Shock, CHF, and Edema

Question 1

What does the Phrenic nerve innervate?

Answer 1

Innervates the diaphragm to help with respiration, comes out of C3, C4, and C5

Question 2

What does the Phrenic nerve assist with?

Answer 2

Sensory signaling from the pericardium

Question 3

How is heart failure classified?

Answer 3

Acute vs. Chronic
Compensated vs. decompensated
Right sided vs. left sided
Systolic vs. diastolic

Question 4

What are the causes of chronic HF?

Answer 4

Ischemia
Valve Disease
HTN –> remodeling

Question 5

Acute HF presents with more sudden onset and severe symptoms, what are the symptoms seen?

Answer 5

Flash pulmonary edema
Shock
Normal cardiac silhouette

Question 6

What sided HF is more common?

Answer 6

Left, due to ventricular failure leading to pulmonary edema

Question 7

How will systolic failure with reduced ejection fraction (HFrEF) present?

Answer 7

Left sided HF (dyspnea, fatigue, rales or crackles) due to decreased SV with decreased EF

May progress to right sided HF with edema

Question 8

What are the causes of diastolic heart failure?

Answer 8

Decreased Preload
- CAD, Restrictive cardiomyopathy, pericarditis

Increased Afterload
- HTN, Aortic stenosis, HOCM

Question 9

What can be seen on physical exam in diagnosing CHF?

Answer 9

S3 heart sound
Crackles
Elevated JVD
Hepatojugular reflux
Peripheral edema
Ascites
SOB, orthopnea

Question 10

How is shock defined?

Answer 10

Life-threatening condition characterized by inadequate delivery of oxygen and nutrients to vital organs relative to their metabolic demand- hypoperfusion

Question 11

What is the cause of cardiogenic shock?

Answer 11

Results from decreased cardiac function (typically LV) resulting in decreased perfusion to peripheral tissue - decreased CO

Question 12

Vasopressors cause

Answer 12

Vasoconstriction

Question 13

When using pressors what must you monitor?

Answer 13

Renal, mesenteric and myocardial ischemia

Question 14

What are causes of cardiogenic shock?

Answer 14

Acute MI
Myocarditis
Arrhythmias
Tamponade
Acute Heart Failure (PE, papillary muscle rupture)

Question 15

What is the most common cause of shock?

Answer 15

Septic shock

Question 16

What type of shock is septic shock?

Answer 16

Distributive shock

Question 17

What types of shock are distributive shock?

Answer 17

Septic
Neurogenic
Anaphylactic

Question 18

Obstructive shock is commonly associated with

Answer 18

PE
Pericardial tamponade
Tension pneumothorax
LV outflow obstruction

Question 19

What is a normal ejection fraction?

Answer 19

50-70%

Question 20

What is the most common cause of CHF?

Answer 20

Uncontrolled HTN

Question 21

What locations are common for edema to accumulate?

Answer 21

LE, genitals, GI tract, and liver

Question 22

What are specific causes of ISOLATED right sided heart failure?

Answer 22

pulmonary HTN, PE, COPD

Question 23

What is the pathophysiology of forward left sided heart failure?

Answer 23

Decreased CO from LV

Less oxygen rich blood getting to tissues

Question 24

What are the clinical features of forward left sided heart failure?

Answer 24

Fatigue, weakness, dizziness
Mental status change
Signs of hypoxia, cyanosis
Oliguria

Question 25

What symptom can be associated with severely reduced LV function?

Answer 25

Oliguria

Question 26

What is the pathophysiology of backward left sided heart failure?

Answer 26

Blood backing up into the lungs (pulmonary congestion), fluid leaking into alveoli, less air exchange, and pulmonary edema

Question 27

What are clinical features of backward left sided heart failure?

Answer 27

Cough, crackles, coughing up "frothy" pink sputum Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea Mild to moderate JVD

Question 28

What is the pathophysiology of forward right sided heart failure?

Answer 28

Less blood being pumped into the lungs for gas exchange therefore less oxygenated blood to dispense to body

Question 29

What clinical features will be associated with forward right sided heart failure?

Answer 29

Fatigue, weakness

Question 30

What is the pathophysiology of backward right sided failure?

Answer 30

Blood backing up into veins (peripheral congestion), increasing venous pressure in vena cava and cascading in a retrograde fashion all the way to capillaries, pushing fluid out of veins into organs and tissues

Question 31

In diagnosing CHF, a regurgitated murmur in the tricuspid area can be suggestive of what sided failure?

Answer 31

Right sided

Question 32

What is the work-up for CHF?

Answer 32

CXR ECG ECHO Angiogram (more invasive) lab work (CBC, electrolytes, renal function tests, glucose, thyroid, BNP)

Question 33

What supplement should be taken with loop diuretics?

Answer 33

Potassium

Question 34

What is the medical treatment for CHF?

Answer 34

Diuretics RAAS Agents (ARNI, ACE, ARB) Beta Blocker

Question 35

What is the 5-year survival after an initial hospitalization with CHF?

Answer 35

35%

Question 36

What is the 5-year survival after an initial hospitalization with CHF?

Answer 36

35%

Question 37

What are some reasons for non-cardiogenic pulmonary edema?

Answer 37

Pulmonary damage Sepsis Low oncotic pressure

Question 38

What are signs of cardiogenic shock?

Answer 38

Low BP, weak or irregular pulse

Question 39

What are symptoms of cardiogenic shock?

Answer 39

Dyspnea, cold extremities, clammy, dizziness, confusion, LOC, decreased urination, LE edema