Fluid Exchange and Hemodynamic Homeostasis Flashcards
1
Q
What are capillaries?
A
Capillaries are the smallest and most numerous blood vessels in the body, connecting arterioles and venules.
2
Q
What is the primary function of capillaries?
A
They play a crucial role in nutrient, gas, and waste exchange between the blood and tissues.
3
Q
What type of cells make up the walls of capillaries?
A
Capillary walls consist of a single layer of endothelial cells.
4
Q
What is the significance of the thin walls of capillaries?
A
The thin walls allow for efficient exchange of substances like oxygen, carbon dioxide, nutrients, and waste products.
5
Q
What is the basal lamina?
A
The basal lamina is a thin basement membrane beneath the endothelial layer that provides structural support.
6
Q
What is the typical diameter range of capillaries?
A
Capillaries typically have a diameter ranging from about 5 to 10 micrometres.
7
Q
What is the effect of capillary diameter on blood flow?
A
The small diameter slows down blood flow, allowing more time for exchange between the blood and tissues.
8
Q
What are fenestrated capillaries?
A
Fenestrated capillaries are those with small pores in the endothelial cells, allowing greater permeability to larger molecules.
9
Q
Where are fenestrated capillaries commonly found?
A
Fenestrated capillaries are found in organs like the kidneys, intestines, and endocrine glands.
10
Q
What are sinusoidal capillaries?
A
Sinusoidal capillaries have larger gaps between endothelial cells, allowing for the exchange of larger proteins and cells.
11
Q
Where can sinusoidal capillaries be found?
A
Sinusoidal capillaries are found in the liver, spleen, and bone marrow.
12
Q
What role do endothelial cells play in capillaries?
A
Endothelial cells regulate permeability and secrete signaling molecules that help regulate blood flow.
13
Q
What is a capillary bed?
A
A capillary bed is a network of capillaries supplying blood to a specific tissue or organ.
14
Q
What are precapillary sphincters?
A
Precapillary sphincters are small muscles that control blood flow through capillary beds.
15
Q
What are the three types of capillaries?
A
The three types of capillaries are:
* Continuous capillaries
* Fenestrated capillaries
* Sinusoidal capillaries
16
Q
What is the primary characteristic of continuous capillaries?
A
Continuous capillaries have tightly joined endothelial cells and minimal permeability.
17
Q
What is the process of diffusion in capillary exchange?
A
Diffusion is the movement of substances from areas of higher concentration to lower concentration through capillary walls.
18
Q
What influences the movement of water and small solutes in capillaries?
A
The movement is influenced by hydrostatic pressure and oncotic pressure.
19
Q
What occurs at the arterial end of capillaries?
A
At the arterial end, filtration predominates.
20
Q
What occurs at the venous end of capillaries?
A
At the venous end, reabsorption occurs.
21
Q
What is pinocytosis in the context of capillaries?
A
Pinocytosis is the process where endothelial cells take in fluid and small molecules via vesicles.
22
Q
What is bulk flow in the context of capillary exchange?
A
The movement of fluid and solutes in response to pressure differences, including filtration and reabsorption.
23
Q
What occurs during filtration at the arterial end of the capillary?
A
Blood pressure is higher than osmotic pressure, forcing water and small solutes out of the capillaries into the interstitial fluid.
24
Q
What is the role of reabsorption at the venous end of the capillary?
A
Promotes the movement of water and some solutes back into the capillaries due to higher osmotic pressure.
25
What substances are typically filtered out of capillaries?
Water, ions, glucose, and oxygen.
26
What is diffusion?
The process by which molecules move from an area of higher concentration to an area of lower concentration.
27
How does diffusion facilitate the exchange of oxygen and nutrients?
Oxygen and nutrients diffuse from the blood (higher concentration) into surrounding tissues (lower concentration).
28
What happens to carbon dioxide and waste products during diffusion?
They diffuse from the tissues (higher concentration) into the capillaries (lower concentration) for removal.
29
What is osmosis?
The movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration.
30
What role do plasma proteins play in osmosis?
They create osmotic pressure that pulls water back into the capillaries from the interstitial space.
31
How does water move in the context of osmosis in capillaries?
From the interstitial fluid (lower solute concentration) into the blood (higher solute concentration).
32
What is oncotic pressure?
The osmotic pressure exerted by plasma proteins that pulls water into the capillaries.
33
What is the summary of the processes involved in capillary exchange?
* Filtration occurs due to blood pressure
* Reabsorption occurs due to osmotic pressure
* Diffusion facilitates gas and small solute exchange
* Osmosis maintains fluid balance
34
True or False: Filtration and reabsorption are both components of bulk flow.
True
35
Fill in the blank: The movement of water into the capillaries due to osmotic pressure is known as _______.
reabsorption
36
What is Capillary Hydrostatic Pressure (CHP)?
The pressure exerted by the blood within the capillaries due to the pumping action of the heart.
## Footnote
CHP is crucial for driving filtration of fluids and solutes from the capillaries.
37
How does Capillary Hydrostatic Pressure (CHP) affect filtration?
CHP drives filtration by pushing fluid and small solutes from the capillaries into the interstitial space.
## Footnote
This occurs primarily at the arterial end of the capillary.
38
Where is Capillary Hydrostatic Pressure (CHP) higher?
At the arterial end of the capillary.
## Footnote
CHP decreases as blood moves toward the venous end of the capillary.
39
What is Interstitial Fluid Hydrostatic Pressure (IFHP)?
The pressure exerted by the fluid in the interstitial space that tends to push fluid back into the capillaries.
## Footnote
IFHP generally opposes filtration.
40
How does Interstitial Fluid Hydrostatic Pressure (IFHP) influence filtration?
IFHP opposes filtration, particularly if interstitial fluid pressure rises due to conditions like edema.
## Footnote
This can reverse the movement of fluid back into the capillaries.
41
What is Blood Colloid Osmotic Pressure (BCOP)?
The osmotic pressure exerted by proteins in the blood plasma that creates an osmotic gradient.
## Footnote
BCOP is mainly influenced by albumin, which cannot pass through the capillary walls.
42
What effect does Blood Colloid Osmotic Pressure (BCOP) have on reabsorption?
BCOP promotes reabsorption of water back into the capillaries by pulling water from the interstitial space.
## Footnote
This occurs due to the high solute concentration in the capillaries.
43
What is Interstitial Fluid Colloid Osmotic Pressure (IFCOP)?
The osmotic pressure exerted by proteins in the interstitial fluid that affects water movement.
## Footnote
IFCOP is weaker than BCOP due to lower protein concentration.
44
How does Interstitial Fluid Colloid Osmotic Pressure (IFCOP) affect filtration?
IFCOP promotes filtration by drawing water out of the capillaries into the interstitial fluid.
## Footnote
Elevated IFCOP can contribute to edema.
45
What is Net Filtration Pressure (NFP)?
The balance between hydrostatic and osmotic pressures determining the movement of fluid across the capillary wall.
## Footnote
NFP is calculated using the formula: NFP=(CHP−IFHP)−(BCOP−IFCOP).
46
What does a positive Net Filtration Pressure (NFP) indicate?
That filtration is occurring (fluid moves out of the capillaries).
## Footnote
This means the forces favoring filtration are greater than those opposing it.
47
What does a negative Net Filtration Pressure (NFP) indicate?
That reabsorption is occurring (fluid moves into the capillaries).
## Footnote
This implies that osmotic pressures are greater than hydrostatic pressures.
48
List the four key pressures involved in the movement of substances across the capillary wall.
* Capillary Hydrostatic Pressure (CHP)
* Interstitial Fluid Hydrostatic Pressure (IFHP)
* Blood Colloid Osmotic Pressure (BCOP)
* Interstitial Fluid Colloid Osmotic Pressure (IFCOP)
## Footnote
These pressures regulate fluid movement and maintain tissue health.
49
Fill in the blank: Capillary Hydrostatic Pressure (CHP) is higher at the _______ end of the capillary.
arterial
50
True or False: Blood Colloid Osmotic Pressure (BCOP) opposes filtration.
True
51
Fill in the blank: Interstitial Fluid Hydrostatic Pressure (IFHP) tends to push fluid _______ into the capillaries.
back
52
Fill in the blank: When Interstitial Fluid Colloid Osmotic Pressure (IFCOP) is elevated, it can contribute to _______.
edema
53
What is the primary function of the lymphatic system?
To maintain fluid balance, defend against infections, and support the circulatory system.
54
What does lymph contain?
White blood cells, proteins, waste products, and excess interstitial fluid.
55
What is the role of lymphatic vessels?
To transport lymph throughout the body.
56
What happens to excess interstitial fluid in the lymphatic system?
It is collected and returned to the bloodstream.
57
What is edema?
Swelling caused by fluid accumulation in tissues.
58
What is lymph?
Excess interstitial fluid that enters the lymphatic vessels.
59
What are lymph nodes responsible for?
Filtering lymph to remove pathogens and foreign particles.
60
What type of immune cells are found in lymph nodes?
Lymphocytes (T cells and B cells).
61
What triggers an immune response in the lymphatic system?
Detection of harmful substances like pathogens.
62
What are lacteals?
Specialized lymphatic vessels in the small intestine that absorb dietary fats.
63
What are chylomicrons?
Lipoproteins that transport absorbed fats from the small intestine.
64
True or False: The lymphatic system helps in the absorption of fat-soluble vitamins.
True.
65
Fill in the blank: The lymphatic system returns excess fluid to the bloodstream at the _______.
subclavian veins.
66
What role does the lymphatic system play in circulatory health?
It maintains fluid balance and supports effective cardiovascular function.
67
What are the key components of the lymphatic system?
* Lymphatic vessels
* Lymph nodes
* Lymphoid organs (thymus, spleen, tonsils)
* Lacteals.
68
What is the function of the thymus in the lymphatic system?
Where T lymphocytes mature.
69
What does the spleen do?
Filters blood and stores immune cells.
