Examn 2 Flashcards
What is the Cardiogenic shock ?
Cardiogenic shock is an extreme degree of left ventricular failure, characterized by a sharp decrease in myocardial contractility ,which is not compensated by an increase in vascular resistance and leads to inadequate blood supply to all organs and tissues, primarily vital organs
Etiology of Cardiogenic shock ?
-extensive myocardial infarction
- Severe, acute onset aortic or mitral stenosis
- Severe, acute onset aortic or mitral insufficiency
- Rupture of the interventricular septum
-Arrhythmias
Pathogenesis of Cardiogenic shock?
1) Activation of the sympathetic nervous system
2) fluid retention
3) Increased peripheral vascular resistance
4)Violation of diastolic relaxation of the left ventricle of the myocardium
5) Metabolic acidosis.
Clinic feature of Cardiogenic shock?
1) A sharp drop in blood pressure (SBP <80-90 mm Hg); 2) The characteristic appearance of the patient:
- pointed facial features,
-very pale skin,
- cyanosis is possible,
- a spotty-marble pattern appears on the skin;
3) Cold clammy sweat;
4) Rapid breathing, wet fine bubbling rales are heard;
5) Frequent, poorly palpable pulse, deaf heart sounds;
6) Oliguria or anuria;
7) Possible loss of consciousness or pulmonary edema.
Cardiogenic shock: emergency care, special events (?)
1) Give the patient a horizontal position - in the absence of signs of congestive heart failure (shortness of breath, moist wheezing in the back of the lungs)
2) Oxygen therapy - oxygen mask;
3) Restoration of optimal BCC - intravenous fluid infusion under the control of blood pressure, heart rate, respiratory rate - about, 9% NaCl solution up to 200 ml in 10 minutes, stop when the SBP reaches 100 mm Hg. or signs of lung congestion (wheezing)
The introduction of narcotic analgesics in Cardiogenic shock patient ?
• 1% solution of mesaton intravenously. At the same time, cordiamine, 10% caffeine solution, or 5% ephedrine solution is injected intramuscularly or subcutaneously. These drugs can be re-administered every 2 hours.
• Sufficiently effective remedy - intravenous drip long-term infusion of 0.2% norepinephrine solution.
• Intravenous drip of hydrocortisone, prednisolone or urbazone.
• It is possible to relieve pain attacks with nitrous oxide.
• Oxygen therapy;
• With bradycardia, heart block, atropine, ephedrine are administered;
• With ventricular extrasystole - intravenous drip of 1% lidocaine solution;
What is the Chronic heart failure?
Chronic heart failure (CHF) is a pathological condition in which the work of the cardiovascular system does not provide the body’s oxygen needs, first during physical exertion, and then at rest.
Pathogenesis of Chronic heart failure?
Pathogenesis consists in a violation of the pumping function of the heart.
-This leads to a decrease in cardiac output. As a result, hypoperfusion of organs and tissues develops.
- The most important is the decrease in perfusion of the heart, kidneys, peripheral muscles.
-Reduction of blood supply to the heart and the development of its insufficiency lead to activation of the sympathetic-adrenal system and an increase in the heart rate.
-Reduction of renal perfusion causes stimulation of the renin-angiotensin system
sputum
بلغم
بلغم
sputum
What is the Acute heart failure ?
Acute heart failure is a sudden decrease in the contractile function of the heart, which leads to impaired circulation in the pulmonary and systemic circulation. It is left ventricular and right ventricular.
What is the Left ventricular heart failure ?
Left ventricular heart failure is an acute decrease in the contractile function of the left ventricle and the resulting pulmonary edema, characterized by the accumulation of fluid in their interstitium with its subsequent effusion into the alveoli
Etiology of acute left ventricular failure
- severe myocarditis
- acute myocardial infarction, - severe hypertension,
- mitral stenosis,
-aortic heart disease, - cardiomyopathy,
- extremely high physical activity,
- intravenous infusion of excessive amounts of fluid.
Development mechanism of acute left ventricular failure ?
According to Sterling’s equation, normally the difference between the hydrostatic pressure in the pulmonary capillaries and the interstitium is balanced by the difference in oncotic pressure, which keeps the fluid in the vascular bed. With an increase in the hydrostatic capillaries in the pulmonary capillaries or a decrease in oncotic pressure, an increase in the permeability of the alveolocapillary membrane or difficulty in lymphatic drainage, fluid accumulates in the lungs.
The inability of the left ventricle to pump blood coming to it leads to a violation of hydrostatic pressure, first in the pulmonary veins, then in the arteries
Clinic features of acute left ventricular failure?
1) An attack of cardiac asthma occurs, as a rule, at night: suffocation, dry cough appears. 2) Patients occupy a forced position with a raised head end or sitting on a bed with lowered
legs.
3) There is a pallor of the skin with a cyanotic shade,
4) breathing is rigid vesicular, dry wheezing may appear.
5) If cardiac asthma is complicated by pulmonary edema, then the patient’s condition
becomes more severe, suffocation increases, a cough with foamy pink (bloody) sputum appears,
اختناق
suffocation
Urgent Care of acute left ventricular failure
1) Calm down the patient, create mental and physical peace,
2) give the patient an elevated position of the head end
3) Oxygen therapy,
4 ) To suppress the function of the respiratory center - in / in 1 ml of 1% morphine solution
5 Peripheral vasodilation with normal or elevated SBP - nitroglycerin - i.v. bolus 10-20 mcg
6 ) Constant monitoring of pulse, heart rate, blood pressure BH, urine output
What is the cardiac asthma, pulmonary edema ?
an acute decrease in the contractile function of the left ventricle and the resulting pulmonary edema, characterized by the accumulation of fluid in their interstitium with its subsequent effusion into the alveoli
Acute right ventricular failure (acute cor pulmonale) ?
characterized by acute expansion of the heart and pulmonary artery, severe hypertension in them, decreased contractile function of the right heart, impaired diffusion of gases in the lungs and hypoxemia, stagnation in the systemic circulation.
There are three stages in the development of chronic cor pulmonale?
Stage 1 (preclinical) - characterized by transient pulmonary hypertension with signs of intense activity of the right ventricle, which are detected only during instrumental examination.
Stage II - is determined by the presence of signs of right ventricular hypertrophy and stable pulmonary hypertension in the absence of circulatory failure
Stage III, or stage of decompensated cor pulmonale (synonym: pulmonary heart failure), occurs from the time the first symptoms of right ventricular failure appear.
