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CABS2: Cardiology > Shock, CHF and Edema > Flashcards

Shock, CHF and Edema Flashcards

1
Q

what innervates the diaphragm and helps with respiration

A

phrenic nerve

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2
Q

where does the phrenic nerve come out of the spine

A

C3, C4 and C5

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3
Q

What is CHF

A

congestive heart failure
now known as just heart failure

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4
Q

what is heart failure

A

the heart isn’t pumping as well as it should. as a result the body isn’t getting enough of the oxygen rich blood it needs to work properly

presents with fluid overload

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5
Q

What are the classifications of heart failure

A

acute vs chronic
compensated vs decompensated
right sided vs left sided
systolic vs diastolic

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6
Q

What is acute heart failure

A

associated with acute heart disease
ACS with wall motion abnormality, acute valve disease, arrhythmia, infection

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7
Q

what is the presentation of acute heart failure

A

more sudden/severe symptoms
flash pulmonary edema
shock
normal cardiac silhouette

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8
Q

what is chronic heart failure

A

develops over months to years
more common
m/c associated with cardiomegaly and subsequent failure

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9
Q

what causes chronic heart failure

A

ischemia, valve disease, HTN -> remodeling

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10
Q

what is the hallmark of chronic heart failure

A

fluid overload (peripheral edema, pulmonary edema)

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11
Q

what is the most common sided heart failure

A

left sided heart failure

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12
Q

what is left sided heart failure

A

most common
decreased CO - can lead to hypotension, tissue ischemia
left ventricular failure will lead to pulmonary edema

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13
Q

what is right sided heart failure

A

failure of the right ventricle
primary: pulmonary HTN, pulmonary valve stenosis, increased preload, decreased contractility
secondary: most common cause: left sided heart failure

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14
Q

What is compensated HF

A

body is able to compensate for the underlying heart dysfunction
typically describes someone’s chronic state

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15
Q

what is decompensated HF

A

acute exacerbation within a patient that has known CHF
body is no longer able to keep up with the remodeling or there was a change in cardiac demand
increase in symptoms associated with volume overload
patients often have orthopnea, exertional dyspnea, fatigue

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16
Q

What are compensatory mechanisms

A

initially - the body will try to fix the strain on the heart and decreased CO
SNS will increase B1 affects and A1 (increase contractility, SV, BP, increase vasoconstriction to increase preload, vasoconstriction to kidneys)
RAAS

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17
Q

What is systolic HF

A

symptoms result from decreased SV with Decreased EF
*HF with Reduced EF (HFrEF)

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18
Q

what is the presentation of systolic HF

A

left sided HF (dyspnea, fatigue, rales or crackles)
May progress to right sided HF with edema

19
Q

what causes systolic HF

A

MI affecting the LV (2/3 cases)
Dilated cardiomyopathy
Increased preload
valvular disease
tachyarrhythmia (decreased diastolic filling time)

20
Q

What is a diastolic HF

A

impaired filling - decrease CO
ejection fraction is maintained = HF with preserved EF (HFpEF)

21
Q

what is the presentation of diastolic HF

A

left sided HF (Dyspnea, fatigue, rales or crackles)
May progress to right sided HF with edema

22
Q

What causes diastolic HF

A

decreased preload: CAD-fibrotic changes, restrictive cardiomyopathy, pericarditis
Increased afterload: HTN, aortic stenosis, HOCM

23
Q

What are the most common pathophysiology/cause of HF

A

ischemia, chronic HTN, Chronic valvular disease

24
Q

when will patients become symptomatic with edema

A

when they are 2.5-3L overloaded
about the same amount as normal plasma volume

25
Q

What is anasarca

A

diffuse edema
not just in the LE

26
Q

what are the types of edema

A

pitting and non-pitting

27
Q

What is shock

A

supply/demand mismatch which will result in end-organ dysfunction
Hypoperfusion

sock does not equal hypotension

28
Q

what is the shock index

A

heart rate / systolic BP

29
Q

What are the different types of shock

A

hypovolemic
cardiogenic
obstructive
distributive

30
Q

What is seen on the exam of a pt in shock

A

Temp: high or low
HR: typically tachy but may be brady
SBP: classically low but can initially be elevated or normal
DBP:
MAP: typically <65
CNS: AMS, confused, coma
REspiratory: tachypenic, ma habe progressive respiratory fialure

31
Q

What is cardiogenic shock

A

result from decreased cardiac function resulting in decreased perfusion to peripheral tissues

marked by increased preload, increased afterload, increased systemic vascular resistance, decreased CO

32
Q

what is cardiogenic shock associated with

A

MI, arrhythmia, HF, valve dysfunction

33
Q

what is a positive inotrope

A

increases muscular contraction

34
Q

what is a postivie chronotrope

A

increases HR

35
Q

what do vasopressors cause

A

vasoconstrictuion

36
Q

what is monitored when using pressors

A

renal, mesenteric or myocardial ischmia

37
Q

what can cause cardiogenic shock

A

Acute MI
Myocarditis
Arrhythmias
Tamponade
Acute HF - PE?, Papillary muscle rupture?

38
Q

What is hypovolemic shock

A

results from decreased intravascular volume
marked by decreased preload, increased systemic vascular resistance and decreased CO

seen with hemorrhage, capillary leak, GI losses, thermal burns

39
Q

What is distributive shock

A

results from redistribution of blood volume
marked by decreased preload, increased systemic vascular resistance, mixed CO
**Septic shock*, neurogenic shock and anaphylaxtic shock

40
Q

what type of shock is septic shock

A

distributive shock

41
Q

What is neurogenic shock

A

disruption of the autonomic pathway
circulatory failure due to loss of vascular resistance
presents with hypotension, bradycardia
initially the tissue damage due to hypoxia is reversible

42
Q

where is neurogenic shock most commonly seen

A

thoracic level trauma

43
Q

What is obstructive shock

A

results from decreased venous return or decreased cardiac compliance
marked by decreased preload, increased systemic vascular resistance, decreased CO

44
Q

what is obstructive shock associated with

A

PE, pericardial tamponade, tension pneumothorax, LV outflow obstruction

CABS2: Cardiology (11 decks)

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