70
What is the significance of lymphatic vessels having valves?
To prevent backflow of lymph.
71
What is the summary of functions of the lymphatic system?
* Maintaining fluid balance
* Immune surveillance and defense
* Absorption of fats and fat-soluble vitamins
* Transport of immune cells.
72
What is the main role of the lymphatic system in immune function?
To filter lymph for pathogens and trigger immune responses.
73
What happens to lymphocytes during an infection?
They are mobilized to the site of infection through the lymphatic system.
74
How does the lymphatic system contribute to overall health?
By maintaining fluid homeostasis and supporting the immune system.
75
What is oedema?
Oedema refers to the abnormal accumulation of fluid in the body's tissues, leading to swelling.
76
In which parts of the body can oedema occur?
Oedema can occur in various parts of the body, such as the legs, ankles, feet, or abdomen.
77
What are some causes of oedema?
Oedema can result from various causes, including:
* Injury
* Inflammation
* Heart failure
* Kidney disease
* Problems with the lymphatic system.
78
True or False: Oedema is always a primary condition.
False. Oedema is often a symptom of an underlying health issue.
79
What may be required to determine the cause of oedema?
Medical evaluation may be required to determine the cause of oedema.
80
What is oedema?
Oedema occurs when there is an imbalance in the mechanisms that regulate fluid distribution between the vascular system and the interstitial spaces.
81
What can contribute to the development of oedema?
Several pathophysiological processes can contribute, including:
* Increased Capillary Hydrostatic Pressure
* Decreased Plasma Oncotic Pressure
* Increased Capillary Permeability
* Lymphatic Obstruction or Dysfunction
* Sodium and Water Retention
* Impaired Venous Return
* Inflammatory and Immune Responses.
82
What is increased capillary hydrostatic pressure?
It is the pressure exerted by the blood on the walls of capillaries, rising pressure forces fluid from the capillaries into surrounding tissues.
83
What is a common cause of increased capillary hydrostatic pressure?
Heart failure, particularly right-sided heart failure.
84
What role does venous obstruction play in oedema?
Venous obstruction (e.g., deep vein thrombosis) increases venous pressure, leading to fluid leakage into the tissues.
85
What is decreased plasma oncotic pressure?
It is the reduced pressure exerted by proteins in the blood plasma that helps draw fluid back into the capillaries.
86
What can cause decreased plasma oncotic pressure?
Causes include:
* Hypoalbuminemia due to liver disease
* Kidney disease
* Malnutrition.
87
What is increased capillary permeability?
It is when capillaries allow more fluid and proteins to leak out into the surrounding tissues.
88
What can increase capillary permeability?
Inflammation, allergic reactions, and burns.
89
What is the role of the lymphatic system in fluid balance?
The lymphatic system helps to return excess fluid from the interstitial spaces back to the bloodstream.
90
What can cause lymphatic obstruction or dysfunction?
Causes include:
* Lymphatic filariasis
* Cancer
* Surgery
* Infections like cellulitis.
91
How does sodium and water retention lead to oedema?
It increases the volume of circulating blood, which can lead to oedema.
92
What are common causes of sodium and water retention?
Causes include:
* Kidney disease
* Excessive salt intake
* Conditions like heart failure.
93
What does impaired venous return refer to?
It refers to the flow of blood back to the heart from the body being impaired.
94
What can impair venous return?
Causes include:
* Varicose veins
* Deep vein thrombosis
* Prolonged immobility.
95
What is the impact of inflammatory and immune responses on oedema?
They increase capillary permeability and promote fluid leakage into tissues.
96
What mediators are released during inflammatory responses?
Mediators include:
* Histamine
* Bradykinin
* Prostaglandins.
97
True or False: Oedema can occur due to both increased capillary hydrostatic pressure and decreased plasma oncotic pressure.
True.
98
Fill in the blank: The pressure exerted by proteins in the blood plasma is known as _______.
[oncotic pressure].
99
What is peripheral oedema?
Accumulation of excess fluid in the interstitial tissues, especially in the lower extremities.
100
What causes increased capillary hydrostatic pressure?
Venous pressure increases, forcing fluid from capillaries into surrounding tissues, often due to heart failure or venous obstruction.
101
What is the role of plasma oncotic pressure in fluid retention?
It helps retain fluid within blood vessels; a loss of albumin reduces this pressure, allowing fluid to accumulate in tissues.
102
What conditions can lead to decreased plasma oncotic pressure?
* Nephrotic syndrome
* Liver cirrhosis
103
How does increased capillary permeability contribute to oedema?
Inflammatory mediators increase the permeability of capillary walls, allowing more fluid to leak into tissues.
104
What is impaired lymphatic drainage?
A condition where the lymphatic system fails to drain excess interstitial fluid, leading to localized fluid accumulation.
105
What is pulmonary oedema?
Accumulation of fluid in the lungs, particularly in the alveolar spaces, leading to impaired gas exchange.
106
What is a common cause of pulmonary oedema?
Left-sided heart failure, which raises pressure in pulmonary veins.
107
How does decreased plasma oncotic pressure affect the lungs?
It allows fluid to leak out of blood vessels and accumulate in the lungs.
108
What is ascites?
Accumulation of fluid within the peritoneal cavity, commonly associated with liver disease.
109
What causes increased capillary hydrostatic pressure in ascites?
Portal hypertension in cirrhosis forces fluid out of peritoneal capillaries.
110
What role does sodium and water retention play in ascites?
It increases overall blood volume and fluid retention, contributing to ascites formation.
111
What is cerebral oedema?
Accumulation of fluid in brain tissue, leading to increased intracranial pressure.
112
What condition can disrupt the blood-brain barrier?
Inflammatory conditions such as encephalitis or traumatic brain injury.
113
What is cytotoxic oedema?
Swelling of cells due to ischemia, leading to the accumulation of intracellular fluid.
114
What is vasogenic oedema?
Fluid and proteins leak into brain tissue due to compromised blood-brain barrier.
115
What is generalized oedema (anasarca)?
Severe, widespread oedema affecting multiple areas of the body.
116
What systemic causes can lead to anasarca?
* Heart failure
* Kidney disease
* Liver disease
* Malnutrition
* Sepsis
117
What is the conclusion regarding the pathophysiology of oedema?
It involves complex interactions of hydrostatic pressure, oncotic pressure, capillary permeability, and lymphatic drainage.
118
What are the common symptoms of Peripheral Oedema?
Swelling, heaviness or tightness, pain or discomfort, weight gain, reduced mobility
## Footnote
Peripheral oedema commonly affects the legs, ankles, and feet.
119
What sign indicates Pitting Oedema?
An indentation persists when pressure is applied to the swollen area
## Footnote
This is a characteristic feature of fluid accumulation.
120
What are the symptoms of Abdominal Oedema (Ascites)?
Abdominal swelling, discomfort, early satiety, weight gain, nausea or vomiting
## Footnote
Ascites is often associated with liver conditions.
121
What is a clinical sign of Abdominal Oedema?
Shifting dullness
## Footnote
This sign is observed during physical examination when fluid moves in the abdomen.
122
What are some symptoms of Pulmonary Oedema?
Breathlessness, paroxysmal nocturnal dyspnoea, cough with frothy sputum, fatigue, wheezing or crackles
## Footnote
Symptoms may worsen with exertion or lying flat.
123
What does elevated jugular venous pressure (JVP) indicate?
Increased central venous pressure
## Footnote
This can result from heart failure leading to pulmonary oedema.
124
What are the symptoms of Cerebral Oedema?
Headache, nausea or vomiting, altered mental status, seizures
## Footnote
Symptoms can progress to coma in extreme cases.
125
What is Papilledema?
Swelling of the optic disc in the eye
## Footnote
This indicates increased intracranial pressure.
126
What characterizes Generalized Oedema (Anasarca)?
Severe swelling of the entire body, fatigue, difficulty breathing
## Footnote
Generalized oedema affects multiple areas, including the face and limbs.
127
What are the signs of Renal Oedema?
Hypertension, proteinuria, edematous skin
## Footnote
These signs indicate kidney disease, such as nephrotic syndrome.
128
Fill in the blank: The presence of protein in the urine is known as _______.
proteinuria
## Footnote
Proteinuria is indicative of kidney disease.
129
True or False: Peripheral Oedema is only associated with swelling in the legs.
False
## Footnote
While it commonly occurs in the legs, it can affect other areas as well.
130
What is a classic radiographic sign of pulmonary oedema?
Butterfly pattern
## Footnote
This sign shows bilateral perihilar consolidation on X-ray.
131
What are common symptoms of Pulmonary Oedema when lying flat?
Orthopnoea
## Footnote
Patients may experience increased breathlessness when in a supine position.
132
What might cause abdominal discomfort in Abdominal Oedema?
Fluid accumulation leading to a feeling of fullness
## Footnote
This can affect breathing and overall comfort.
133
What is a sign of fluid retention in the context of Generalized Oedema?
Taut, shiny skin
## Footnote
This occurs due to stretching from fluid accumulation.
134
What is the significance of crackles heard on auscultation of the lungs?
Indicates fluid in the alveoli
## Footnote
This is a sign of pulmonary oedema.
135
What are the potential outcomes of altered mental status due to Cerebral Oedema?
Confusion, irritability, lethargy, coma
## Footnote
Symptoms can progress in severity.
136
What is the pathological process associated with increased capillary hydrostatic pressure?
Increased pressure in the blood vessels forces fluid from the capillaries into the surrounding tissues, leading to oedema.
137
What are common causes of increased capillary hydrostatic pressure?
* Left-sided heart failure
* Right-sided heart failure
* Venous obstruction
* Cirrhosis
138
What is the pathological process associated with decreased plasma oncotic pressure?
Decreased levels of plasma proteins, particularly albumin, reduce the osmotic pull that normally keeps fluid within the blood vessels, leading to fluid leakage into the surrounding tissues.
139
What are common causes of decreased plasma oncotic pressure?
