by congenital bicuspid valve degeneration in older persons
What is afterload?
the pressure that the heart must work against to eject blood during systole (ventricular contraction)
What is Prinzmetal Angina?
AKA variant angina
-Chest pain that is attributed to transient ischemia of the myocardium that occurs unpredictably and often at rest
What is Atrial Septal Defect (ASD)?
pulmonary over circulation & slow growth – SOBOE – right ventricle becomes less compliant with age
-May be closed surgically
stable angina characteristics? (Will’s notes)
■ Atherosclerosis (stable plaques)
■ recurrent, predictable chest pain caused by chronic coronary obstruction
Patho for distributive/anaphylactic shock?
● Vasodilation → decreased BP → decreased organ perfusion
What is the pain caused by in stable engine pectoris?
Build up of lactic acid OR
■ Abnormal stretching of the ischemic myocardium (irritated nerve fibers)
● Nerve fibers are from C3-T4 of spine
What can Prinzmetal angina cause?
What illicit drug is associated with?
What kind of condition is it?
Can cause Dysrhythmias
Associated with cocaine use
it is a benign condition
What does a loss in vascular tone result in with neurogenic shock?
Relative hypovolemia in which blood volume has not changed but SVR decreases drastically so that the amount of space containing the blood has increased
What are the two kind of Myocardial Infarctions? How are they categorized? What are they?
1.) STEMI and nSTEMI
2.) Characterized by ST segments
3.)
Non-STEMI
○ Persistent coronary occlusion leads to infarction of the myocardium closest to the endocardium
○ Non ST elevation ● STEMI
○ Continued coronary occlusion leads to transmural infarction extending from endocardium to pericardium
○ ST elevation
Causes of myocardial ischema?
1.) Most common cause is atherosclerotic plaques in coronary circulation
■ Thrombus formation can result in acute myocardial ischemia
■ If vessel obstruction cannot be reversed, then infarction will happen
2.) Other causes: coronary spasm, hypotension, dysrhythmias, anemia, hypoxemia
3.) Lack of O2 flow → lactic acid accumulation
What symptoms can silent ischema have?
Myocardial ischemia may not cause detectable symptoms such as angina.
It can be completely asymptomatic (silent ischema), or individuals may complain of Fatigue, dyspnea, feeling of unease
Manifestations of angina in men?
Chest pain”
■ OPQRST (onset, provocation/palliation, quality of pain, region/radiation, severity of pain, time (history))
● Triggered by exercise, sleep cycle, or nothing
● Substernal
● Pressure, tightness, squeezing,
● “Elephant sitting on my chest”
● May radiate to neck, arm, jaw
● Diaphoresis, dyspnea, pallor, nausea, vomiting
What is myocardial infarction (MI)?
When there is prolonged ischemia causing irreversible damage to the heart muscle - clot remains, vessel occluded for longer period of time
Risk factos for developing Ventricular septal defect, atrial septal defect, and patent ductus arterioles heart defects?
For all – risk for development of endocarditis, heart failure, and pulmonary hypertension
What is a nSTEMI?
Persistent coronary occlusion leads to infarction of the myocardium closest to the endocardium
○ Non ST elevation
What are some atypical heart attack symptoms women may experience?
palpations, anxiety, weakness, and fatigue - 42% of women do not experience chest pain
woman presented with more fatigue and Right sided Chest pain
What is right sided heart failure? It is due to?
Unable to pump blood effectively to the lungs, back of fluid in the vena cava – backed up into circulation
Inability of right ventricle to effectively push deoxygenated blood forward INTO the pulmonary circulation ➔ Hypoxemia
● Back up of blood into systemic veins backward
● Due to left heart failure, COPD, congenital heart defects
MI involving the left ventricle? (heart failure)
MI involving the right ventricle?
Left ventricle: pulmonary venous congestion
Right ventricle: increase in system venous pressures
Signs and symptoms for septic shock?
Temperature instability, high or low, renal dysfunction, jaundice, clotting abnormalities, decreased mental status
What is hert failure?
General term to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues
Heart failure: when heart is unable to generate an adequate cardiac output, causing:
○ Inadequate perfusion of tissues
○ Increased diastolic pressure of LV
○ or BOTH
What is a Ventricular septal defect?
-Most common defect
-Blood continues to flow through the hole between ventricles
Hole in-between the ventricles
What kind of cardiovascular change manifestations do we see with MIs?
■ Temporary increase in HR and BP
■ Abnormal extra heart sounds (LV dysfunction)
■ Skin is cool and clammy
■ Pulmonary congestion if individual develops HF
What is myocardial stunning?
It is a temporary loss of contractile function that persists for hours to days after perfusion has been restored in a MI
What does persistent ischemia or the complete occlusion of coronary artery disease cause?
It causes the acute coronary syndromes including, infarction, or irreversible myocardial damage
What is Aortic regurgitation?
– inability of aortic valve
It results from an inability of the aortic valve leaflets to close properly during diastole because of abnormalities of the leaflets, the aortic root and annulus or both
What is heart failure with preserved ejection fraction? What does it cause?
–less common – pulmonary congestions without a reduction in stroke volume – back up in pulmonary system but they are maintaining stroke volume
Decreased compliance of left ventricle – pressure pushes back into pulmonary circulation
Leads to pulmonary edema, pulmonary hypertension, & right ventricle hypertrophy
What happens if O2 coronary blood flow is insufficient to meet the metabolic demands of myocardial cells?
Myocardial ischemia
-oxygen content of coronary blood cannot meet the metabolic demands of the myocardium
Signs and symptoms of a newborn born with a Patent ductus arterioles birth defect?
Respirations - faster and harder than normal – audible murmur – fatigue – poor eating
When does right sided heart failure occur with left ventricular failure? What is happening here?
Occurs without left ventricular failure in COPD cystic fibrosis, ARDS, -
increase in right ventricle afterload – how much pressure the right ventricle is pushing against during systole – pressure is coming back
What is increased respiratory rate or respiratory alkalosis an indicator of with shock?
RR increased – respiratory alkalosis indicator of impending shock
What is happening in mitral regurgitation?
prolapse of mitral valve
Mitrial regurgitation permits back flow of blood from the left ventricle into the left atrium during ventricular systole, producing a holosytolic murmur that is best heard at the apex
What is aortic stenosis?
-It is the most common valve disorder/abnormality
- Orifice of the aortic valve narrows causing resistance to blood flow- back of blood causes left ventricle hypertrophy – increased myocardial oxygen demand - angina
Textbook: The orifice of the aortic valve narrows, causing resistance ro blood flow from the left ventricle into the aorta. The outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening
What is silent Ischemia?
Asymptomatic ischmia
In septic shock tissue perfusion is?
Inadequate
Unstable angina is ischemia that is still?
Reversible
Patho for hypovolemic shock
1.) Initially heart rate and SVR (systemic vascular resistance) increase – boosts cardiac output and tissue perfusion pressures.
2.) Interstitial fluid moves into vascular compartment.
3.) Liver and spleen release stored RBC and plasma. Aldosterone release – retention of sodium and water, ADH increases water retention
4.) As condition continues – compensation starts to fail
5.) Anaerobic metabolism and lactate production result in lactic acidosis and serum and cellular electrolyte abnormalities
What are the 3 clinical manifestations of Myocardial Ischemia?
1.) Stable angina
2.) Prinzmetal’s angina
3.) Silent ischemia and mental stress - induced ischemia
Cardiogenic shock patho (Will notes - very basic)
Impaired contractility → decreased BP → decreased organ perfusion
