Cardiogenic Shock, Orthostatic Hypotension, & Syncope

Question 1

what is the most common cause of cardiogenic shock?

Answer 1

Acute MI

Question 2

clinical condition of inadequate tissue perfusion due to the inability of the heart to pump an adequate amount of blood

Answer 2

cardiogenic shock

Question 3

what is the most common presentation of cardiogenic shock?

Answer 3

severe dysfunction of the LV (anterior MI)

Question 4

what do a majority of patients with cardiogenic shock present with on ECG?

Answer 4

acute STEMI

Question 5

what are 2 major risk factors for cardiogenic shock?

Answer 5

ST elevation MI
left BBB

Question 6

a patient presents with hypotension, oligura, cold clammy skin, and metabolic acidosis on labs. what are they likely experiencing?

Answer 6

cardiogenic shock

Question 7

what changes in labs will indicate metabolic acidosis in cardiogenic shock? (2)

Answer 7

elevated lactate
decreased serum bicarbonate

Question 8

what lab values will indicate renal hypoperfusion in cardiogenic shock? (2)

Answer 8

elevated blood urea nitrogen + creatinine

Question 9

what diagnostic can be done for suspected cardiogenic shock if diagnosis remains unclear?

Answer 9

pulmonary artery catheterization

Question 10

what is the medical treatment for cardiogenic shock? (3)

Answer 10

ventilatory support (raise pH)

norepi + dopamine for hypotension

Question 11

what inotrope can be used in less sick patients for cardiogenic shock?

Answer 11

dobutamine

Question 12

what is the mechanical treatment for cardiogenic shock in the presence of mechanical defects like MR or ventricular septal defect?

Answer 12

intra-aortic balloon pump

Question 13

what are 3 treatments that can be used for cardiogenic shock to encourage reperfusion?

Answer 13

primary percutaneous coronary intervention

CABG

fibrinolysis

Question 14

a significant reduction in BP upon standing; dropping 20 systolic or 10 diastolic, 3 mins after standing

Answer 14

orthostatic hypotension

Question 15

in patients with orthostatic hypotension, a _____ _____ fails, leading to a decline in BP with assumption of upright posture

Answer 15

compensatory mechanism

Question 16

what are 2 risk factors for orthostatic hypotension?

Answer 16

elderly
antihypertensive (side effect)

Question 17

a patient presents with coat hanger headache, dizziness, and weakness. what are they likely experiencing?

Answer 17

orthostatic hypotension

Question 18

what are 3 lifestyle modifications to treat orthostatic hypotension?

Answer 18

elastic stockings
raise head of bed
exercise

Question 19

what are 3 physical maneuvers to treat orthostatic hypotension?

Answer 19

increase salt + water intake
cross legs while standing
handgrip while standing

Question 20

what is the primary goal of treatment of orthostatic hypotension?

Answer 20

decrease symptoms

Question 21

what are 2 medications that can be used for orthostatic hypotension?

Answer 21

fludrocortisone
milodrine

Question 22

what medication can be used for orthostatic hypotension that is associated with meals?

Answer 22

octreotide

Question 23

abrupt and transient loss of consciousness associated with the absence of postural tone, followed by complete and rapid spontaneous recover

Answer 23

syncope

Question 24

patients with an underlying _____ cause of syncope have higher rates of SCD

Answer 24

cardiovascular

Question 25

what is the underlying mechanism in all syncope events?

Answer 25

cerebral hypoperfusion

Question 26

what is the mnemonic for etiologies of syncope?

Answer 26

Pressure Arrhythmias Seizures Sugar Output Unusual Transient

Question 27

what is the most common type of syncope?

Answer 27

reflex syncope

Question 28

causes vasovagal syncope due to stimuli triggering sudden vasodilation and bradycardia, resulting in hypotension

Answer 28

pressure

Question 29

causes sudden syncope with no warning + loss of consciousness

Answer 29

arrhythmias

Question 30

what is the difference between a seizure and syncope?

Answer 30

seizure patients have prolonged confusion/lethargy after seizure + aura

Question 31

what is the gold standard of diagnosing a seizure?

Answer 31

history

Question 32

what are 3 unusual causes of syncope?

Answer 32

anxiety panic disorder somatization disorder

Question 33

what are 3 transient causes of syncope?

Answer 33

stroke transient ischemic attack (TIA) subarachnoid hemorrhage

Question 34

Predicts risk for serious outcomes at 7 days in patients presenting with syncope or near-syncope

Answer 34

san francisco syncope rule

Question 35

what are the 5 parts of the san francisco syncope rule?

Answer 35

hx of CHF hematocrit <30% abnormal ECG SOB systolic BP <90 at triage

Question 36

what are 2 meds that can be used for syncope?

Answer 36

midodrine fludricortisone

Question 37

what is the single most common cardiac cause of syncope?

Answer 37

bradycardia