* Nephrotic syndrome
* Cirrhosis
* Malnutrition
* Protein-losing enteropathy
140
What is the pathological process associated with increased capillary permeability?
Increased permeability of capillaries allows proteins and fluid to leak from the vascular space into the interstitial tissues.
141
What are common causes of increased capillary permeability?
* Acute inflammation
* Infection
* Burns
* Sepsis
* Angioedema
142
What is the pathological process associated with impaired lymphatic drainage?
The lymphatic system, responsible for draining excess interstitial fluid, can be obstructed or dysfunctional, leading to fluid buildup in tissues.
143
What are common causes of impaired lymphatic drainage?
* Lymphatic obstruction
* Surgical removal of lymph nodes
* Infections
* Congenital lymphatic malformations
* Post-radiation fibrosis
144
What is the pathological process associated with sodium and water retention?
The kidneys regulate fluid balance by controlling sodium and water excretion. When the kidneys retain too much sodium and water, it leads to an increase in blood volume and fluid accumulation in tissues.
145
What are common causes of sodium and water retention?
* Heart failure
* Chronic kidney disease (CKD)
* Cirrhosis
* Nephrotic syndrome
* Pregnancy
146
What is the pathological process related to inflammatory and immune responses?
Inflammation and immune reactions lead to the release of mediators that increase capillary permeability and promote fluid leakage into tissues.
147
What are common causes of inflammation and immune responses leading to oedema?
* Allergic reactions
* Autoimmune diseases
* Infections
* Post-surgical oedema
148
What are common causes of oedema related to endocrine disorders?
* Hypothyroidism
* Cushing's syndrome
149
What is a common cause of gravity-dependent oedema?
Prolonged standing or sitting can result in gravity-dependent oedema in the lower limbs.
150
Identify the mechanisms that can cause oedema.
* Increased capillary hydrostatic pressure
* Decreased plasma oncotic pressure
* Increased capillary permeability
* Impaired lymphatic drainage
* Sodium and water retention
* Inflammatory responses
151
What is the importance of identifying the underlying cause of oedema?
Identifying the underlying cause of oedema is crucial for appropriate diagnosis and treatment.
152
What is heart failure?
A condition in which the heart is unable to pump blood effectively enough to meet the body’s needs for oxygen and nutrients.
153
What are the two main types of heart failure?
* Systolic heart failure
* Diastolic heart failure
154
What characterizes systolic heart failure?
The heart’s ability to contract and pump blood is reduced.
155
What characterizes diastolic heart failure?
The heart's ability to relax and fill with blood is impaired, often due to stiffness in the heart muscles.
156
What are common causes of heart failure?
* High blood pressure
* Heart attacks
* Coronary artery disease
* Other conditions that damage or overwork the heart
157
What are common symptoms of heart failure?
* Shortness of breath
* Fatigue
* Swelling in the legs or abdomen
* Reduced ability to exercise
158
True or False: Heart failure is a chronic condition.
True
159
What treatments can help manage heart failure symptoms?
* Medications
* Lifestyle changes
* Sometimes surgeries
160
Fill in the blank: Heart failure occurs when the heart becomes too _______ or _______ to function properly.
[weak] or [stiff]
161
What are the risk factors for heart failure?
* Hypertension
* Coronary artery disease
* Diabetes mellitus
* Obesity
* Smoking
* Age
* Family history of heart disease
162
Define the term aetiology in the context of heart failure.
Aetiology refers to the study of the causative factors or origins of heart failure.
163
Fill in the blank: The main aetiological factors for heart failure include _______.
[hypertension, coronary artery disease, diabetes mellitus]
164
True or False: Obesity is a risk factor for heart failure.
True
165
List any three risk factors for heart failure.
* Hypertension
* Diabetes mellitus
* Smoking
166
What is the relationship between age and heart failure?
Increased age is a significant risk factor for heart failure.
167
True or False: Family history of heart disease does not influence the risk of heart failure.
False
168
Name a lifestyle risk factor for heart failure.
Smoking
169
Fill in the blank: Aetiology of heart failure encompasses factors such as _______.
[hypertension, coronary artery disease, diabetes mellitus]
170
What is hypertension?
Chronic high blood pressure that leads to heart muscle thickening and reduces heart efficiency.
## Footnote
Hypertension is a leading cause of heart failure.
171
What does coronary artery disease (CAD) refer to?
Narrowing or blockage of the coronary arteries supplying blood to the heart muscle.
## Footnote
Reduced blood flow can damage the heart muscle and increase heart failure risk.
172
What is a heart attack?
Damage to the heart muscle impairing its ability to pump effectively.
## Footnote
This damage can lead to heart failure over time.
173
How does diabetes increase heart failure risk?
Poorly controlled diabetes increases risk of heart disease and damages blood vessels.
## Footnote
High blood sugar levels contribute to coronary artery disease and hypertension.
174
What role does obesity play in heart failure?
Increases risk through high blood pressure, diabetes, and increased workload on the heart.
## Footnote
Obesity is a significant risk factor for heart failure.
175
What is valvular heart disease?
Damage or dysfunction of heart valves leading to heart failure.
## Footnote
Conditions include mitral regurgitation and aortic stenosis.
176
How does chronic kidney disease relate to heart failure?
Poor kidney function can lead to fluid buildup and increased blood pressure, straining the heart.
## Footnote
This condition is often linked to heart failure.
177
What is the impact of smoking on heart health?
Contributes to coronary artery disease and increases heart failure risk.
## Footnote
Smoking damages blood vessels and promotes atherosclerosis.
178
What are the effects of excessive alcohol consumption on the heart?
Can damage the heart muscle, leading to alcoholic cardiomyopathy and increased heart failure risk.
## Footnote
Chronic consumption directly weakens the heart.
179
How does physical inactivity contribute to heart failure?
Associated with higher risks of obesity, hypertension, and diabetes.
## Footnote
A sedentary lifestyle is a significant risk factor.
180
What is the significance of family history in heart failure?
A family history of heart failure or genetic disorders increases the likelihood of developing the condition.
## Footnote
Genetic predisposition plays a role in heart failure risk.
181
How does age affect the risk of heart failure?
Older adults are at greater risk as heart function naturally declines with age.
## Footnote
Age is a significant risk factor for heart failure.
182
What are the main categories of causes of heart failure?
1. Ischemic
2. Non-Ischemic
3. Other Causes
4. Genetic Factors
## Footnote
These categories encompass various risk factors and underlying conditions.
183
What is ischemic heart disease?
Coronary artery disease causing reduced blood flow and potential heart attacks, leading to heart failure.
## Footnote
Atherosclerosis can result in ischemia of the heart muscle.
184
What is dilated cardiomyopathy?
A condition where the heart becomes enlarged and weak, often due to genetic factors or other causes.
## Footnote
This type of cardiomyopathy impairs the heart's ability to pump blood.
185
What is hypertrophic cardiomyopathy?
Abnormal thickening of the heart muscle that can obstruct blood flow.
## Footnote
This condition impairs heart function.
186
What is restrictive cardiomyopathy?
Condition where the heart walls become stiff and less able to expand.
## Footnote
Often associated with conditions like amyloidosis or fibrosis.
187
What are arrhythmias?
Irregular heart rhythms that can reduce the efficiency of the heart’s pumping.
## Footnote
Conditions like atrial fibrillation increase the risk of heart failure.
188
How can endocrine disorders affect heart function?
Conditions like thyroid disease and adrenal disorders can impact heart function.
## Footnote
These disorders can lead to heart failure.
189
What role do infections play in heart failure?
Viral and bacterial infections can damage the heart muscle or valves.
## Footnote
Examples include viral myocarditis and bacterial endocarditis.
190
What is the effect of chronic exposure to toxins on heart health?
Can lead to chronic heart damage and heart failure.
## Footnote
Toxins include alcohol, cocaine, or chemotherapy drugs.
191
What is peripartum cardiomyopathy?
Heart failure developing during pregnancy or shortly after childbirth.
## Footnote
This rare condition weakens the heart.
192
What is the relationship between genetic factors and heart failure?
Genetic mutations can predispose individuals to certain cardiomyopathies leading to heart failure.
## Footnote
Structural and functional heart muscle genes are involved.
193
Summarize the multifactorial nature of heart failure.
Heart failure results from damage or dysfunction of the heart due to ischemic disease, high blood pressure, valvular disorders, cardiomyopathies, and other factors.
## Footnote
Understanding these causes is crucial for prevention and treatment.
194
What is heart failure classified based on?
The severity of the condition and its impact on the patient’s ability to function.
195
What are the two commonly used systems for classifying heart failure?
NYHA (New York Heart Association) Functional Classification and ACC/AHA (American College of Cardiology/American Heart Association) Staging System.
196
What does the NYHA Functional Classification categorize?
Heart failure based on the degree of physical limitation caused by the condition.
197
What is Class I in the NYHA Functional Classification?
No limitation of physical activity.
198
What symptoms occur in Class II of the NYHA Functional Classification?
Symptoms occur with ordinary physical activity.
199
Describe the conditions of Class III in the NYHA Classification.
Marked limitation of physical activity; symptoms occur with less than ordinary activity.
200
What characterizes Class IV in the NYHA Classification?
Unable to carry out any physical activity without discomfort; symptoms occur at rest.
201
What does the ACC/AHA Staging System focus on?
The underlying progression of heart failure and its potential for worsening.
202
What does Stage A of the ACC/AHA Staging System indicate?
At high risk for heart failure but without structural heart disease or symptoms.
203
What is the condition of individuals in Stage B of the ACC/AHA Staging System?
Structural heart disease but without signs or symptoms of heart failure.
204
What defines Stage C in the ACC/AHA Staging System?
Structural heart disease with prior or current symptoms of heart failure.
205
What does Stage D of the ACC/AHA Staging System represent?
Refractory heart failure requiring specialized interventions.
206
What is a key difference between the NYHA and ACC/AHA classifications?
