CV readings Flashcards
Patients with shock had inadequate ____ _____and there is a lack of _______ delivery to major ______
tissue perfusion ; oxygen; organ
Shock must be treated immediately to prevent _________ or ________
multisystem organ failure; death
The components of blood pressure are _______and _______
Cardiac output; Systemic vascular Resistance
Patients with shock will have either an inadequate ____________ or a low _____ due to arterial vaso_______
Cardiac index; SVR; dilation
Shock is classified as : ________,________,_______,_______
Hypovolemic, Cardiogenic, extra-cardiac obstructive, distributive
Hypovolemic shock is a result of _______ preload secondary to _______ and _________
decreased; dehydration ; hemorrhage
Cardiogenic shock is a result of _________ due to various causes such as _______,_______,______
heart failure “Pump failure”; myopathy; cardiac valves issues; arrhythmias.
Extra-cardiac obstructive shock is secondary to _______ or ________
Tension pneumothorax ; pulmonary emboli; Pulmonary HTN
3 types of distributive shock are:
Septic; anaphylaxis, neurogenic
Distributive shock results from excessive _______, therefore there is low ________. Patients will have Cardiac index (normal, low or elevated) ______
Vasodilation; SVR. normal or elevated
Hypovolemic, cardiogenic and extra-cardiac obstructive result from poor ______and the patients usually have an elevated _______as a ______mechanism
Cardiac index; SVR; compensatory
Pharmacologic agents that increase BP by causing arteriole vasoconstriction are called___
Vasopressors
Agents that increase cardiac contractility and therefore _______ are called_________
Cardiac index; inotropes
Examples of Catecholamines are :_______ ______ ______ ______ ______ ________
Dobutamine, isoproterenol, dopamine, epinephrine, norepinephrine, phenylephrine.
Phosphodiesterase inhibitors (PDIs) are
Milrinone and inamrinone
Catecholamines or __________ agents ALL act on receptors of the _________nervous system or ______: Remember what ACRONYM
sympathomimetic ; sympathetic (or Adrenergic) SYMP-ADRE
Stimulation of the Beta 1 receptors of the heart will result in _______ inotropic meaning _______contractility and ________; also result in chronotropic meaning _______in heart rate ; dromotropic meaning ________in conduction of impulse
positive; increase; cardiac index; increase; increase
Stimulation of Beta 2 receptors of the heart will result in _______ ____ _____ which can result in _______ and a decrease in ________
Smooth muscle relaxation; vasodilation; SVR
Stimulation of alpha receptors of the heart will result in ___________and an increase in ________and ______ but can cause a reduction of ______to the increase in _______
vasoconstriction; SVR; BP; Cardiac index; afterload
For phosphodiesterase inhibitors –> the inhibition of ___________leads to the inhibition of the breakdown of ____ _____ _______. This results in increase in ______ ______ therefore increase ________and venous and arterial ______(decrease _____ and ____)
Phosphodiesterase; cyclic adenosine monophosphate; myocardial contractility; cardiac index; dilation; preload and SVR
There are 3 vasopressin receptors
V1, V2, V3
Activation of V1 receptors results in ________ of systemic, splanchnic, renal and coronary arteries via activation of ______ resulting in an increase in _______ ________
vasoconstriction; voltage-gated calcium channels; intracellular calcium
Activation of V2 receptors results in _______Effect of vasopressin
antidiuretic effect
Vasopression V3 receptors are located in the _________ _____ gland and Activation of V3 receptors results in secretion of __________ Hormone
anterior pituitary; adrenocorticotropin
Unlike ____________ the actions of vasopressin may be preserved in _________ and ________
catecholamines; hypoxia; acidosis
The Half life of catecholamines is ____ minutes and maximum concentration is achieved in ____ minutes
1-2 ; 10
Dobutamine acts on ____ and _____ receptors and with ______HR , ______CI, and ______SVR
B1 and B2, increase; increase; increase
Norepinephrine acts on _____ but more on ____ receptors. Will produce variable effects on _____, will have no effect or decrease _______, _______SVR and _____MAP
B1; alpha; HR; CI; Increase; increase
Milrinone half life in a patient with normal renal function is
2 hours
Vasopression elimination half life is _______minutes
15 minutes
What are determinates of myocardial oxygen consumption _____,_____,______
HR; ventricular wall tension; contractility
Beta agonists and PDI can _______HR, and _______ thereby increasing ______ ______ ______
increase ; contractility ; myocardial oxygen demand.
Alpha agonists and Vasopressin can also cause ______of coronary vessels leading to decrease in myocardial oxygen ______
Vasoconstriction; supply
Increases in myocardial oxygen demand or decrease in myocardial oxygen supply can lead to ____________
myocardial ischemia.
