Week 3 Flashcards
What is the typical diameter of capillaries?
5–10 µm
What type of cells make up the wall of capillaries?
Single layer of thin, flattened endothelial cells
What is the role of the basal lamina in capillaries?
Helps maintain the structural integrity of the capillary
What are pericytes?
Contractile cells present along the outside of the basement membrane
What is a key feature of capillary beds?
Form dense networks with a large total cross-sectional area
Why is close proximity of capillaries to cells significant?
Facilitates efficient exchange
What is the relationship between flow velocity and surface area in capillaries?
Low flow velocity, high surface area
What characterizes continuous capillaries?
Endothelial cells joined by tight junctions
What types of substances can pass through continuous capillaries?
Small water-soluble solutes, lipid-soluble substances, macromolecules via pinocytotic vesicles
Where are continuous capillaries commonly found?
- Muscle tissue
- Central nervous system
- Lungs
- Skin
What distinguishes fenestrated capillaries from continuous capillaries?
Numerous pores (fenestrations) in endothelial cells
What is the permeability of fenestrated capillaries compared to continuous capillaries?
Greatly increased permeability to fluids and small solutes
Where are fenestrated capillaries commonly located?
- Kidneys (glomeruli)
- Intestinal villi
- Endocrine glands
What is the structure of sinusoidal (discontinuous) capillaries?
Large gaps between endothelial cells, discontinuous basement membrane
What can pass through sinusoidal capillaries?
Large molecules and even cells
Why is blood flow through sinusoids slower?
Allows time for exchange
Where are sinusoidal capillaries typically found?
- Liver (hepatic sinusoids)
- Bone marrow
- Spleen
What is the primary mechanism responsible for the movement of dissolved gases and small lipid-soluble substances across the endothelial cell membrane?
Diffusion
Diffusion is the primary process for gas exchange in capillaries.
What does Fick’s Law of Diffusion state?
The rate of diffusion is proportional to the concentration gradient, membrane surface area, and permeability, and inversely proportional to membrane thickness.
This law helps predict how substances move across membranes.
What is the difference between transcellular and paracellular pathways?
Transcellular: Lipid-soluble gases diffuse through endothelial cell membranes.
Paracellular: Small water-soluble substances diffuse through intercellular clefts.
These pathways describe how substances move across capillary walls.
Define bulk flow in the context of capillary processes.
Movement of fluid (water + dissolved solutes) en masse from one compartment to another, driven by pressure differences.
Bulk flow is crucial for nutrient delivery and waste removal.
Where does filtration predominantly occur in capillaries?
At the arteriolar end of capillaries, where capillary hydrostatic pressure is higher.
This is where fluid moves out into the interstitial space.
What happens during the reabsorption process in capillaries?
Fluid moves back into capillaries from the interstitium, mainly at the venular end.
This occurs when blood colloid osmotic pressure predominates.
What determines whether there is a net gain or loss of fluid from the capillary?
The balance between filtration and reabsorption.
Net filtration or reabsorption is critical for fluid homeostasis.
What is osmosis?
Movement of water across a semipermeable membrane from low solute concentration to high solute concentration.
Osmosis is essential for maintaining fluid balance in tissues.
What is the main osmotic force exerted in capillaries?
Plasma proteins, especially albumin, create an osmotic gradient (colloid osmotic pressure).
This gradient helps retain fluid within the vascular space.
What are the four Starling’s forces that govern fluid exchange across the capillary?
- Capillary Hydrostatic Pressure (CHP)
- Interstitial Fluid Hydrostatic Pressure (IFHP)
- Blood Colloid Osmotic Pressure (BCOP)
- Interstitial Fluid Colloid Osmotic Pressure (IFCOP)
These forces are essential for understanding fluid dynamics in the circulatory system.
Define Capillary Hydrostatic Pressure (CHP)
The fluid (blood) pressure within the capillary lumen
CHP tends to push fluid out of the capillary, favoring filtration.
What is the typical value of Capillary Hydrostatic Pressure (CHP) at the arteriolar end?
~35 mmHg
This value can vary by tissue and physiological state.
What is the typical value of Capillary Hydrostatic Pressure (CHP) at the venular end?
~15 mmHg
This value can vary by tissue and physiological state.
Define Interstitial Fluid Hydrostatic Pressure (IFHP)
The hydrostatic pressure of the fluid within the interstitial (tissue) space
IFHP tends to push fluid into the capillary if positive, or favors outward movement if negative.