NYHA focuses on functional impact; ACC/AHA focuses on disease progression.
207
True or False: The NYHA Classification is static over time.
False.
208
Fill in the blank: The NYHA system is ______, meaning it can change over time.
dynamic.
209
Fill in the blank: The ACC/AHA system is ______, meaning once diagnosed, a person typically remains at that stage.
static.
210
What are some risk factors for Stage A heart failure?
* Hypertension
* Diabetes
* Obesity
* Family history of heart disease
211
What symptoms might indicate Stage C heart failure?
* Fatigue
* Shortness of breath
* Fluid retention
212
What specialized treatments might be required in Stage D heart failure?
* Heart transplantation
* Left ventricular assist devices (LVAD)
* Palliative care
213
What occurs during left heart failure?
The left side of the heart is unable to pump blood effectively to the body, particularly to vital organs.
214
Which part of the heart is primarily affected in left heart failure?
The left ventricle.
215
What are the two key processes involved in the pathophysiology of left heart failure?
Systolic dysfunction and diastolic dysfunction.
216
What is reduced ejection fraction (EF) indicative of?
Systolic heart failure (HFrEF).
217
What EF percentage is typically considered indicative of systolic heart failure?
Below 40%.
218
Name three causes of systolic dysfunction.
* Coronary artery disease
* Myocardial infarction
* Dilated cardiomyopathy
219
What is one consequence of decreased cardiac output in left heart failure?
Less blood is delivered to the systemic circulation.
220
What compensatory mechanisms are activated in response to systolic dysfunction?
* Renin-angiotensin-aldosterone system (RAAS)
* Sympathetic nervous system (SNS)
* Antidiuretic hormone (ADH)
221
What is ventricular remodeling in the context of left heart failure?
Hypertrophy and dilation of the heart muscle that impair function.
222
What is impaired in diastolic heart failure (HFpEF)?
The left ventricle’s ability to relax and fill with blood during diastole.
223
What is a common ejection fraction for diastolic heart failure?
Typically > 50%.
224
What condition leads to pulmonary congestion in diastolic dysfunction?
Impaired ventricular relaxation.
225
What common causes lead to diastolic dysfunction?
* Hypertension
* Diabetes
* Obesity
* Aging
226
What symptom is considered the most common in left heart failure?
Shortness of breath (Dyspnea).
227
What is orthopnea?
Difficulty breathing while lying flat.
228
What is paroxysmal nocturnal dyspnea (PND)?
Sudden episodes of shortness of breath that awaken the patient from sleep.
229
What can advanced left heart failure lead to in terms of pulmonary symptoms?
Pulmonary edema.
230
What systemic symptoms can arise from left heart failure?
* Fatigue and weakness
* Dizziness or lightheadedness
231
What are signs of volume overload due to fluid retention in left heart failure?
* Peripheral edema
* Ascites
* Weight gain
232
What does the presence of an S3 heart sound indicate?
Rapid filling of a dilated ventricle.
233
What heart sound is often seen in diastolic heart failure?
S4 gallop.
234
What is tachycardia in the context of left heart failure?
Elevated heart rate as a compensation for reduced cardiac output.
235
What is jugular venous distention (JVD) associated with?
Increased left atrial pressure that backs up into the venous system.
236
List three clinical features of left heart failure.
* Dyspnea
* Orthopnea
* Pulmonary edema
237
What can untreated left heart failure progress to?
Right-sided heart failure and worsening overall organ function.
238
Why is early diagnosis and treatment of left heart failure critical?
To improve outcomes and quality of life for patients.
239
What occurs in right heart failure?
The right side of the heart is unable to pump blood effectively into the lungs for oxygenation.
240
Which part of the heart is primarily affected in right heart failure?
The right ventricle.
241
What are common causes of right heart failure?
* Chronic pulmonary diseases
* Right ventricular myocardial infarction
* Left-sided heart failure
242
Define primary right ventricular dysfunction.
It refers to conditions that directly impair the right ventricle's ability to pump blood effectively.
243
List some chronic pulmonary diseases that can lead to right heart failure.
* Chronic obstructive pulmonary disease (COPD)
* Pulmonary hypertension
* Pulmonary embolism
244
What happens to the right ventricle during chronic pulmonary diseases?
It becomes dilated and weakened, eventually leading to failure.
245
How can a right ventricular myocardial infarction affect heart function?
It can lead to ischemia and damage to the right ventricle, impairing its pumping ability.
246
What is the relationship between left-sided heart failure and right heart failure?
Left-sided heart failure can lead to increased pressure in the pulmonary circulation, causing the right ventricle to work harder.
247
What does sustained high pressure in the pulmonary circulation lead to?
Dilatation and hypertrophy of the right ventricle, impairing its pumping ability.
248
What is the main factor contributing to right heart failure?
Increased pulmonary vascular resistance (PVR).
249
What are the consequences of right ventricular dysfunction?
It leads to venous congestion in the body.
250
What classic signs indicate right heart failure?
* Peripheral edema
* Ascites
* Jugular venous distention (JVD)
251
What causes peripheral edema in right heart failure?
Backup of blood into the systemic veins leading to fluid accumulation in tissues.
252
What is ascites?
Fluid accumulation in the abdomen due to congestion in abdominal organs.
253
What is jugular venous distention (JVD)?
Abnormal bulging of the jugular veins in the neck due to increased venous pressure.
254
What condition can hepatomegaly lead to in severe cases of right heart failure?
Cirrhosis and liver dysfunction.
255
Why does renal dysfunction occur in right heart failure?
Due to poor perfusion of the kidneys and activation of the renin-angiotensin-aldosterone system (RAAS).
256
What symptoms may patients with right heart failure experience due to decreased perfusion?
* Fatigue
* Weakness
257
What causes rapid weight gain in right heart failure?
Fluid retention from edema and ascites.
258
What gastrointestinal symptoms are associated with right heart failure?
* Anorexia
* Nausea
259
True or False: Pulmonary symptoms are primarily associated with right heart failure.
False.
260
What are some pulmonary symptoms that can occasionally occur in right heart failure?
* Shortness of breath
* Dyspnea
261
What is the summary of clinical features of right heart failure?
* Peripheral edema
* Ascites
* Jugular venous distention (JVD)
* Hepatomegaly
* Renal dysfunction
* Fatigue and weakness
* Rapid weight gain
* Anorexia and nausea
* Pulmonary symptoms
262
What is the significance of prompt diagnosis and treatment in right heart failure?
It is essential to manage the condition and prevent further complications.
263
What does cardiac remodeling refer to?
Structural and functional changes in the heart in response to injury, stress, or disease.
264
What are the main alterations that occur during cardiac remodeling?
Changes in size, shape, and thickness of the heart muscle, as well as changes in the heart's chambers and blood vessels.
265
What events can trigger cardiac remodeling?
Heart attack, hypertension, heart failure, or valvular disease.
266
What are the two main types of cardiac remodeling?
* Compensatory remodeling
* Pathological remodeling
267
What is compensatory remodeling?
Changes the heart undergoes to compensate for damage or increased workload, initially helping to maintain heart function.
268
What is pathological remodeling?
Maladaptive changes that can lead to worsening heart function, heart failure, arrhythmias, and other complications.
269
What is hypertrophy in the context of cardiac remodeling?
Thickening of the heart muscle.
270
What does dilation refer to in cardiac remodeling?
Enlargement of the heart chambers.
271
What is fibrosis in relation to cardiac remodeling?
Scarring of the heart tissue.
272
What can altered electrical conduction during cardiac remodeling lead to?
Arrhythmias.
273
Fill in the blank: Cardiac remodeling can involve _______ of the heart muscle.
hypertrophy
274
True or False: Compensatory remodeling always leads to improved heart function.
False
275
Fill in the blank: Pathological remodeling can lead to _______ heart function.
worsening
276
What is cardiac remodeling?
Cardiac remodeling is the structural alteration of the heart due to various stresses or injuries.
277
What triggers cardiac remodeling?
Factors such as myocardial infarction, hypertension, heart failure, valvular heart disease, chronic ischemia, arrhythmias, endocrine disorders, genetic factors, alcohol abuse, toxins and medications, infections, obesity, chronic kidney disease, and physical stress.
278
Define myocardial infarction.
The death of heart muscle tissue due to blockage of blood flow.
279
How does hypertension affect the heart?
It increases the workload on the heart, causing hypertrophy and can lead to chamber dilation and fibrosis over time.
280
What is the impact of heart failure on cardiac structure?
It causes structural changes, leading to dilation of the chambers and thickening of the walls.
281
What is valvular heart disease?
Conditions like aortic stenosis or mitral regurgitation that alter blood flow and cause remodeling.
282
What is chronic ischemia?
Long-term inadequate blood supply to the heart muscle due to coronary artery disease.
283
How do chronic arrhythmias contribute to cardiac remodeling?
They induce abnormal electrical and mechanical stresses on the heart.
284
List some endocrine disorders that can influence cardiac remodeling.
* Hyperthyroidism
* Hypothyroidism
* Diabetes
285
What is alcoholic cardiomyopathy?
A form of heart failure characterized by changes in the heart's structure and function due to chronic alcohol consumption.
286
What role do toxins and medications play in cardiac remodeling?
Certain drugs and toxins can directly damage the heart muscle.
287
What is myocarditis?
Inflammation of the heart muscle due to infections, often viral.
288
How does obesity contribute to cardiac remodeling?
It increases workload on the heart through mechanisms like increased blood pressure and inflammation.
289
What impact does chronic kidney disease have on the heart?
It can lead to fluid retention and increased blood pressure, contributing to cardiac remodeling.
290
Fill in the blank: Intense and prolonged physical stress, particularly without proper recovery, can lead to _______.
maladaptive remodeling.
291
True or False: Genetic factors can predispose individuals to abnormal heart remodeling.
True
292
What is concentric remodeling?
