Hemodynamic Disorders Lecture 2 Flashcards
An 80-year-old black male has a history of smoking, hypertension, obesity, diabetes and dyslipidemia. What is your Dx?
heart failure
He presents with increasing dyspnea on exertion, paroxysmal nocturnal dyspnea and 2-pillow orthopnea.
What is your Dx?
heart failure
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.
heart failure
Why do CHF pts have leg edema?
dec CO –>
1. dec renal perfusion –> renin
2. inc oncotic pressure –> ADH
= fluid overload/edema
Why do CHF pts have tachycardia?
dec CO –> lower MAP –> baroreceptors sense and signal …
- sympathetic NS stimuation
- Epi and Norepi released from adrenal
Why do CHF pts have elevated B-type NP? What effect does it have?
stretch of atira volume leads to release of ANPs even though MAP is low
vasodialtion
B-type NP is ______
RED SLIDE
counter regulatory
**aka it opposes what other hormones are doing (HF –> dec CO –> vasoconstriction, but ANP causes vasodilation)
Does HF ever lead to a pro-inflammatory cytokine profile? If so, what are the cytokines.
Is this helpful (for dealing with the HF)?
yes, inc TNF, IL-1, and IL-6
No!
What is the most common symptom of infective endocarditis?
What are the 3 symptoms in a 3 way tie for 2nd most common symptom?
Fever**
chills, weakness, dyspnea
How do the bacterial that cause infective endocarditis get into the blood stream? Most common?
**central venous catheterization**: pic lines the mouth (gingivitis, dental proceedures, flossing teeth)
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
infective endocarditis
infective endocarditis evolves from _____
merantic endocarditis
The ______ the vegetation, the more likely it is to be infective
larger (2-3 cm)…rarely bigger than 3 cm bc the valves are only 3 cm big…
infective endocarditis is _________ and cause…(4 things)
DESTRUCTIVE and causes:
- perforation of valve
- adjacent abscesses
- fibrotic scarring
- calcification
T or F: infective endocarditis do not embolize
F: they do
Where are infected emboli from infective endocarditis likely to go?
kidney
spleen
brain
heart
Early: firbin + platelets + masses of organisms +/- neutrophils and necrosis
Later: \+/-lymphocytes, \+/- macrophages, \+/- fibroblasts, \+/- fibrosis
infective endocarditis
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?
Total SV = 120 mL
forward = 60 mL
Yes
What is normal EDV?
amt left over from last systole?
amt that is from left atrium?
50 mL
150 mL
100 mL
Sever acute uncompensatied aortic reguritation is a ______
RED SLIDE
surgical emergency
rugical replacement of the valves
olser nodes
infective endocarditis
*not specific to endocarditis, just a common finding
spliter hemorrhages
infective endocarditis
*not specific to endocarditis, just a common finding
janeway lesions
= hemorrhages on palms or soles
infective endocarditis
conjunctival and retinal hemorrhages
infective endocarditis
test for detecting vegetations
transthorasic and transesophageal echocardiogram
Dx of endocarditis requires
blood cultures showing continuous low grade bacteriemia
a murmur, vegetation, electrocardiogram is not enough
continuous low grade bacteriemia
infective endocarditis
What is the minimum # of blood cultures to Dx infective endocarditis
3 from 3 sites, 30 to 60 mins apart BEFORE abx
Why should you altert the micro lab that endocarditis is suspected?
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
_______ are essential for making a specific Dx to guide abx therapy for infective endocarditis
RED SLIDE
blood cultures
on what valves does infective endocarditis commonly form (and what sides)?
AV: atrial
semilunar: ventricular
Bacteria under a layer of fibrous tissue w/o any neutrophils
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)
