Shock, CHF and Edema Flashcards
what innervates the diaphragm and helps with respiration
phrenic nerve
where does the phrenic nerve come out of the spine
C3, C4 and C5
What is CHF
congestive heart failure
now known as just heart failure
what is heart failure
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
What are the classifications of heart failure
acute vs chronic
compensated vs decompensated
right sided vs left sided
systolic vs diastolic
What is acute heart failure
associated with acute heart disease
ACS with wall motion abnormality, acute valve disease, arrhythmia, infection
what is the presentation of acute heart failure
more sudden/severe symptoms
flash pulmonary edema
shock
normal cardiac silhouette
what is chronic heart failure
develops over months to years
more common
m/c associated with cardiomegaly and subsequent failure
what causes chronic heart failure
ischemia, valve disease, HTN -> remodeling
what is the hallmark of chronic heart failure
fluid overload (peripheral edema, pulmonary edema)
what is the most common sided heart failure
left sided heart failure
what is left sided heart failure
most common
decreased CO - can lead to hypotension, tissue ischemia
left ventricular failure will lead to pulmonary edema
what is right sided heart failure
failure of the right ventricle
primary: pulmonary HTN, pulmonary valve stenosis, increased preload, decreased contractility
secondary: most common cause: left sided heart failure
What is compensated HF
body is able to compensate for the underlying heart dysfunction
typically describes someone’s chronic state
what is decompensated HF
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
What are compensatory mechanisms
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
What is systolic HF
symptoms result from decreased SV with Decreased EF
*HF with Reduced EF (HFrEF)
what is the presentation of systolic HF
left sided HF (dyspnea, fatigue, rales or crackles)
May progress to right sided HF with edema
what causes systolic HF
MI affecting the LV (2/3 cases)
Dilated cardiomyopathy
Increased preload
valvular disease
tachyarrhythmia (decreased diastolic filling time)
What is a diastolic HF
impaired filling - decrease CO
ejection fraction is maintained = HF with preserved EF (HFpEF)
what is the presentation of diastolic HF
left sided HF (Dyspnea, fatigue, rales or crackles)
May progress to right sided HF with edema
What causes diastolic HF
decreased preload: CAD-fibrotic changes, restrictive cardiomyopathy, pericarditis
Increased afterload: HTN, aortic stenosis, HOCM
What are the most common pathophysiology/cause of HF
ischemia, chronic HTN, Chronic valvular disease
when will patients become symptomatic with edema
when they are 2.5-3L overloaded
about the same amount as normal plasma volume
What is anasarca
diffuse edema
not just in the LE
what are the types of edema
pitting and non-pitting
What is shock
supply/demand mismatch which will result in end-organ dysfunction
Hypoperfusion
sock does not equal hypotension
what is the shock index
heart rate / systolic BP
What are the different types of shock
hypovolemic
cardiogenic
obstructive
distributive
What is seen on the exam of a pt in shock
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
What is cardiogenic shock
result from decreased cardiac function resulting in decreased perfusion to peripheral tissues
marked by increased preload, increased afterload, increased systemic vascular resistance, decreased CO
what is cardiogenic shock associated with
MI, arrhythmia, HF, valve dysfunction
what is a positive inotrope
increases muscular contraction
what is a postivie chronotrope
increases HR
what do vasopressors cause
vasoconstrictuion
what is monitored when using pressors
renal, mesenteric or myocardial ischmia
what can cause cardiogenic shock
Acute MI
Myocarditis
Arrhythmias
Tamponade
Acute HF - PE?, Papillary muscle rupture?
What is hypovolemic shock
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
What is distributive shock
results from redistribution of blood volume
marked by decreased preload, increased systemic vascular resistance, mixed CO
**Septic shock*, neurogenic shock and anaphylaxtic shock
what type of shock is septic shock
distributive shock
What is neurogenic shock
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
where is neurogenic shock most commonly seen
thoracic level trauma
What is obstructive shock
results from decreased venous return or decreased cardiac compliance
marked by decreased preload, increased systemic vascular resistance, decreased CO
what is obstructive shock associated with
PE, pericardial tamponade, tension pneumothorax, LV outflow obstruction