A type of cardiac remodeling where the heart's muscle thickens without significant chamber dilation.
293
What typically triggers concentric remodeling?
Increased pressure overload, such as from hypertension.
294
What happens to the heart's chamber size during concentric remodeling?
It often remains normal or only slightly reduced.
295
What is the primary mechanism of concentric remodeling?
The left ventricle thickens its walls to maintain efficient blood pumping.
296
What are common causes of concentric remodeling?
* Hypertension
* Aortic Stenosis
* Coarctation of the Aorta
* Chronic Volume Overload
* Endocrine and Metabolic Disorders
297
What is the most common cause of concentric remodeling?
Hypertension (High Blood Pressure).
298
What is a complication of concentric remodeling related to heart function?
Heart Failure with Preserved Ejection Fraction (HFpEF).
299
What can thickening of the heart muscle lead to regarding electrical pathways?
Increased risk of arrhythmias.
300
What is left ventricular diastolic dysfunction?
Impaired ability of the heart to relax and fill with blood due to thickened walls.
301
What can happen if the coronary arteries cannot meet the heart's increased demand?
Ischemia, leading to angina or even a heart attack.
302
What can chronic high blood pressure lead to aside from heart issues?
End-organ damage to the kidneys, brain, and eyes.
303
What is a rare but severe complication of concentric remodeling?
Aortic Dissection.
304
What is a key management strategy for concentric remodeling?
Control of blood pressure.
305
Name a lifestyle change recommended for managing concentric remodeling.
* Weight management
* Reducing alcohol intake
* Smoking cessation
* Improving diet and exercise
306
What advanced therapies might be required if concentric remodeling progresses?
* Surgical interventions
* Implantable devices (e.g., pacemakers, defibrillators)
* Heart transplantation
307
True or False: Concentric remodeling always leads to heart failure.
False.
308
Fill in the blank: The thickened myocardium can eventually impair the ability of the heart to _______.
relax and fill with blood properly.
309
What is the relationship between concentric remodeling and heart failure?
Unchecked remodeling can lead to heart failure with reduced ejection fraction (HFrEF).
310
What is eccentric remodeling?
A type of cardiac remodeling where the heart's chambers dilate and the walls become thinner, often due to volume overload.
311
What is the key difference between eccentric remodeling and concentric remodeling?
Eccentric remodeling leads to an increase in chamber size with unchanged or decreased wall thickness, while concentric remodeling involves thickening of the heart muscle walls.
312
What are the mechanisms involved in eccentric remodeling?
* Increased Preload
* Myocyte Stretch
* Compensatory Mechanisms
313
What condition is associated with increased preload in eccentric remodeling?
Conditions that lead to excessive blood returning to the heart.
314
What happens to myocytes during eccentric remodeling?
Myocytes become elongated due to increased volume, initially increasing contractility but potentially impairing force generation over time.
315
List some causes of eccentric remodeling.
* Chronic Valvular Regurgitation
* Heart Failure with Reduced Ejection Fraction (HFrEF)
* Chronic Volume Overload from congenital conditions
* High Output States
* Chronic Kidney Disease
* Chronic Pulmonary Hypertension
* Post-Myocardial Infarction
316
What is chronic valvular regurgitation?
Conditions like mitral or aortic regurgitation where blood leaks backward through the heart's valves, leading to chamber dilation.
317
How does heart failure with reduced ejection fraction (HFrEF) relate to eccentric remodeling?
In heart failure, the ventricle may dilate due to the inability to pump blood effectively, leading to eccentric remodeling.
318
What are high output states that can lead to eccentric remodeling?
Conditions such as hyperthyroidism or anemia that increase blood volume returning to the heart.
319
What are some complications of eccentric remodeling?
* Heart Failure with Reduced Ejection Fraction (HFrEF)
* Arrhythmias
* Increased Risk of Thromboembolism
* Progression to Severe Heart Failure
* Cardiac Dilatation and Dysfunction
* Pulmonary Hypertension
* Valve Dysfunction
320
What arrhythmias are commonly associated with eccentric remodeling?
* Atrial Fibrillation
* Ventricular Arrhythmias
321
What is the risk of thromboembolism in eccentric remodeling?
Enlarged heart chambers can cause turbulent blood flow, increasing the risk of blood clots.
322
What is dilated cardiomyopathy?
A condition where chronic dilation causes the heart muscle to become too thin and weak.
323
How does valve dysfunction occur in eccentric remodeling?
Dilated heart chambers can impair valve function, leading to valvular regurgitation.
324
What are common pharmacological therapies for managing eccentric remodeling?
* ACE inhibitors
* Angiotensin II receptor blockers (ARBs)
* Beta-blockers
* Diuretics
* Aldosterone antagonists
325
What surgical intervention may be necessary for valvular regurgitation?
Surgery to repair or replace the faulty valve.
326
What lifestyle modifications can help manage eccentric remodeling?
* Dietary changes (low salt, healthy fats)
* Regular physical activity
* Smoking cessation
* Weight management
327
Fill in the blank: Eccentric remodeling occurs as a response to _______.
[chronic volume overload]
328
True or False: Eccentric remodeling can lead to serious complications if left untreated.
True
329
What is the initial benefit of eccentric remodeling?
It helps the heart accommodate increased blood volume.
330
What role do cardiac devices play in managing eccentric remodeling?
They may prevent sudden cardiac death and assist in heart function during severe dilation.
331
What is the first step in diagnosing heart failure?
Gathering a thorough history
332
What symptom is characterized by shortness of breath when lying flat?
Orthopnea
333
What does paroxysmal nocturnal dyspnea (PND) indicate?
Sudden shortness of breath during sleep
334
What key symptom is associated with fluid retention in heart failure?
Swelling (edema)
335
What is a common cause of cough or wheezing in left-sided heart failure?
Pulmonary congestion
336
What does a rapid increase in weight indicate in heart failure patients?
Fluid retention
337
What medical history factors are significant in diagnosing heart failure?
Coronary artery disease, hypertension, valvular heart disease, diabetes mellitus, family history
338
What lifestyle factors may contribute to heart failure?
Alcohol use, smoking, illicit drug use, exercise habits, diet
339
What vital sign changes are commonly seen in heart failure?
Elevated heart rate, low blood pressure, increased respiratory rate
340
What condition is indicated by jugular venous distention (JVD)?
Increased central venous pressure
341
What physical examination finding indicates fluid in the lungs?
Rales (crackles) or wheezing
342
What is an S3 gallop indicative of in heart failure?
Increased ventricular filling pressures
343
What abdominal examination finding may occur due to right-sided heart failure?
Hepatomegaly or splenomegaly
344
What is assessed through an electrocardiogram (ECG) in heart failure diagnosis?
Arrhythmias, left ventricular hypertrophy, signs of myocardial infarction
345
What does cardiomegaly indicate on a chest X-ray?
Enlarged heart associated with heart failure
346
What is the significance of the ejection fraction (EF) in heart failure?
It measures the heart's pumping efficiency
347
What defines HFrEF (Heart Failure with Reduced Ejection Fraction)?
EF < 40%
348
What biomarker is released by the heart in response to increased pressure and volume overload?
B-type natriuretic peptide (BNP)
349
What blood test is used to assess kidney function in heart failure patients?
Basic metabolic panel (BMP)
350
What imaging tests can provide detailed structural information about cardiomyopathies?
Cardiac MRI or CT
351
What diagnostic procedure is used if coronary artery disease (CAD) is suspected?
Coronary angiography
352
What is the purpose of an Electrocardiogram (ECG) in diagnosing heart failure?
To assess the electrical activity of the heart and identify underlying conditions contributing to heart failure
## Footnote
Common conditions include arrhythmias, ischemic heart disease, and structural changes.
353
What arrhythmias are commonly seen in heart failure?
* Atrial fibrillation
* Ventricular tachycardia
## Footnote
Particularly prevalent in advanced stages of heart failure.
354
What do ST-segment changes on an ECG indicate in heart failure?
Signs of ischemia, indicating myocardial infarction or chronic ischemia
355
What does left ventricular hypertrophy (LVH) indicate on an ECG?
Evidence of structural changes in the heart, often associated with heart failure
356
What is a common conduction abnormality that can complicate heart failure diagnosis?
Bundle branch block, especially left bundle branch block (LBBB)
357
What does the presence of an S3 gallop indicate?
Abnormal ventricular filling, suggestive of heart failure
358
What are B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) used for?
Biomarkers released in response to increased wall stress and pressure overload, indicating heart failure
359
What BNP level strongly suggests heart failure?
Greater than 400 pg/mL
360
What BNP level suggests a low likelihood of heart failure?
Less than 100 pg/mL
361
What does elevated troponin levels indicate in the context of heart failure?
Myocardial injury or infarction, contributing to or exacerbating heart failure
362
What is the purpose of a chest X-ray in heart failure diagnosis?
To evaluate heart size, pulmonary vasculature, and fluid accumulation in the lungs
363
What does cardiomegaly indicate on a chest X-ray?
An enlarged heart, often seen in chronic heart failure or dilated cardiomyopathy
364
What is pulmonary edema, and how is it seen on a chest X-ray?
Fluid in the lungs, often showing as bilateral infiltrates or Kerley B lines
365
What does an echocardiogram assess in heart failure?
Cardiac structure and function, including ejection fraction (EF) and underlying causes
366
What defines HFrEF?
Heart Failure with Reduced Ejection Fraction: EF < 40%
367
What defines HFpEF?
Heart Failure with Preserved Ejection Fraction: EF ≥ 50%
368
What does diastolic dysfunction indicate?
Impaired relaxation and filling of the heart, characteristic of HFpEF
369
What can Doppler echocardiography assess?
The flow of blood through the heart and great vessels, identifying valvular abnormalities
370
What additional imaging may be used if echocardiograms are inconclusive?
* Cardiac MRI
* CT angiography
371
What is the purpose of cardiac catheterization?
