shocks & heart sounds

Question 1

umbrella term for all heart or vascular diseases

Answer 1

cardiovascular disease

Question 2

most common type of heart disease

Answer 2

coronary artery disease

Question 3

arteriosclerosis vs atherosclerosis

Answer 3

• both mena that the arteries are hard and narrow; thick and stiff
• if its due to plaque then its athero-

Question 4

dx of metabolic syndrome requires 3 out of 5 these

Answer 4

• 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

Question 5

6 things that increase cardiac output

Answer 5

anxiety, eating, exercise, high temp, pregnancy, epi

Question 6

amount of blood ejected in each heart beat; controlled by preload, afterload, contractility (& partially ANS)

Answer 6

stroke volume

Question 7

total tissue blood flow

Answer 7

Cardiac output

Question 8

what is the frank-starling law

Answer 8

Volume of blood ejected (stroke volume) increases in response to increased volume of blood in ventricles before contraction (end diastolic volume)

Question 9

preload vs after load

Answer 9

• 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

Question 10

chronotrope vs inotrope

Answer 10

• chronotrope– HR
• inotrope– strength

Question 11

two things that control PVR

Answer 11

arteriole diameter & viscosity of blood

Question 12

which vessel is NOT dually innervated

Answer 12

capillaries

Question 13

inadequate tissue perfusion

Answer 13

shock

Question 14

shock from the heart pump is failing

Answer 14

cardiogenic shock

Question 15

shock from hemorrhage, loss of fluid, decreased intravascular volume

Answer 15

hypovolemic shock

Question 16

shock from poor distribution of blood volume; septic shock, anaphylaxis, neurogenic shock (spinal cord injury)

Answer 16

distributive shock

Question 17

pericardial tamponade, pulmonary problems including massive PE, tension pneumothorax belong in what shock category

Answer 17

obstructive shock

Question 18

pericardial effusion vs cardiac tamponade vs tension pneumothorax

Answer 18

• 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

Question 19

causes of cardiogenic shock (2)

Answer 19

myocardial abnormalities
any LV failure (ie. MI) causing decreased perfusion and CO

Question 20

3 ways the body compensates for cardiogenic shock

Answer 20

• baroreceptor reflex
• chemoreceptor reflex
• CNS ischemic response

Question 21

what is the baroreceptor reflex

Answer 21

• baroreceptors in the aortic arch and carotid sinus sense low pressure, send feedback signals → increases arterial pressure

Question 22

what is the chemoreceptor reflex

Answer 22

• sense low oxygen, CO2 excess, H ion excess; excite vasomotor center→ increases arterial pressure

Question 23

what is the CNS ischemic response

Answer 23

• sense cerebral ischemia; Vasoconstrictor and cardioaccelerator neurons in the vasomotor center of the brain → increases arterial pressure

Question 24

systolic & diastolic BP values needed to diagnose orthostatic hypotension

Answer 24

SBP drops 20 mmHg OR DBP drops 10 mmHg

Question 25

where do you listen for S1 and S2

Answer 25

S1 @ apex
S2 @ base

Question 26

which intensity is changed by severe systemic HTN - S1 or S2?

Answer 26

S2

Question 27

how do you hear S3 and S4

Answer 27

• listen during diastole w/ pt in LLD and bell at apex

Question 28

S3 vs S4 is caused by___

Answer 28

• S3 is from volume overload; blood bouncing around ventricles
• S4 is from pressure overload; stiff ventricles often d/t hypertrophy

Question 29

physiology behind S3 (2)

Answer 29

• Decreased ventricular compliance (elastic quality)
• Increased ventricular diastolic volume

Question 30

what does S4 coincide with?

Answer 30

Coincides with atrial contraction injecting blood into stiff ventricle

Question 31

which 2 maneuvers decrease SV/delivery to heart?

Answer 31

valsalva maneuver
standing

Question 32

which 3 maneuvers increase SV/delivery to heart?

Answer 32

inspiration
squatting
amyl nitrate