What is the typical value of Interstitial Fluid Hydrostatic Pressure (IFHP) under normal conditions?
Around 0 mmHg or slightly negative
This value can influence fluid movement into or out of the capillaries.
Define Blood Colloid Osmotic Pressure (BCOP)
Also called ‘plasma oncotic pressure,’ primarily generated by plasma proteins, especially albumin
BCOP draws water into the capillary, favoring reabsorption.
What is the typical value of Blood Colloid Osmotic Pressure (BCOP) under normal physiological conditions?
~25 mmHg
This pressure is crucial for maintaining fluid balance in the capillaries.
Define Interstitial Fluid Colloid Osmotic Pressure (IFCOP)
Oncotic pressure due to proteins present in the interstitial space
IFCOP draws water out of the capillary, favoring filtration.
What is the typical value of Interstitial Fluid Colloid Osmotic Pressure (IFCOP)?
Usually low (~1–5 mmHg)
This value can rise significantly if vascular permeability is increased.
Write the equation for Net Filtration Pressure (NFP).
NFP = (CHP - IFHP) - (BCOP - IFCOP)
NFP determines whether net filtration or net reabsorption occurs.
What occurs when Net Filtration Pressure (NFP) is positive?
Net filtration occurs
This means fluid is moving out of the capillaries into the interstitial space.
What occurs when Net Filtration Pressure (NFP) is negative?
Net reabsorption occurs
This indicates fluid is moving from the interstitial space back into the capillaries.
What is the average amount of fluid filtered from capillaries that is not reabsorbed?
~2–3 L/day
What role does the lymphatic system play in relation to excess fluid?
Collects excess fluid and returns it to the venous circulation via the thoracic duct or right lymphatic duct
What are lymph nodes responsible for?
Filtering pathogens, debris, and foreign antigens
Which immune cells are involved in immune responses within lymph nodes?
Lymphocytes and macrophages
How does the lymphatic system regulate interstitial protein oncotic balance?
Helps clear proteins from interstitial fluid to prevent excess accumulation
What can excessive accumulation of proteins in tissue space lead to?
Increased interstitial fluid colloid osmotic pressure (IFCOP) and fluid retention
What is lymphedema?
Accumulation of excess fluid in the interstitium due to inadequate lymphatic drainage
What are some causes of lymphatic blockage?
Filariasis, tumor invasion
Fill in the blank: The lymphatic system returns excess fluid to the venous circulation via the _______.
[thoracic duct or right lymphatic duct]
True or False: The lymphatic system has no role in immune functions.
False
Define Oedema
Oedema refers to the excess accumulation of fluid in the interstitial spaces or within cells, leading to tissue swelling.
Clinically recognized by palpable or visible increase in tissue fluid volume.
What physiological factors regulate fluid exchange between capillaries and interstitial compartments?
Starling’s forces, which include:
* Capillary hydrostatic pressure
* Capillary oncotic pressure
* Interstitial fluid hydrostatic pressure
* Interstitial fluid oncotic pressure
Also influenced by lymphatic drainage.
What is localized oedema?
Localized oedema may reflect local injury or inflammation, such as in an inflamed joint or around a site of infection.
What is generalized oedema?
Generalized oedema, such as anasarca, often points to systemic disorders like heart failure, liver disease, or nephrotic syndrome.
What is the core mechanism behind increased capillary hydrostatic pressure?
Excessive fluid filtration into tissues due to elevated blood pressure in capillaries.
What are common causes of increased capillary hydrostatic pressure?
- Elevated venous pressures (e.g., heart failure)
- Venous obstruction (e.g., deep vein thrombosis)
- Excess fluid retention (e.g., renal failure)
Particularly seen in right-sided heart failure.
What does decreased plasma oncotic pressure cause?
Diminished inward pulling force that normally retains fluid in the vascular space.
List common causes of decreased plasma oncotic pressure.
- Hypoalbuminemia
- Liver disease (decreased albumin synthesis)
- Nephrotic syndrome (loss of protein through urine)
- Malnutrition (inadequate albumin production)
Leads to fluid shifting into the interstitial compartment.
What is the core mechanism of increased capillary permeability?
Damage or disruption of the endothelial barrier allows proteins and fluid to move freely into the interstitial space.
What are common causes of increased capillary permeability?
