Heart Failure & Shock Flashcards
What is the most common cause of cardiac failure?
Ischemic heart disease
_____ is seen in virtually all conditions associated with chronic heart failure?
Ventricular hypertrophy
What unique histological finding is present in the nuclei of a heart with hypertrophy?
Boxcar nuclei with hyperchromatic nuclei and thick, enlarged myocardial cells
What are the three classifications of heart failure?
Left-heart failure
Right-heart failure
Biventricular failure
What are the potential causes of left-sided heart failure?
Ischemic heart disease
Hypertension
Valvular disease
What is the most common cause of left-sided heart failure?
Ischemic heart disease
What are the clinical features of left heart failure?
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Hemoptysis
Heart-Failure cells
What form of heart failure causes pulmonary edema in the lungs?
Left-heart failure
What cell is commonly seen in the lungs in a patient with left-sided heart failure?
Heart-failure cells
What is a heart failure cell and what pathology will it be present in?
Hemosiderin-laden macrophages in the alveolar air spaces of the lungs present in left-sided heart failure
What is orthopnea? What is it a clinical feature of?
Discomfort breathing while laying flat indicative of left-sided heart failure
What is paroxysmal nocturnal dyspnea? What is it a clinical feature of?
Short attacks of short breath occurring at night indicative of left-sided heart failure
With left heart failure, the lungs experience ____ failure?
Backward
With left heart failure, the kidneys, brain, and skeletal muscle all experience ____ failure?
Forward
What signs and symptoms will be present in a brain experiencing forward left heart failure?
Altered states of consciousness or personality changes
What signs and symptoms will be present in skeletal muscle experiencing left heart failure?
Atrophy, fatigue, weakness, and exercise intolerance
What signs and symptoms will be present related to the kidney in a patient with left heart failure?
Increased BUN and creatinine, decreased pH (acidic), increased renal pressure
What type of overload and myocardial hypertrophy causes pulmonary edema?
Pressure overload and concentric hypertrophy
Aortic stenosis can cause (Pressure/Volume) overload leading to (Concentric/Eccentric) hypertrophy and pulmonary edema?
Pressure, concentric
Aortic stenosis can cause (Right/Left) heart failure and pressure overload?
Left
Pulmonary stenosis can cause (Right/Left) heart failure?
Right
What is the most common etiology of right heart failure?
Left-heart failure
What are common etiologies of right heart failure?
Left-heart failure
Pulmonary hypertension/Cor pulmonale
Intrinsic diseases
Pulmonary hypertension results in (Pressure/Volume) overload and (Concentric/Eccentric) hypertrophy as well as (Right/Left) heart failure?
Pressure, concentric, right
Late stage cor pulmonale results in (Pressure/Volume) overload and (Concentric/Eccentric) hypertrophy as well as (Right/Left) heart failure?
Volume, eccentric, right
What does COPD stand for? What cardiac pathology can it cause?
Chronic obstructive pulmonary disease causing pulmonary hypertension and right-sided heart failure
COPD results in (Pressure/Volume) overload and (Concentric/Eccentric) hypertrophy as well as (Right/Left) heart failure?
Pressure, concentric, right
What are the clinical features of right-sided heart failure?
Neck vein distension
Elevated jugular venous pressure (EJV)
Hepato-abdomino-jugular reflex
Hepatomegaly
Splenomegaly
Ascites
Bilateral pitting edema in the lower extremities
Neck vein distension and elevated jugular venous pressure are clinical signs of (Right/Left) sided heart failure?
Right
The hepato-abdomino-jugular reflex, hepatomegaly, and/or splenomegaly are clinical signs of (Right/Left) sided heart failure?
Right
Ascites is a clinical sign indicative of (Right/Left) sided heart failure?
Right
Bilateral pitting edema in the lower extremities is most likely caused by (Right/Left) sided heart failure?
Right
Nutmeg liver is most commonly caused by (Right/Left) sided heart failure?
Right
What is the criteria for determining the severity of pitting edema?
Depth of pit and time that pit lasts
What is shock?
Global hypoperfusion of tissues
What is hypovolemic shock?
Shock resulting from loss of blood volume and plasma
What is septic shock?
Shock caused by a gram negative bacterial infection and lipid A endotoxins
What is cardiogenic shock?
Shock that results when the heart is unable to meet the demands placed on it by the body
What is anaphylactic shock?
Shock due to an allergic or hypersensitivity reaction resulting in increased IgE, histamine, eosinophils, and basophils
What is neurogenic shock?
Shock caused by a brain or spinal cord injury
What are the three sequential stages of shock?
Non-progressive
Progressive
Irreversible
What systems are active in the non-progressive stage of shock?
RAAS, sympathetic nervous system, autoregulation
What signs occur during the progressive stage of shock?
Metabolic acidosis and hypotension
What signs occur during irreversible stage of shock?
Multi-system organ failure, increased LDH, CK, BUN, creatinine, amylase, and lipase
What effect does shock have on the heart?
Decreased cardiac output, clotting, and possible MI
What effect does shock have on the kidney?
Oliguria and increased BUN
What is oliguria and what can cause it?
Decreased urine output by the kidney caused by shock
What effect does shock have on the lungs?
Foamy cough, dyspnea, “deathrattle” sound
What effect does shock have on the GI tract?
Ischemic infarct, gangrenous necrosis,
melena, and hematochezia
What is hematochezia and what can cause it?
Bright red blood in the stool indicative of a lower GI bleed caused by shock, hemorrhoids, or neoplasias
What is melena and what can cause it?
Black, tarry stool indicative of an upper GI bleed caused by shock or neoplasias
What effect does shock have on the brain?
Loss of consciousness, dizziness, comatose state
What effect does shock have on the skin?
Cold cyanosis
