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CVS A > Session 5 Lecture 2 > Flashcards

Session 5 Lecture 2 Flashcards

1
Q

What is the concept behind the control of arterial blood pressure?

A

Control cardiac output and peripheral resistance

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2
Q

Mean arterial blood pressure =

A

CO x TPR

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3
Q

CO =

A

SV x HR

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4
Q

What is haemodynamic shock?

A

Acute circulatory failure with either inadequate or inappropriately distributed tissue perfusion, resulting in generalised lack o oxygen supply to cells

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5
Q

What is hymodynamic shock also called?

A

Circulatory shock

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6
Q

What can cause haemodynamic shock?

A

Fall in CO or fall in TPR beyond capacity of the heart to cope

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7
Q

Why might you get a fall in cardiac output?

A

Mechanical pump can’t fill
Pump failure
Loss of blood volume

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8
Q

Why might you get a fall in peripheral resistance?

A

Due to excessive dilation

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9
Q

What are the different shocks that might arise due to all in cardiac output?

A

Cardiogenic shock
Mechanical shock
Hypovolaemic shock

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10
Q

What is cardiogenic shock?

A

Pump failure

Ventricle can’t empty properly

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11
Q

What is mechanical shock?

A

Obstructive

Ventricles can’t fill properly

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12
Q

What is hypovolaemic shock?

A

Reduced blood volume leads to poor venous return

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13
Q

What type of failure leads to cardiogenic shock and why?

A

Acute failure of the heart to maintain cardiac output - PUMP FAILURE

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14
Q

What are the potential causes of cardiogenic shock?

A

Following MI - damage to left ventricle
Due to serious arrhythmias
Acute worsening of heart failure

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15
Q

What actually is happening in cardiogenic shock?

A

Heart fills but fails to pump effectively

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16
Q

What can cardiogenic shock lead to?

A

CVP may be normal or raised. Dramatic drop in arterial BP. Tissues poorly perfused

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17
Q

What tissues might be poorly perfused due to cardiogenic shock?

A

Coronary arteries

Kidneys - reduced urine production

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18
Q

What is the definition of a cardiac arrest?

A

Unresponsiveness associated with lack of pulse

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19
Q

What is asystole?

A

Loss of electrical and mechanical activity

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20
Q

What is PEA?

A

Pulseless Electrical Activity - electrical activity is seen on ECG but you have no mechanical activity

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21
Q

Why might you get PEA?

A

Prolonged hypoxia or acidosis

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22
Q

What is ventricular fibrillation?

A

Uncoordinated electrical activity

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23
Q

What are the different forms of cardiac arrest?

A

Asystole, PEA, ventricular fibrillation

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24
Q

When does ventricular fibrillation occur?

A

Often following MI, or electrolyte imbalance or some arrhythmias (eg long QT)

25
Q

What pathophysiology is happening in a cardiac arrest?

A

Heart has stopped or has ceased to pump effectively.

26
Q

What is needed to treat a cardiac arrest?

A

Basic life support, advanced life support, adrenaline

27
Q

What does basic life support entail?

A

Chest compressions and external ventilation

28
Q

What does advanced life support entail?

A

Defibrillation

29
Q

How does a defibrillator work?

A

Electric current delivered to the heart, depolarises all the cells (puts them in refactory period) therefore allows coordinated electrical activity to restart

30
Q

How does adrenaline help in a cardiac arrest?

A

Enhances myocardial function and increase peripheral resistance

31
Q

What are the different types of mechanical shock?

A

Cardiac tamponade and pulmonary embolism

32
Q

What is cardiac tamponade?

A

Blood or fluid build up in pericardial space

33
Q

How does cardiac tamponade lead to mechanical shock?

A

Restricted filling of the heart - limits EDV. Affects left and right sides of heart.

34
Q

How does cardiac tamponade affect pressures?

A

High CVP

Low arterial blood pressure

35
Q

How does pulmonary embolism lead to shock?

A 
Pulmonary artery pressure is high 
RV can't empty 
CVP high
Reduced return to left side
Limits filling
LA pressure low
Arterial blood pressure low
Shock
36
Q

What symptoms might someone with pulmonary embolism get?

A

Chest pain and dysnpnoea

37
Q

How might an embolus reach the lungs?

A

Typically deep vein thrombosis. Portion of thrombus breaks off and travels to right side of the heart

38
Q

What is the cause of hypovolaemic shock?

A

Reduced blood volume most commonly due to haemorrhage

39
Q

What is the severity of shock related to?

A

The amount and speed of blood loss

40
Q

How does haemorrhage lead to hypovolaemic shock?

A

Venous pressure falls, CO falls, arterial pressure falls and detected by the baroreceptors

41
Q

How can a compensatory response lead to hypovolaemic shock?

A 
Increased sympathetic stimulation
Tachycardia 
Increased force of contraction 
Peripheral vasoconstriction 
Venoconstriction
42
Q

What are the symptoms of someone who has hypovolaemic shock?

A

Tachycardia, weak pulse, pale skin and cold clammy extremities.

43
Q

Other than haemorrhage and compensatory response, what else can lead to hypovolaemic shock?

A

Severe burns, sever e diarrhoea or vomiting

44
Q

What are the ossicle dangers of hypovolaemic shock?

A

Danger of decompensation - peripheral vasoconstriction impairs tissue perfusion therefore damage de to hypoxia could lead to multi system failure

45
Q

What is distributive shock?

A

Low resistance shock - (normovolaemic)

46
Q

What pathophysiology is occurring in someone with distributive shock?

A

Profound peripheral vasodilation therefore dec TPR- blood volume is constant but volume of the circulation has increased

47
Q

Name two examples of distributive shock?

A

Toxic shock and anaphylactic shock

48
Q

What is toxic shock also know as?

A

Septic shock

49
Q

What is sepsis?

A

Serious life threatening response to infection

50
Q

What is septic shock?

A

Persisting hypotension requiring treatment to maintain a blood pressure despite fluid resuscitation

51
Q

What happens in septic shock?

A

Decreased arterial pressure - detected by barorresptors so increased sympathetic output. Vasoconstrictor effect overrides by mediators of vasodilation. HR and SV increased.

52
Q

What symptoms does the septic shock patient have?

A

Tachycardia, warm, red extremities but later stages of sepsis - vasoconstriction - localised hypo-perfusion

53
Q

What is an anaphylactic shock?

A

Severe allergic reaction (anaphylaxis)

54
Q

What pathophysiology is involved in an anaphylactic shock?

A

Release of histamine from mast cells. Powerful vasodilator effect - fall in TPR. Drop in arterial pressure. Impaired perfusion

55
Q

Why do you get difficulty breathing in an anaphylactic shock?

A

Mediators cause bronchoconstriction and laryngeal oedema.

56
Q

How does a patient with anaphylactic shock present?

A

Difficulty breathing, collapsed, rapid heart rate and red, warm extremities

57
Q

What is the treatment for someone who has had an anaphylactic shock?

A

Adrenaline - vasoconstriction via action at alpha 1 adrenoceptors

58
Q

What does decreased tissue perfusion lead to?

A

Multi organ failure

CVS A (18 decks)

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