High Yield Topics-Cardiovascular

Question 1

Intravenous drug users are at ↑ risk of _____ endocarditis

Answer 1

Tricuspid Valve

• HINT: remember staph. aureus sketchymicro!

Question 2

An abnormal breathing pattern characterized by crescendo-decrescendo (spindle-like curve) pattern of tidal volumes followed by a period of apnea

Answer 2

Cheyne-Stokes breathing

Question 3

Common causes of Cheyne-Stokes breathing is usually due to

Answer 3

cardiac insult (HF)

Question 4

Dyspnea, bilateral lower extremity edema, increased JVP, and right axis deviation on ECG indicate

Answer 4

Right Heart Failure

aka. Right Ventricular Dysfunction

Question 5

What physiological mechanism is causing lower extremity edema seen in RHF?

Answer 5

increased capillary hydrostatic pressure due to RHF causing venous congestion (backflow) –> fluid leakage into interstitium —> edema

Question 6

Pulmonary hypertension will present with what heart sound?

• HINT: due to increased right ventricular afterload

Answer 6

Split S2 (Loud P2)

Question 7

Cold temperature activates increased (para/sympathetic) system

Answer 7

sympathetic system

Question 8

Increased sympathetic system in response to cold cause what change in vasculature

Answer 8

peripheral vasoconstriction to preserve heat

Question 9

Cold temperature activates heating center in the

Answer 9

posterior hypothalamus

Question 10

Activation of posterior hypothalamus in response to cold causes

Answer 10

shivering

Question 11

Hot temperature activates cooling center in the

Answer 11

Anterior hypothalamus

Question 12

Describe hemodynamic measurements in “Hypovolemic Shock” as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 12

CVP: ↓ 
PCWP: ↓
CO: ↓
SVR: ↑  
SvO2: ↓
HR: ↑

Question 13

Pathophysiology of “Hypovolemic Shock”

Answer 13

Hemorrhage/Fluid Loss –> ↓ left heart preload –> ↓ CO –> ↓ CVP (less blood returning to right heart) –> compensatory ↑ HR, ↑ SVR (vasoconstriction to prevent blood loss)

Question 14

Describe hemodynamic measurements in “Cardiogenic Shock” as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 14

CVP: ↑
PCWP: ↑
CO: ↓
SVR: ↑
SvO2: ↓
HR: ↑

Question 15

Pathophysiology of “Cardiogenic Shock”

Answer 15

Dysfunction of Heart (MI, HF, arrhythmia) –> ↓ heart pumping –> ↓ CO –> compensatory ↑ HR, ↑ SVR (vasoconstriction due to increased catecholamines)

↓ heart pumping –> ↑ back flow of blood –> ↑ left heart preload & ↑CVP

Question 16

Describe hemodynamic measurements in “Obstructive Shock” due to PE as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 16

CVP: ↑ 
PCWP: ↓ 
CO: ↓
SVR: ↑
SvO2: ↓
HR: ↑

Question 17

Pathophysiology of “Obstructive Shock” due to PE

Answer 17

PE –> Obstruction of pulmonary arteries –> ↑ CVP (due to back flow) –> ↓ diastolic filling (preload) in left heart –> ↓ CO –> compensatory ↑ HR, ↑ SVR

Question 18

Why is PCWP paradoxically ↑ in an obstructive shock caused by “cardiac tamponade”?

Answer 18

Due to EXTERNAL compression by pericardial fluid

Question 19

Describe hemodynamic measurements in “Distributive Shock” due to sepsis as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 19

CVP: ↓
PCWP: ↓
CO: ↑
SVR: ↓
SvO2: ↑
HR: ↑

Question 20

Pathophysiology of “Distributive Shock” due to sepsis

Answer 20

Infection –> Vasodilation (↓ SVR) & capillary leakage (↓ CVP due to fluid redistribution from intravascular to the extravascular compartment) –> ↑ CO (due to ↓ SVR & compensatory ↑ HR) –> ↓ PCWP (less fluid sitting in the left heart due to increased CO)

Question 21

Describe hemodynamic measurements in “Distributive Shock” due to anaphylaxis as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 21

CVP: ↓
PCWP: ↓
CO: ↑
SVR: ↓
SvO2: ↓
HR: ↑

Question 22

Pathophysiology of “Distributive Shock” due to anaphylaxis

Answer 22

Anaphylaxis (type 1 HSR) –> Degranulation of mast cells –> ↑ histamine release –> Vasodilation (↓ SVR) & capillary leakage (↓ CVP due to fluid redistribution from intravascular to the extravascular compartment) –> ↑ CO (due to ↓ SVR & compensatory ↑ HR) –> ↓ PCWP (less fluid sitting in the left heart due to increased CO)

Question 23

Describe hemodynamic measurements in “Distributive Shock” due to CNS injury as ↑ ↓

CVP (right heart preload)
PCWP (left heart preload)
CO (cardiac output)
SVR (afterload)
SvO2 (oxygen saturation)
HR (heart rate)

Answer 23

CVP: ↓
PCWP: ↓
CO: ↓
SVR: ↓
SvO2: ↓
HR: ↓

Question 24

Pathophysiology of “Distributive Shock” due to CNS injury

Answer 24

CNS injury –> loss of sympathetic activation (↓ HR & ↓ contraction & ↓ SVR (vasodilation) –> ↓ CO –> ↓ PCWP (less fluid sitting in the left heart due to increased CO)

• ↓ CVP due to fluid redistribution (don’t know why)

Question 25

Why is SVR all ↓ in all distributive shock types?

Answer 25

They all cause vasoDILATION

Question 26

What type of shock has ↓ HR?

Answer 26

“Distributive Shock” due to CNS injury

Question 27

What type of shock has ↑ O2 saturation?

Answer 27

“Distributive Shock” due to sepsis