To assess blockages in cases where coronary artery disease (CAD) is suspected
372
Fill in the blank: Elevated BNP levels can also occur in _______.
renal failure, pulmonary diseases, and atrial fibrillation
373
What laboratory tests are used to rule out anemia or infection in heart failure?
Complete blood count (CBC)
374
What tests are used to assess kidney function in heart failure?
* Creatinine
* Blood urea nitrogen (BUN)
* eGFR
375
What do elevated liver enzymes indicate in heart failure?
Hepatic congestion due to right-sided heart failure
376
What electrolyte imbalances are important to monitor in heart failure treatment?
* Potassium
* Sodium
377
What is alveolar edema?
Accumulation of fluid in the alveoli due to elevated pulmonary venous pressure
## Footnote
Alveolar edema is a hallmark sign of acute pulmonary edema, commonly seen in acute decompensated heart failure or severe left-sided heart failure.
378
What are the CXR findings associated with alveolar edema?
* Diffuse bilateral infiltrates
* Classic 'bat-wing' or 'butterfly' pattern
379
What does upper lobe diversion indicate?
Increased pulmonary venous pressure and fluid redistribution
## Footnote
This finding reflects pulmonary venous congestion due to left-sided heart failure or left atrial pressure elevation.
380
What are the CXR findings for upper lobe diversion?
* Prominent upper lobe vessels
* Diminished lower lobe vessels
381
Define cardiomegaly
Enlarged heart often due to increased workload on the heart
## Footnote
Cardiomegaly is often seen in chronic heart failure, especially in dilated cardiomyopathy, hypertensive heart disease, or valvular heart disease.
382
What are the CXR findings indicating cardiomegaly?
* Enlarged cardiac silhouette
* Cardiothoracic ratio greater than 50%
* Globular or round shape of the heart
383
What is pleural effusion?
Fluid accumulation between the parietal and visceral pleurae
## Footnote
Pleural effusions in heart failure often result from pulmonary venous congestion.
384
What are the CXR findings for pleural effusions?
* Blunting of the costophrenic angles
* Meniscus sign
* Bilateral pleural effusions
385
What are Kerley B lines?
Short, horizontal lines seen in peripheral lung fields indicating pulmonary congestion
## Footnote
They suggest interstitial fluid accumulation before more obvious alveolar edema develops.
386
What are the CXR findings for Kerley B lines?
Thin, horizontal lines at the lung periphery, usually near the costophrenic angles
387
What causes pulmonary venous congestion?
Left ventricle fails to pump blood effectively, leading to increased pressure in the pulmonary veins
388
What are the CXR findings associated with pulmonary venous congestion?
* Prominent upper lobe vessels
* Redistribution of pulmonary blood flow
* Peribronchial cuffing
389
What features indicate right-sided heart failure on CXR?
* Enlarged right heart border
* Dilation of the superior vena cava or right atrium
* Prominent lower lung vessels
390
What is pulmonary edema?
Pulmonary edema occurs when the left ventricle fails to pump blood effectively, causing a buildup of fluid in the lungs.
## Footnote
It leads to dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.
391
What causes pulmonary edema?
Fluid from the blood vessels leaks into the alveoli, impairing gas exchange.
## Footnote
This leads to severe shortness of breath and cyanosis.
392
What are the management options for pulmonary edema?
Treatment typically involves:
* Diuretics
* Oxygen
* Positive pressure ventilation (CPAP/BiPAP)
393
What are arrhythmias in the context of heart failure?
Arrhythmias are electrical disturbances in the heart that increase the risk of conditions such as atrial fibrillation and ventricular arrhythmias.
## Footnote
They can worsen heart failure symptoms.
394
What is atrial fibrillation?
Atrial fibrillation is the most common arrhythmia in heart failure, causing irregular heart rhythms and reducing the heart's pumping ability.
395
What are the life-threatening arrhythmias associated with heart failure?
Life-threatening arrhythmias include:
* Ventricular tachycardia (VT)
* Ventricular fibrillation (VF)
396
What are the management strategies for arrhythmias in heart failure?
Management includes:
* Anticoagulation for atrial fibrillation
* Antiarrhythmic drugs
* Implantable cardioverter-defibrillator (ICD)
* Electrophysiological procedures (e.g., ablation)
397
How does atrial fibrillation increase the risk of strokes?
Atrial fibrillation increases the risk of thrombus formation in the atria, which can embolize to the brain, causing a stroke.
398
What are the symptoms of a stroke?
Symptoms include:
* Sudden weakness
* Numbness
* Difficulty speaking
* Visual disturbances
399
What is the recommended management for patients with AF and heart failure to prevent stroke?
Long-term anticoagulation therapy (e.g., warfarin, NOACs) is recommended.
400
What is kidney dysfunction in heart failure?
Renal dysfunction is a common complication due to poor perfusion of the kidneys from low cardiac output.
401
What mechanism leads to kidney dysfunction in heart failure?
Decreased blood flow activates the renin-angiotensin-aldosterone system (RAAS), causing fluid retention.
402
What are the symptoms of kidney dysfunction in heart failure?
Symptoms include:
* Elevated serum creatinine
* Reduced glomerular filtration rate (GFR)
* Edema
* Ascites
403
What is cardiac cirrhosis?
Cardiac cirrhosis is a form of cirrhosis related to heart failure, resulting from hepatic congestion.
404
What are the symptoms of liver congestion in heart failure?
Symptoms include:
* Jaundice
* Ascites
* Abdominal pain
* Splenomegaly
* Elevated liver enzymes (AST, ALT)
405
What is hypotension and shock in the context of heart failure?
Hypotension and cardiogenic shock occur due to insufficient cardiac output, particularly in advanced stages.
406
What are the symptoms of cardiogenic shock?
Symptoms include:
* Dizziness
* Syncope
* Cold extremities
* Weak pulse
* Oliguria
407
What are the management options for cardiogenic shock?
Management includes:
* Inotropic agents (e.g., dobutamine, milrinone)
* Vasopressors
* Mechanical circulatory support (e.g., IABP)
* Heart transplantation in some cases
408
What is thromboembolism in heart failure?
Thromboembolism is the increased risk of thrombus formation that may embolize to various parts of the body, particularly in patients with atrial fibrillation.
409
What types of embolism are associated with heart failure?
Types include:
* Pulmonary embolism
* Systemic embolism (e.g., stroke)
410
What is heart failure cachexia?
Heart failure cachexia is characterized by unintentional weight loss, muscle wasting, and fatigue, commonly seen in advanced heart failure.
411
What are the symptoms of heart failure cachexia?
Symptoms include:
* Significant weight loss
* Fatigue
* Muscle weakness
* Poor nutritional status
412
What management strategies are used for heart failure cachexia?
Management includes:
* Nutritional support
* Exercise
* Medications addressing inflammation or malnutrition
413
How is depression related to heart failure?
Heart failure is associated with higher rates of depression and anxiety due to the chronic nature of the disease and its impact on lifestyle.
414
What are the symptoms of depression in heart failure patients?
Symptoms include:
* Low mood
* Loss of interest
* Fatigue
* Sleep disturbances
* Appetite changes
415
What management strategies are recommended for depression in heart failure?
Management includes:
* Psychosocial support
* Cognitive-behavioral therapy (CBT)
* Antidepressants
416
What is acute decompensated heart failure?
Acute decompensated heart failure is characterized by rapid worsening of symptoms due to triggers like infections or non-compliance.
417
What are the symptoms of acute decompensated heart failure?
Symptoms include:
* Rapid worsening of shortness of breath
* Orthopnea
* Fatigue
* Fluid retention (edema)
418
What management strategies are used for acute decompensated heart failure?
Management includes:
* Hospitalization
* IV diuretics
* Vasodilators
* Inotropes
* Mechanical support (e.g., ventilator)
419
What is the relationship between sleep apnea and heart failure?
Many patients with heart failure suffer from sleep-disordered breathing, including obstructive sleep apnea (OSA) or central sleep apnea.
420
What are the symptoms of sleep apnea in heart failure patients?
Symptoms include:
* Daytime fatigue
* Loud snoring
* Waking with shortness of breath during sleep
421
How can sleep apnea worsen heart failure?
Sleep apnea can worsen heart failure by increasing sympathetic nervous activity, blood pressure, and myocardial oxygen demand.
422
What is the management for sleep apnea in heart failure?
Management includes positive airway pressure (PAP) therapy (e.g., CPAP or BiPAP).
423
What is acute decompensated heart failure (ADHF)?
A medical emergency requiring prompt treatment to relieve symptoms, stabilize the patient, and prevent complications.
424
What are the primary goals of treatment for ADHF?
* Improving cardiac output
* Relieving pulmonary congestion
* Reducing fluid overload
* Addressing the underlying cause
425
What is the role of oxygen therapy in ADHF management?
To maintain oxygen saturation levels above 90-92%, especially in patients with pulmonary edema or hypoxemia.
426
What techniques are included in non-invasive positive pressure ventilation (NIPPV)?
* CPAP (Continuous Positive Airway Pressure)
* BiPAP (Bilevel Positive Airway Pressure)
427
What is the mechanism of action of Furosemide?
It inhibits sodium and chloride reabsorption in the loop of Henle, increasing urine output.
428
What is Furosemide indicated for in the context of ADHF?
First-line therapy for fluid overload and pulmonary edema.
429
How is Furosemide typically administered in acute heart failure?
IV furosemide is given initially due to impaired oral absorption.
430
What should be monitored during diuretic therapy?
* Renal function
* Electrolytes (e.g., potassium, sodium)
* Urine output
431
What is the mechanism of action of nitrates like nitroglycerin?
They reduce preload by acting as venodilators, relieving pulmonary congestion and reducing heart workload.
432
When are nitrates indicated in ADHF?
In patients with severe pulmonary edema or left-sided heart failure when diuretics are insufficient.
433
What must be continuously monitored when administering nitrates?
Blood pressure, due to the risk of hypotension.
434
What is the function of inotropes in ADHF?