PDI may cause a reflex__________
Tachycardia
Patient receiving any of the catecholamines and/or PDIs should be monitored for signs of _______
Myocardial ischemia
Sympathomimetic amines such as ________and ________can cause direct tachyarrhythmias (atrial and ventricular) by increasing myocardial oxygen _______
Dobutamine; isoproterenol ;consumption
Pure alpha agents such as _________ can cause a reflex _______ secondary to an increase in _____ _____
bradycardia; BP
Because of the increase in ________alpha agonists can decrease _________and induce ________
afterload; cardiac index, heart failure
Mixed alpha and beta effects medications such as ______ and _______ will generally ________(increase or decrease) CI in lower doses and ________ (increase or decrease) CI in higher doses
dopamine; epinephrine; increase; decrease
Sympathomimetic agents can cause ________ blood sugar through ______and ________, ________levels should be monitored
high; glycolysis; gluconeogenesis; Blood glucose
All vasoconstrictors can cause ________If they extravasate
severe tissue necrosis
B2 agonists such as _______ _______ can decrease serum _______ which may induce _______ so serum _____ should be monitored
Dobutamine and isoproterenol; potassium; potassium
For alpha agonists such as ______ _____ _______ extravasation can be prevented by injecting the alpha blocker _____________ subcutaneously into the area of infiltrate
Norepinephine, phenylephrine and dopamine: PHENTOLAMINE
When using vasopressor, the use of low dose _________does not show any real benefits for renal function and should not be use
Dopamine
Excessive Vasoconstriction may________blood flow to vital organs.
decrease
Vasopressors such as epinephrine and norepinephrine can decrease ________blood flow and increase regional ________ _______
splanchnic; lactic acidosis
Hypovolemic and septic shock patients should always be given ________ ________ prior to vasopressors and inotropes because if _______ is inadequate, vasopressors will cause further reduction in _______ and inotropes with worsen tachyarrhythmias and induce ______
Fluid resuscitation; preload; cardiac output; ischemia
PDIs and sympatomimetics amines with beta effects that increase CI should used in caution with patients with severe ___________
aortic stenosis
_______monitoring is imperative in the clinical use of sympathomimetic and PDIs
Cardiac
if sympatomimetic amines are needed in patients on MAOIs, stated at ______ the usual dose
one tenth
2 hemodynamic goals in septic shock and Acute Respiratory Distress Syndromen (ARDS)
- Adequate perfusion pressure to ensure blood flow to vital organs
- adequate oxygen delivery.
In septic shock and ARDS, goal MAP is
60-65mmg HG
In septic shock and ARDS, goal CI is
Greater than 4.5L/min
In septic shock and ARDS, goal oxygen delivery
> 600 ml/min/m2
In septic shock and ARDS, goal oxygen consumption
> 170ml/min/m2
Early Goal directed therapy in the treatment of sepsis and shock recommends: Treatment in ED with _______ and colloids to maintain CVP ____ to _____; ___________ to achieve a MAP of _______ and transfusion of _______ or __________ to achieve a central venous oxygen saturation of (ScvO2) of _____ or greater
crystalloids; colloids; 8; 12; >65; RBCs; dobutamine; 70%
In septic shock, ARDS, and other forms of non-cardiogenic shock, ________is secondary to ______volume depletion and excessive ________
hypotension; intravascular; vasodilation.
Vasopressors recommended for septic shock _______and _________ . Studies have demonstrated that ________ and _______ are effective when dopamine fails. However_______is reserved for _______ ________
Dopamine and norepinephrine. Norepinephrine and epinephrine; refractory hypotension
Recommended vasopressin dose
0.03 units/minute
The inotrope that he been mostly widely studies in sepsis is _____________ and it’s used also to increase
Dobutamine ; oxygen delivery
ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation.
Dobutamine ; low CI and low; MAP
ACCM recommends the use of _______ as first choice in septic patients with ______and ________venous saturation and adequate ______following fluid resuscitation. May also be used in patients with signs of hypoperfusion as evidenced by ________ or elevated ________
Dobutamine ; low CI and low; MAP; low urine output ; lactic acid
An important point to stress is that __________ and _______ should be titrated separately to different goals
Vasopressors; inotropes
Vasopressors are titrated to maintain an ________ while inotropes are titrated to the desired effect on _________(desired ________or central venous saturation > __%)
adequate MAP; oxygen delivery; Cardiac index ; 70%
Unlike PDIs, Tolerance does occur with the use of _________ within ___ to ___ hours
Dobutamine; 48-72
Inoptropic support should be _____term because _____term treatment with inotropes is associated with ________ _________
short; long; increased mortality.
PDI and Dobutamine may be used in combination when _______ cannot be obtained with either agent alone
Cardiac index
Postpartum cardiomyopathy is usually treated with
ACEI
____________is a thiazide diuretic and will potentiate the effects of lisinopril, amlodipine, and losartan.
Hydrochlorothiazide
Top causes of metabolic acidosis
Hypoxia
Uremia
DKA
Lactic acidosis
