Cardiogenic shock, trauma, surgery, aneurysms Flashcards
What are some ways to enhance the effectiveness of the pump?
Positive inotropic support
- norepinephrine
- dopamine
- dobutamine
Avoid negative inotropic agents
- vasodilators
What are some ways to decrease the demand on the pump?
- preload reduction (or optimization)
- afterload reduction
- Optimize oxygenation
- Mechanical ventilation
- treat pain
- IABP for short term support
- VAD may be used
IABP inflation increases ___.
coronary artery perfusion
IABP inflation occurs at ___.
the dicrotic notch of the arterial waveform; at the beginning of diastole
IABP deflation decreases ___.
afterload
IABP deflates when?
right before systole begins; it is determined by a set trigger for deflation: R wave of ECG or upstroke of the arterial pressure wave
What do you want to avoid in patients with Valve repair or replacement?
a drop in preload. Most patients who have had valvular stenosis or chronic regurgitation have had elevated end-diastolic volumes. Sudden preload normalization may result in hypotension
What would you anticipate in a post op Valve repair / replacement patient?
conduction disturbances since the mitral, tricuspid, and aortic valves are anatomically close to conduction pathways. Temporary or permanent pacing may be needed
What are some signs and symptoms of cardiac tamponade?
- restlessness and agitation
- hypotension
- increase JVD
- equalization of CVP, pulmonary artery diastolic and PAOP
- muffled heart tones
- enlarging cardiac silhouette and mediastinum on chest radiograph
- narrowed pulse pressure
- pulsus paradoxus
What is pulsus paradoxus?
excessive drop in SBP during inspiration. Cardiac muscle restriction due to tamponade, with inspiration, intrathoracic pressure increases, decreases venous return
Which valve is at most risk for rupture due to trauma?
Aortic valve because it is most anterior in the chest
immune response after an MI, surgery, or traumatic injury
Dressler’s syndrome
What is the etiology of medical Pericarditis?
- Trauma
- viral
- after MI
- post op cardiac surgery
- radiation
- idiopathic
What is the etiology of trauma - myocardial contusion
trauma
- worse outcome than pericarditis
- broken vessels bleed into heart, similar to MI
- cardiac dysrhythmias
- death can occur within the first 48 hours
What are signs and symptoms of pericarditis?
- chest pain
- pain worsens with inspiration
- dyspnea
- low-grade temp
- increase sed rate
- ST elevation in all leads
- cardiac tamponade
- Post MI, Dressler’s syndrome, may last months
