Lecture 13 - Cardiac Failure, Heart Sounds, & Shock

Question 1

This is the primary mechanism for acute compensation of decreased cardiac output.
A. Water/salt retention in the kidney
B. Increased SNS tone
C. Decreased capillary permeability
D. Increased venous dilation

Answer 1

B. Increased SNS tone

Question 2

Long term compensation of decreased cardiac output after MI is accomplished by:
A. Water/salt retention in the kidney
B. Increased SNS tone
C. Decreased capillary permeability
D. Increased venous dilation

Answer 2

A. Water/salt retention in the kidney

Question 3

Sympathetic nervous system response will raise the Psf by _____.

Answer 3

12-14 mmHg (increasing venous return)

Question 4

Summarize the dynamics of circulatory changes following an acute, moderate MI

Answer 4

1) Reduced cardiac output/increased venous pressure from “damming” blood
2) Increased SNS stimulation with increased RAP
3) Fluid/salt retention at kidney

Question 5

Explain the pathophysiology of pulmonary, but not peripheral edema, in heart failure

Answer 5

• Ischemia of the heart, usually in left heart -> decreased CO
• Decreased CO -> increased blood “pooling” in both pulmonic and systemic vasculature
• However, more blood remains stagnant in the pulmonary circulation
• Increasing pulmonary capillary pressure (and decreasing mean aortic pressure) forces fluid into the alveoli (increased filtration through pulmonary capillaries)

Question 6

Digtalis MOA on decompensated heart failure

Answer 6

• Digitalis blocks the normal cardiac Na/K/ATPase
• Na/K/ATPase block -> decreased ECF [Na]
• Decreased ECF [Na] produces less Ca2+/Na+ exchange, “trapping” Ca2+ in the cells
• Increased myocardial intracellular [Ca2+] increases the force of contraction
• Increased contractile strength -> greater inotropy

Question 7

A direct path from artery to vein in AV fistula will \_\_\_\_ TPR and \_\_\_\_ CO. This can cause "High output cardiac failure," resulting in an inability for the heart to pump correctly.
A. decrease; decrease
B. increase; decrease
C. decrease; increase
D. increase; increase

Answer 7

C. decrease; increase

Question 8

Deficiency of Vitamin B1 (Thiamin) produces an inability to \_\_\_\_\_, which results in decreased blood flow to \_\_\_\_ and increased fluid retention.
A. vasoconstrict; kidneys
B. vasodilate; kidneys
C. vasoconstrict; heart
D. vasodilate; heart

Answer 8

A. vasoconstrict; kidneys

Question 9

Heart sound S1 is caused by:
A. Closure of AV at onset of ventricular systole
B. Closure of semilunar at onset of ventricular systole
C. Closure of AV at end of ventricular systole
D. Closure of semilunar at end of ventricular systole

Answer 9

A. closure of AV at onset of ventricular systole

Question 10

Heart sound S2 is caused by ______:
A. Closure of AV at onset of ventricular systole
B. Closure of semilunar at onset of ventricular systole
C. Closure of AV at end of ventricular systole
D. Closure of semilunar at end of ventricular systole

Answer 10

D. closure of semilunar at end of ventricular systole

Question 11

Mnenomic for the different types of valvular defects.

Answer 11

hARD fall - Aortic regurg - diastolic
ASS bump - Aortic stenosis - systolic
MSD you - Mitral stenosis - diastolic
MRS through - Mitral regurg - systolic

Question 12

A patient presents with mixing of oxygenated blood with deoxygenated blood in central circulation. There is noted cyanosis in the extremities, indicated a failure of blood flow through the systemic circulation. This patient probably has what type of valve defect?

A. Tetrology of Fallot; left-to-right shunt
B. Patent Ductus Arteriosus; Right-to-left shunt
C. Tetrology of Fallot; right-to-left-shunt
D. Patent ductus arteriosis; left-to-right shunt

Answer 12

D. PDA; left-to-right shunt

Question 13

A patient presents with poor oxygenation, an overriding aorta, and pulmonary artery stenosis. What is your diagnosis?

A. Tetrology of Fallot; left-to-right shunt
B. Patent Ductus Arteriosus; Right-to-left shunt
C. Tetrology of Fallot; right-to-left-shunt
D. Patent ductus arteriosis; left-to-right shunt

Answer 13

C. Tetrology of Fallot; right-to-left shunt

Question 14

Generalized inadequate circulation to the body to meet tissue needs.

Answer 14

circulatory shock

Question 15

What factors may decrease venous return, and thereby decrease cardiac output?

Answer 15

Diminished blood volume (hemorrhage)
Decreased vascular tone (venous pooling)
Obstruction to blood flow

Question 16

What factors may decreased the ability of the heart to pump, and thereby decrease cardiac output?

Answer 16

MI, toxic heart, valvular disfunction, arrhythmias, cardiogenic shock

Question 17

The CNS ischemic response is activated by arterial pressures

Answer 17

C. 50 mmHg

Question 18

Cellular deterioration in decompensated shock includes decreased mitochondrial activity secondary to _____ failure. Why is this important?

Answer 18

Na/K/ATPase pump; Without proper Na/K/ATPase activity, the body is unable to move nutrients as needed to maintain cardiac output

Question 19

Shock without loss of blood volume, results from loss of vasomotor tone

Answer 19

neurogenic shock

Question 20

Neurogenic shock is produced by loss of SNS stimulation leading to _______ and decreased TPR.

Answer 20

decreased venous tone

Question 21

Failure of the heart to pump enough blood to satisfy the needs of the body.
A. Cardiac Index
B. Decreased cardiac output
C. Cardiac Failure

Answer 21

C. Cardiac failure