shocks & heart sounds Flashcards
umbrella term for all heart or vascular diseases
cardiovascular disease
most common type of heart disease
coronary artery disease
arteriosclerosis vs atherosclerosis
- both mena that the arteries are hard and narrow; thick and stiff
- if its due to plaque then its athero-
dx of metabolic syndrome requires 3 out of 5 these
- Waist >40 in males >35 in females
- Tg >150 or tx
- HDL < 40 mg/dl in men, < 50 in women or on tx
- BP >130/85 or HTN tx
- Fasting glucose >110 or tx for elevated glucose
6 things that increase cardiac output
anxiety, eating, exercise, high temp, pregnancy, epi
amount of blood ejected in each heart beat; controlled by preload, afterload, contractility (& partially ANS)
stroke volume
total tissue blood flow
Cardiac output
what is the frank-starling law
Volume of blood ejected (stroke volume) increases in response to increased volume of blood in ventricles before contraction (end diastolic volume)
preload vs after load
- preload– end diastolic pressure when ventricle has filled
- afterload– force against which the ventricles need to eject blood (systemic vascular resistance): pressure in aorta or pulmonary artery
chronotrope vs inotrope
- chronotrope– HR
- inotrope– strength
two things that control PVR
arteriole diameter & viscosity of blood
which vessel is NOT dually innervated
capillaries
inadequate tissue perfusion
shock
shock from the heart pump is failing
cardiogenic shock
shock from hemorrhage, loss of fluid, decreased intravascular volume
hypovolemic shock
shock from poor distribution of blood volume; septic shock, anaphylaxis, neurogenic shock (spinal cord injury)
distributive shock
pericardial tamponade, pulmonary problems including massive PE, tension pneumothorax belong in what shock category
obstructive shock
pericardial effusion vs cardiac tamponade vs tension pneumothorax
- pericardial effusion is fluid in pericardial space
- cardiac tamponade is when that fluid stops the heart from beating fully; Lungs CTAB
- tension pneumothorax is when air accumulating in pleural space cannot leave, putting tension on thoracic structures; lungs NOT CTAB
causes of cardiogenic shock (2)
myocardial abnormalities
any LV failure (ie. MI) causing decreased perfusion and CO
3 ways the body compensates for cardiogenic shock
- baroreceptor reflex
- chemoreceptor reflex
- CNS ischemic response
what is the baroreceptor reflex
- baroreceptors in the aortic arch and carotid sinus sense low pressure, send feedback signals → increases arterial pressure
what is the chemoreceptor reflex
- sense low oxygen, CO2 excess, H ion excess; excite vasomotor center→ increases arterial pressure
what is the CNS ischemic response
- sense cerebral ischemia; Vasoconstrictor and cardioaccelerator neurons in the vasomotor center of the brain → increases arterial pressure
systolic & diastolic BP values needed to diagnose orthostatic hypotension
SBP drops 20 mmHg OR DBP drops 10 mmHg
where do you listen for S1 and S2
S1 @ apex
S2 @ base
which intensity is changed by severe systemic HTN - S1 or S2?
S2
how do you hear S3 and S4
- listen during diastole w/ pt in LLD and bell at apex
S3 vs S4 is caused by___
- S3 is from volume overload; blood bouncing around ventricles
- S4 is from pressure overload; stiff ventricles often d/t hypertrophy
physiology behind S3 (2)
- Decreased ventricular compliance (elastic quality)
- Increased ventricular diastolic volume
what does S4 coincide with?
Coincides with atrial contraction injecting blood into stiff ventricle
which 2 maneuvers decrease SV/delivery to heart?
valsalva maneuver
standing
which 3 maneuvers increase SV/delivery to heart?
inspiration
squatting
amyl nitrate
