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Cardiology > Shock and Acute Heart Failure > Flashcards

Shock and Acute Heart Failure Flashcards

1
Q

Where does the sarcoplasmic reticulum interface with the sarcolemma membrane?

A

At T-tubule

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2
Q

What are L-type calcium channels involved in?

A

within T-tubule, open in resposne to membrane depolarization

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3
Q

The small inward calcium current activates what receptor on SR?

A

ryanodine receptor

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4
Q

What does activiation of ryanodine receptor activate?

A

trigger large amounts of calcium from SR, which binds to troponin C; leads to conformational change in the actin thin filament. Mosin binding sites are exposed and myocyte contraction occurs.

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5
Q

What occurs in diastole with calcium in cardiac contraction?

A

rapid reuptake of calcium and myosin binding ceases

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6
Q

What is the venous return curve?

A

Reflect circulatory volume, peripheral vascular resistance and venous and arterial compliance

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7
Q

What is the frank-starling relationship?

A

connects force and muscle fiber length; more bridge made to cycle, more contractile force will be generated, further stretch more bridge connections available

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8
Q

What are factors that influence cariac output?

A

hear rate and contractility and extrinsic(preload and afterload)

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9
Q

What is the equation for wall tension?

A

La Place: Wall stress=(pressure*radius)/wall thickness

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10
Q

What is a compensatory mechanism for chamber dilation?

A

ventricular hypertrophy

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11
Q

Elevated filling pressures impede what in failing hearts?

A

impede adequate cardiac output

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12
Q

What is inotropic drugs do?

A

used to stimulate contractility and increase dilation; ; stim icrease in intracellular calcium

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13
Q

What are the two types of inotropic drugs?

A

Beta agonists such as dobutamine, epinephrine and norepi

phosphodiesterase inhibitors which degrade cAMP; milrinone

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14
Q

What are techniques to measure hemodynamics?

A

swan-ganz catheter; based on fick principle

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15
Q

What is CO equal to as far as measuring oxygen consumption?

A

CO=O2 consumption/((arterial O2)-MVO2)

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16
Q

What are the symptoms of warm and wet heart failure?

A

increased weight, elevated JVD, peripheral edema, dyspnea/orthopnea/rales

17
Q

What are the symptoms of cold and dry heart failure?

A

dry mucous membrane, tachy, hypotensions, cold extremities

18
Q

What are the symptoms of cold and wet heart failure

A 
most severe;
hypotension, tachy
cold extremities
elevated JVD
dyspnea/orthopnea
19
Q

What is an echocardiogram?

A

used to determine LVEF; in heart falilure by doppler measurment of flow

20
Q

What percentages ndicate the different levels of heart failure normally?

A

45-50 mild
35-44 moderate
less than 35 is severe

21
Q

What is a swan-ganz catheter physically and where is it placed?

A

catheter with ballon that goes through right atrium, ventricle and into the pulmonary artery

measure PCWP directly

22
Q

In what pts is swan-ganz catheter used

A

pts with refactory sxs or severe disease

23
Q

What lab tests are often gotten for acute heart failure?

A 
chest xray
basic metabolic panel
Nt-pro BNP
tropoonin level
ECG
24
Q

What are treatments of acute heart failure?

A

loop diuretics-furosemide
IV admin is recommended as a bolus or continuous infusion
also thiazide diuretics

afterload reduction by nitroprusside, nitroglycerine, nesteride

inotropes

mechanical support

25
Q

What are the stages of shock?

A

inital
compensatory
progressive
refactory

26
Q

What are the signs of initial shock?

A

hypo-perfusion
tissue hypoxia
lactic acidosis

27
Q

What are the signs of compensatory heart failure

A

cytokine relase, hyperventilation for CO2 removal, endogenous catecholamine release

28
Q

What are progressive stage of shock

A

failing compensatory mechanisms, worsensing capillary leakage, metabolic acidosis, increased blood viscosity, microsludging, MODS

29
Q

What is refactory stage of shock?

A

irreversible organ damagge, cell death degradation of ATP to adenosine

30
Q

What is SIRS?

A

systemic inflammatory response syndrome
tachypnea
WBC90 minutes
Temp Fever or hypothermia

31
Q

What is sepsis?

A

at least 1 of the following manifestations of inadequate organ funciton

32
Q

What is severe sepsis?

A

sepsis plus sepsis induced organ dysfunction

33
Q

What is MODS?

A

inflammatory injury involving more than one vital organ

Cardiology (12 decks)

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