They increase cardiac contractility, improving cardiac output.
435
What are common inotropes used in ADHF?
* Dobutamine
* Milrinone
436
What is the mechanism of action of Dobutamine?
It is a β1-adrenergic agonist that increases heart rate and contractility.
437
How does Milrinone work?
It increases cyclic AMP, improving contractility and causing vasodilation.
438
What is Nitroprusside and its mechanism of action?
A balanced vasodilator that reduces both preload and afterload, improving cardiac output.
439
When is Nitroprusside indicated in ADHF?
In patients with severe heart failure and hypertension when nitrates are insufficient.
440
What is the monitoring requirement for Nitroprusside?
Continuous blood pressure monitoring to avoid hypotension.
441
What is the role of ACE inhibitors and ARBs in ADHF?
They reduce afterload and preload, improving cardiac output.
442
Why are ACE inhibitors or ARBs typically not used immediately in acute decompensated states?
Due to the potential for hypotension.
443
What should be monitored when using ACE inhibitors or ARBs?
* Blood pressure
* Renal function
* Electrolytes (especially potassium)
444
What is the mechanism of action of Morphine in ADHF?
It alleviates anxiety, reduces pain, and decreases preload through venodilation.
445
What are the indications for using Morphine in ADHF?
To alleviate severe anxiety and respiratory distress.
446
What is the monitoring requirement for Morphine?
Monitoring for respiratory depression and hypotension.
447
What is the purpose of anticoagulation in patients with atrial fibrillation and ADHF?
To prevent thrombus formation and reduce the risk of stroke.
448
What should be monitored for patients on warfarin?
INR regularly.
449
What are other key considerations in managing ADHF?
* Fluid restriction
* Sodium restriction
* Patient education on medication adherence and monitoring symptoms
450
What is the overall focus of ADHF management?
Symptom relief and stabilization.
451
What is the primary focus of chronic heart failure (CHF) management?
Improving symptom control, preventing disease progression, and reducing the risk of hospitalizations and mortality.
452
What role does pharmacologic therapy play in managing chronic heart failure?
Targets various mechanisms to reduce cardiac workload, improve cardiac function, and modulate neurohormonal systems.
453
What is the mechanism of action of beta-blockers in CHF?
Inhibit the sympathetic nervous system by blocking beta-adrenergic receptors, reducing heart rate, myocardial contractility, and oxygen demand.
454
What are the common beta-blockers used for chronic heart failure?
* Carvedilol
* Metoprolol succinate
* Bisoprolol
455
What is the indication for using beta-blockers in CHF?
First-line therapy for chronic heart failure with reduced ejection fraction (HFrEF).
456
What should be monitored when initiating beta-blocker therapy?
Heart rate and blood pressure.
457
What is the mechanism of action of ACE inhibitors?
Block the angiotensin-converting enzyme, leading to decreased angiotensin II levels and improved cardiac output.
458
What are common ACE inhibitors used in CHF?
* Enalapril
* Lisinopril
* Ramipril
459
What is the indication for ACE inhibitors in CHF?
First-line for HFrEF, hypertension, and post-myocardial infarction.
460
What should be monitored when using ACE inhibitors?
Renal function, blood pressure, and potassium levels.
461
What is the mechanism of action of Angiotensin Receptor Blockers (ARBs)?
Block the angiotensin II receptor, preventing vasoconstriction and aldosterone secretion.
462
What are common ARBs used in CHF?
* Losartan
* Candesartan
* Valsartan
463
What is the indication for using ARBs in CHF?
Alternative to ACE inhibitors for patients with cough or angioedema.
464
What is the mechanism of action of Angiotensin Receptor-Neprilysin Inhibitor (ARNI)?
Inhibits neprilysin, enhancing vasodilation and natriuresis.
465
What is a common combination of ARNI used in CHF?
Entresto (Sacubitril/Valsartan).
466
What should be monitored when using ARNI?
Renal function, blood pressure, and potassium levels.
467
What is the mechanism of action of Mineralocorticoid Receptor Antagonists (MRAs)?
Block the action of aldosterone, reducing sodium retention and cardiac remodeling.
468
What are common MRAs used in CHF?
* Spironolactone
* Eplerenone
469
What is the indication for using MRAs in CHF?
Used in HFrEF, particularly after a myocardial infarction with reduced ejection fraction.
470
What should be monitored when using MRAs?
Serum potassium and renal function.
471
What is the mechanism of action of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors?
Block SGLT2 in the kidneys, reducing glucose reabsorption and promoting glucose excretion.
472
What are common SGLT2 inhibitors used in CHF?
* Dapagliflozin
* Empagliflozin
* Canagliflozin
473
What is the indication for SGLT2 inhibitors in CHF?
Approved for HFrEF, shown to reduce hospitalizations and improve survival.
474
What should be monitored when using SGLT2 inhibitors?
Renal function, electrolytes, and volume status.
475
What is the mechanism of action of Digoxin?
Increases intracellular calcium, improving contractility and reducing heart rate.
476
What is the indication for using Digoxin in CHF?
Symptomatic relief in patients with HFrEF and atrial fibrillation.
477
What should be monitored when using Digoxin?
Serum digoxin levels, renal function, and electrolytes.
478
What lifestyle modifications should be advised for patients with chronic heart failure?
* Low-sodium diet
* Limit fluid intake
* Avoid excessive alcohol
479
What role does exercise training play in chronic heart failure management?
Improves exercise tolerance and quality of life.
480
What device therapies may be considered for symptomatic HFrEF patients?
* Implantable cardioverter-defibrillators (ICDs)
* Cardiac resynchronization therapy (CRT)
481
What is shock?
A medical emergency characterized by inadequate blood flow and oxygen delivery to tissues and organs, leading to cellular dysfunction and potential organ failure.
482
What are the main types of shock?
Hypovolemic, cardiogenic, distributive, and obstructive shock.
483
Define hypovolemic shock.
Occurs when there is a significant loss of blood volume or fluid from the body, leading to insufficient circulation and oxygen delivery to tissues.
484
What are common causes of hypovolemic shock?
* Hemorrhage
* Dehydration
* Burns
* Severe Diuresis
485
List key features of hypovolemic shock.
* Low blood pressure
* Rapid, weak pulse
* Pale, cool, and clammy skin
* Decreased urine output
486
Define cardiogenic shock.
Occurs when the heart is unable to pump blood effectively, leading to inadequate tissue perfusion despite normal blood volume.
487
What are common causes of cardiogenic shock?
* Myocardial Infarction
* Heart Failure
* Arrhythmias
* Cardiomyopathy
488
List key features of cardiogenic shock.
* Low blood pressure despite adequate blood volume
* Rapid, weak pulse
* Pulmonary edema
* Cool, clammy skin
* Decreased urine output
489
Define distributive shock.
Occurs when there is widespread vasodilation, leading to a significant drop in systemic vascular resistance and inadequate blood flow to tissues.
490
What types of distributive shock are there?
* Septic Shock
* Anaphylactic Shock
* Neurogenic Shock
491
What causes septic shock?
Bacterial, viral, or fungal infections, especially in immunocompromised individuals.
492
List key features of septic shock.
* Fever
* Hypotension
* Warm, flushed skin
* Signs of infection
493
What causes anaphylactic shock?
Exposure to allergens (e.g., foods, insect stings, medications).
494
List key features of anaphylactic shock.
* Difficulty breathing
* Swelling (especially in the throat)
* Hives or rash
495
What causes neurogenic shock?
Disruption in the autonomic nervous system due to spinal cord injury, severe brain injury, or anesthetic agents.
496
List key features of neurogenic shock.
* Bradycardia
* Hypotension
* Warm and dry skin
497
List key features of distributive shock.
* Low blood pressure
* Warm, flushed skin
* Tachycardia
* Respiratory distress
498
Define obstructive shock.
Occurs when there is a physical obstruction to blood flow, preventing adequate circulation and oxygen delivery to tissues.
499
What are common causes of obstructive shock?
* Pulmonary Embolism
* Cardiac Tamponade
* Tension Pneumothorax
* Aortic Dissection
500
List key features of obstructive shock.
* Symptoms of the underlying obstruction
* Low blood pressure
* Tachycardia
* Jugular venous distension
* Difficulty breathing
501
What are the four primary stages of shock?
* Initial Stage (Early Stage)
* Compensatory Stage (Non-progressive Stage)
* Progressive Stage
* Irreversible Stage (Refractory Stage)
## Footnote
These stages represent a continuum of shock severity and physiological response.
502
Define the Initial Stage of shock.
The very beginning of shock, where there are subtle changes indicating the body’s compensatory mechanisms are beginning to engage.
## Footnote
This stage may not show immediately noticeable symptoms.
503
What are characteristics of the Initial Stage of shock?
* Compensatory response to decreased tissue perfusion
* Blood flow prioritized to vital organs
* Mild anaerobic metabolism occurs
* No significant drop in blood pressure
## Footnote
The body maintains perfusion through compensatory mechanisms.
504
What symptoms may be present in the Initial Stage of shock?
* Mild tachycardia
* Slight anxiety
## Footnote
Symptoms may not be noticeable at this stage.
505
Define the Compensatory Stage of shock.
This stage is when the body attempts to compensate for reduced blood flow through physiological responses.
## Footnote
The compensatory mechanisms can still prevent significant organ dysfunction.
506
What are characteristics of the Compensatory Stage of shock?
* Increased heart rate (tachycardia)
* Vasoconstriction to maintain blood pressure
* Activation of the renin-angiotensin-aldosterone system (RAAS)
* Increased respiratory rate
## Footnote
These mechanisms help maintain blood flow to vital organs.
507
What symptoms may be present in the Compensatory Stage of shock?
* Tachycardia
* Increased respiratory rate (tachypnea)
* Pale, cool, clammy skin
* Decreased urine output
* Mild confusion or anxiety
## Footnote
Blood pressure may still be within normal range or only mildly reduced.
