Valvular Heart Disease and Cardiogenic Shock

Question 1

Name the signs and symptoms of Cardiac Tamponade

Answer 1

Dyspnea, Cyanosis, Beck’s Triad, Pulsus paradoxus, Shock symptoms.

Question 2

What is Beck’s Triad?

Answer 2

Hypotension, Muffled Heart Sounds, and Distended Neck Veins.

Question 3

Describe pulsus paradoxus

Answer 3

A drop in Systolic BP 10> mmHg during inspiration.

Question 4

What result occurs due to the presence of pressure overload over time caused by Aortic stenosis?

Answer 4

The result is Concentric LV hypertrophy and increased end diastolic pressure (EDP)

Question 5

What is the definitive diagnosis for someone suspected of sever AS?

Answer 5

Low-dose Dobutamine stress test.

Question 6

What is the treatment for symptomatic AS?

Answer 6

Surgery. Beta blockers provide relief from angina and may protect from tachydysrhythmias.

Question 7

T/F: Vasodilators are contraindicated in treatment of patients with symptomatic AS

Answer 7

False, Low-dose sodium nitroprusside 150 mcg/kg/min (NPS) is shown to increase CO in normotensive patients with CHF and AS. Potent vasodilators are CI.

Question 8

Explain why adequate preload volume is crucial s/p AV replacement.

Answer 8

LVH caused by aortic stenosis significantly reduces compliance and thus small decreases in preload cause severe hypotensive symptomology.

Question 9

A 65 year old female s/p AVR is hypotensive, BP 87/53, HR 124. What intervention/s should be done immediately?
A. Betta blocker for HR control.
B. Fluid bolus and Amioderone for A-fib.
C. Monitor, hypotension is expected.
D. Administration of Nitro for preload reduction.

Answer 9

B. Fluid resuscitation to maintain preload and treatment for A-fib are crucial due to LV hypertrophy and non-compliance.

Question 10

At what age is Coronary angiography recommended in the setting of aortic valve dysfunction?

Answer 10

> 40 years.

Question 11

Cardiac index equating to shock is
<4.0
<1.0
<2.0
<2.5

Answer 11

<2.0

Question 12

Briefly describe the compensatory stage of shock.

Answer 12

Fight or flight response, Hormonal release of Rennin causing decreased urine output, Chemically increase in Na osmolality increasing vascular fluid.

Question 13

What happens during the progressive stage of shock?

Answer 13

Compensatory measures begin to fail. symptoms include lethargy, hypoactive bowel sounds, Increase BUN/Creat, Increased Liver enzymes,

Question 14

What is the mark of Refractory Shock?

Answer 14

Multi organ failure.

Question 15

The hemodynamic findings consistent with a diagnosis of cardiogenic shock are:

a. CI< 2.0 & SVR >2000
b. PAOP 18 mm Hg & CI 2.8
c. BP 110/72 and PAOP >22 mmHg
d. SVR>2000 dynes and SVO2 70%

Answer 15

A. CI<2.0 and SVR >2000 BP <90 sys PAOP <8 or >22 SVO2 < 60%