Hemodynamic Disorders Lecture 2

Question 1

An 80-year-old black male has a history of smoking, hypertension, obesity, diabetes and dyslipidemia. What is your Dx?

Answer 1

heart failure

Question 2

He presents with increasing dyspnea on exertion, paroxysmal nocturnal dyspnea and 2-pillow orthopnea.

What is your Dx?

Answer 2

heart failure

Question 3

His temperature is 37, heart rate 110, blood pressure 110/70, respirations 20 and saturation 95%. He has a third heart sound, but no murmurs. He has pulmonary crackles at both lung bases. His abdomen is soft and non-tender. He has leg edema up to the knees.

Answer 3

heart failure

Question 4

Why do CHF pts have leg edema?

Answer 4

dec CO –>
1. dec renal perfusion –> renin
2. inc oncotic pressure –> ADH
= fluid overload/edema

Question 5

Why do CHF pts have tachycardia?

Answer 5

dec CO –> lower MAP –> baroreceptors sense and signal …

1. sympathetic NS stimuation
2. Epi and Norepi released from adrenal

Question 6

Why do CHF pts have elevated B-type NP? What effect does it have?

Answer 6

stretch of atira volume leads to release of ANPs even though MAP is low

vasodialtion

Question 7

B-type NP is ______

RED SLIDE

Answer 7

counter regulatory

**aka it opposes what other hormones are doing (HF –> dec CO –> vasoconstriction, but ANP causes vasodilation)

Question 8

Does HF ever lead to a pro-inflammatory cytokine profile? If so, what are the cytokines.

Is this helpful (for dealing with the HF)?

Answer 8

yes, inc TNF, IL-1, and IL-6

No!

Question 9

What is the most common symptom of infective endocarditis?

What are the 3 symptoms in a 3 way tie for 2nd most common symptom?

Answer 9

Fever**

chills, weakness, dyspnea

Question 10

How do the bacterial that cause infective endocarditis get into the blood stream? Most common?

Answer 10

**central venous catheterization**: pic lines 
the mouth (gingivitis, dental proceedures, flossing teeth)

Question 11

large vegetations (up to 3 cm), friable, single or multiple, large range of colors (tan grey, red or brown), along the valve closure line, atrial side of AV valves, ventricualr side of semilunar valves

Answer 11

infective endocarditis

Question 12

infective endocarditis evolves from _____

Answer 12

merantic endocarditis

Question 13

The ______ the vegetation, the more likely it is to be infective

Answer 13

larger (2-3 cm)…rarely bigger than 3 cm bc the valves are only 3 cm big…

Question 14

infective endocarditis is _________ and cause…(4 things)

Answer 14

DESTRUCTIVE and causes:

• perforation of valve
• adjacent abscesses
• fibrotic scarring
• calcification

Question 15

T or F: infective endocarditis do not embolize

Answer 15

F: they do

Question 16

Where are infected emboli from infective endocarditis likely to go?

Answer 16

kidney
spleen
brain
heart

Question 17

Early: firbin + platelets + masses of organisms +/- neutrophils and necrosis

Later: 
\+/-lymphocytes, 
\+/- macrophages,
\+/- fibroblasts,
\+/- fibrosis

Answer 17

infective endocarditis

Question 18

Suppose infective endocarditis just ate a hole in your aortic valve letting half of your SV fall backward into left ventricle in diastole and the best you could manage was 20% increase in stroke volume.

What would your SV be?
Would you have heart failure?

Answer 18

Total SV = 120 mL
forward = 60 mL

Yes

Question 19

What is normal EDV?
amt left over from last systole?
amt that is from left atrium?

Answer 19

50 mL
150 mL
100 mL

Question 20

Sever acute uncompensatied aortic reguritation is a ______

RED SLIDE

Answer 20

surgical emergency

rugical replacement of the valves

Question 21

olser nodes

Answer 21

infective endocarditis

*not specific to endocarditis, just a common finding

Question 22

spliter hemorrhages

Answer 22

infective endocarditis

*not specific to endocarditis, just a common finding

Question 23

janeway lesions

Answer 23

= hemorrhages on palms or soles

infective endocarditis

Question 24

conjunctival and retinal hemorrhages

Answer 24

infective endocarditis

Question 25

test for detecting vegetations

Answer 25

transthorasic and transesophageal echocardiogram

Question 26

Dx of endocarditis requires

Answer 26

blood cultures showing continuous low grade bacteriemia

a murmur, vegetation, electrocardiogram is not enough

Question 27

continuous low grade bacteriemia

Answer 27

infective endocarditis

Question 28

What is the minimum # of blood cultures to Dx infective endocarditis

Answer 28

3 from 3 sites, 30 to 60 mins apart BEFORE abx

Question 29

Why should you altert the micro lab that endocarditis is suspected?

Answer 29

bc some of the bacteria can be slow growing or fastidious

= there is special culture media they can use and they can hold them for longer

Question 30

_______ are essential for making a specific Dx to guide abx therapy for infective endocarditis
RED SLIDE

Answer 30

blood cultures

Question 31

on what valves does infective endocarditis commonly form (and what sides)?

Answer 31

AV: atrial
semilunar: ventricular

Question 32

Bacteria under a layer of fibrous tissue w/o any neutrophils

Answer 32

infective endocarditis
**neutrophils dont’t have access (infection then fibrous material laid down and bacteria were left behind and multiplied there (cut off from immune cells)