508
Define the Progressive Stage of shock.
In this stage, compensatory mechanisms begin to fail, leading to worsening organ perfusion and deterioration of the patient's condition.
## Footnote
Signs of severe tissue hypoxia and metabolic acidosis become more evident.
509
What are characteristics of the Progressive Stage of shock?
* Severe hypoperfusion
* Reduced heart pumping efficiency
* Organ dysfunction (kidneys, liver, lungs)
* Ineffective compensatory mechanisms
## Footnote
This stage marks a critical decline in the patient's condition.
510
What symptoms may be present in the Progressive Stage of shock?
* Hypotension
* Worsening tachycardia
* Altered mental status
* Weak, thready pulse
* Cold, mottled skin
* Decreased urine output
## Footnote
Metabolic acidosis and lactic acidosis may lead to rapid, shallow breathing.
511
Define the Irreversible Stage of shock.
The final, most severe stage of shock where tissue damage and organ failure become irreversible, even with aggressive intervention.
## Footnote
The body's compensatory mechanisms can no longer maintain blood pressure or tissue perfusion.
512
What are characteristics of the Irreversible Stage of shock?
* Multiple organ failure
* Extremely compromised metabolic state
* Severe acidosis and electrolyte imbalances
* Irreversible damage to critical organs
## Footnote
This stage typically leads to death without drastic measures.
513
What symptoms may be present in the Irreversible Stage of shock?
* Severe hypotension
* Loss of consciousness or coma
* Cold, cyanotic skin
* Absent or very weak pulse
* Multi-organ failure
## Footnote
Death is imminent without extraordinary measures.
514
What is cardiogenic shock?
A condition characterized by the inability of the heart to pump blood effectively, leading to inadequate tissue perfusion and oxygen delivery to vital organs.
515
What are the common causes of cardiogenic shock?
* Severe myocardial infarction (MI)
* Myocardial dysfunction (e.g., cardiomyopathy)
* Arrhythmias (e.g., ventricular fibrillation, tachycardia)
* Severe valvular heart disease
516
What is cardiac output (CO)?
The amount of blood the heart pumps per minute, a product of heart rate and stroke volume.
517
What happens to heart rate in cardiogenic shock?
Heart rate may be either elevated or reduced, depending on the underlying cause.
518
What is stroke volume?
The amount of blood pumped by the heart with each beat.
519
What is meant by increased myocardial oxygen demand?
In states of myocardial ischemia, the heart requires more oxygen but is not receiving adequate supply due to reduced blood flow.
520
What are the hemodynamic changes in cardiogenic shock?
* Reduced cardiac output
* Hypotension
* Increased pulmonary pressure
521
What is the effect of reduced cardiac output on mean arterial pressure (MAP)?
It leads to reduced MAP, which is essential for perfusion of vital organs.
522
What is pulmonary edema?
A condition caused by increased pulmonary venous pressure, leading to difficulty breathing and impaired gas exchange.
523
What causes tissue hypoxia in cardiogenic shock?
Reduced perfusion leads to a lack of oxygen, causing anaerobic metabolism and lactic acid accumulation.
524
What is the role of the sympathetic nervous system in cardiogenic shock?
It activates in response to reduced blood pressure, releasing catecholamines to increase heart rate, contractility, and peripheral vasoconstriction.
525
What is the renin-angiotensin-aldosterone system (RAAS)?
A system activated by reduced renal perfusion, leading to vasoconstriction and sodium and water retention.
526
What is the effect of excessive ADH release in cardiogenic shock?
It may contribute to fluid overload and exacerbate pulmonary edema.
527
What are the signs of renal dysfunction in cardiogenic shock?
* Oliguria (reduced urine output)
* Azotemia (elevated blood urea nitrogen and creatinine levels)
528
What can decreased blood flow to the liver cause?
Hepatic congestion, elevated liver enzymes, and impaired detoxification processes.
529
What is cerebral hypoperfusion?
Reduced blood flow to the brain, leading to confusion, agitation, or loss of consciousness.
530
What is endothelial dysfunction?
Increased risk of thrombus formation and further compromise of blood flow due to inflammatory mediators.
531
What role do pro-inflammatory cytokines play in cardiogenic shock?
They contribute to systemic inflammation and microvascular dysfunction, exacerbating vascular permeability.
532
True or False: Systemic Inflammatory Response Syndrome (SIRS) can develop in cardiogenic shock.
True
533
What is cardiogenic shock?
A life-threatening condition characterized by the heart's inability to pump blood effectively, leading to inadequate tissue perfusion.
534
What are the stages of cardiogenic shock?
Compensatory, Progressive, Irreversible.
535
Define the Compensatory Stage of cardiogenic shock.
The stage where the body’s compensatory mechanisms maintain blood pressure and organ perfusion despite impaired heart function.
536
What activates the sympathetic nervous system during the Compensatory Stage?
The body increases heart rate (tachycardia) and contractility to maintain cardiac output.
537
What role does the Renin-Angiotensin-Aldosterone System (RAAS) play in the Compensatory Stage?
It leads to vasoconstriction and sodium retention to increase blood volume and blood pressure.
538
List clinical manifestations of the Compensatory Stage.
* Tachycardia
* Peripheral Vasoconstriction
* Hypotension
* Decreased Urine Output
* Mild Confusion or Anxiety
* Pulmonary Congestion
539
Define the Progressive Stage of cardiogenic shock.
The stage where compensatory mechanisms begin to fail, leading to inadequate perfusion to vital organs and further organ dysfunction.
540
What happens to cardiac output in the Progressive Stage?
It dramatically reduces despite increased heart rate and vasoconstriction.
541
What is pulmonary edema and how is it related to the Progressive Stage?
It occurs due to left ventricular dysfunction, leading to fluid leakage into the alveoli.
542
List clinical manifestations of the Progressive Stage.
* Severe Hypotension
* Tachycardia
* Pulmonary Edema
* Cold, Cyanotic Extremities
* Oliguria to Anuria
* Altered Mental Status
* Acidosis
543
Define the Irreversible Stage of cardiogenic shock.
The final stage characterized by failure of compensatory mechanisms and widespread organ dysfunction, often fatal without immediate intervention.
544
What is multi-organ failure in the context of the Irreversible Stage?
As tissue hypoxia worsens, multiple organs begin to fail, and the body cannot maintain homeostasis.
545
List clinical manifestations of the Irreversible Stage.
* Profound Hypotension
* Unresponsiveness
* Cold, Cyanotic Skin
* Severe Pulmonary Edema
* Anuria
* Complete Organ Failure
546
What is the typical blood pressure in the Compensatory Stage?
Systolic pressure is typically below 90 mm Hg but often still within a tolerable range.
547
What are the signs of renal hypoperfusion in the Compensatory Stage?
Decreased Urine Output: urine output dropping to less than 30 mL/hr (oliguria).
548
True or False: In the Progressive Stage, blood pressure may drop significantly and may not respond to vasopressors.
True.
549
What is the significance of lactic acid accumulation in the Progressive Stage?
It indicates a switch to anaerobic metabolism due to reduced oxygen delivery.
550
What is the consequence of severe acidosis in the Irreversible Stage?
Lactic acid levels rise significantly, and the body’s pH drops to dangerous levels.
551
Fill in the blank: Severe hypotension in the Irreversible Stage is characterized by systolic BP < _______.
60 mm Hg
552
What does cold, cyanotic skin indicate in the context of cardiogenic shock?
Poor perfusion to peripheral tissues.
553
What is the typical outcome without life-saving interventions in the Irreversible Stage?
The prognosis is poor and often fatal.
554
What is the primary goal in the management of cardiogenic shock?
To stabilize the patient, restore adequate perfusion, and address the underlying cause.
555
What does ABC stand for in initial stabilization?
Airway, Breathing, Circulation.
556
What is the target SpO2 level for adequate oxygenation in cardiogenic shock?
Target SpO2 > 90%.
557
What should be monitored to assess hemodynamic status?
Blood pressure, heart rate, oxygen saturation, central venous pressure (CVP), pulmonary artery pressure, and urine output.
558
What is the role of Dobutamine in pharmacologic support?
Increases myocardial contractility and cardiac output by stimulating beta-1 receptors.
559
Fill in the blank: Norepinephrine is the preferred _______ to increase systemic vascular resistance and blood pressure.
[vasopressor]
560
What is Furosemide (Lasix) used for in the management of cardiogenic shock?
To manage fluid overload, reduce pulmonary edema, and improve symptoms of congestion.
561
What type of support might be required for patients with severe cardiogenic shock?
Mechanical Circulatory Support (MCS).
562
How does the Intra-Aortic Balloon Pump (IABP) provide hemodynamic support?
Inflates during diastole and deflates during systole, increasing coronary perfusion and reducing afterload.
563
What is the purpose of Extracorporeal Membrane Oxygenation (ECMO)?
Temporarily takes over the function of both the heart and lungs.
564
What procedure is recommended for cardiogenic shock due to acute myocardial infarction (MI) with ST-segment elevation?
Early primary Percutaneous Coronary Intervention (PCI).
565
Fill in the blank: IV fluid boluses may be used initially to improve _______ and cardiac output.
[preload]
566
What are antiarrhythmic medications used for in cardiogenic shock management?
To control arrhythmias like ventricular tachycardia or fibrillation.
567
What type of monitoring is essential in the management of cardiogenic shock?
Continuous monitoring of vital signs, arterial blood gases, electrolytes, renal function, and lactate levels.
568
What is the purpose of renal replacement therapy in cardiogenic shock?
To manage fluid and electrolyte balance and support renal function.
569
What may be indicated if cardiogenic shock is secondary to STEMI and PCI is not available?
Thrombolytic therapy (e.g., alteplase).
570
What is crucial for managing severe cases of cardiogenic shock?
Consultation with a multidisciplinary team.
571
True or False: End-of-life care may need to be considered in cases of irreversible multi-organ failure.
True