- Inflammation/Infection
- Allergic reactions (e.g., anaphylaxis)
- Burns or trauma
Results in higher interstitial fluid colloid osmotic pressure, drawing fluid into tissues.
What is the core mechanism behind lymphatic obstruction?
Blockage of lymphatic vessels prevents the return of excess interstitial fluid and proteins to the venous circulation.
List common causes of lymphatic obstruction.
- Malignancy (tumor growth)
- Infections (e.g., filariasis)
- Surgical disruption (e.g., lymph node removal)
Leads to accumulation in the tissue, often presenting as non-pitting oedema.
What are common causes of elevated venous pressures?
- Congestive heart failure
- Deep venous thrombosis
- Hepatic cirrhosis with portal hypertension
Characterized by pitting peripheral oedema and jugular venous distension.
What is a characteristic clinical manifestation of peripheral oedema?
Often noticed in the ankles and feet due to gravity-dependent fluid accumulation.
What is pitting oedema?
When pressed, a temporary indentation persists.
What are clinical correlations of pulmonary oedema?
- Dyspnea (especially orthopnea)
- Paroxysmal nocturnal dyspnea
- Crackles (rales) on lung auscultation
Often a hallmark of left-sided heart failure.
What is ascites?
Fluid accumulation in the peritoneal cavity.
List clinical presentations of ascites.
- Abdominal distension
- Fullness
- Discomfort
- Shifting dullness on percussion
- Fluid wave sign
Commonly associated with portal hypertension or hypoalbuminemia.
What is hepatomegaly?
Enlargement of the liver, which may be tender or non-tender on palpation.
What is raised JVP (Jugular Venous Pressure)?
Visually assessed by looking at the neck veins in a semi-recumbent position.
What does an elevated JVP indicate?
Increased central venous pressure.
True or False: Increased capillary permeability can be caused by trauma.
True
Define Heart Failure
Heart Failure is a clinical syndrome in which the heart fails to pump sufficient blood to meet the body’s metabolic demands or can only do so at the cost of elevated filling pressures.
Common manifestations include fluid retention and inadequate organ perfusion.
What are common manifestations of Heart Failure?
- Fluid retention (leading to oedema and/or pulmonary congestion)
- Inadequate organ perfusion (leading to fatigue, reduced exercise tolerance, and end-organ dysfunction)
What physiological changes occur in Heart Failure?
Compensatory mechanisms such as sympathetic activation, RAAS stimulation, and ventricular remodeling eventually become maladaptive, exacerbating the syndrome.
What is Systolic Heart Failure (HFrEF)?
Heart Failure with reduced Ejection Fraction (EF typically <40%), primarily due to impaired myocardial contractility.
What is Diastolic Heart Failure (HFpEF)?
Heart Failure with preserved Ejection Fraction (EF >50%), often due to decreased ventricular compliance and relaxation abnormalities.
What is Borderline Heart Failure (HFmEF)?
A ‘mid-range’ EF category (41–49%) recognized in some guidelines.
List major risk factors for Heart Failure.
- Hypertension
- Coronary Artery Disease
- Diabetes Mellitus
- Obesity
- Valvular Heart Disease
- Advanced Age
What are the primary etiologies of Heart Failure?
- Ischemic Heart Disease
- Hypertension
- Valvular Disorders
- Cardiomyopathies
- Arrhythmias
- Other Causes
What is the pathophysiology of Forward Failure in Left Heart Failure?
The left ventricle fails to effectively pump blood into the systemic circulation, reducing cardiac output and tissue perfusion.
What is Backward Failure in Left Heart Failure?
Elevated left ventricular end-diastolic pressure transmits back into the left atrium and pulmonary veins, causing pulmonary congestion.
What are common clinical features of Left Heart Failure?
- Dyspnea on exertion and orthopnea
- Paroxysmal nocturnal dyspnea
- Bibasilar Crackles (Rales)
- Fatigue and Reduced Exercise Tolerance
- S3 Heart Sound
What is the pathophysiology of Right Heart Failure?
Secondary to Left-Sided Failure or isolated right-sided failure from primary pulmonary disease.
List clinical features of Right Heart Failure.
- Peripheral Edema
- Jugular Venous Distension (JVD)
- Hepatomegaly
- Ascites
- Congestion of Visceral Organs
What are the ACC/AHA stages of Heart Failure?
- Stage A: High risk for developing HF but no structural heart disease
- Stage B: Structural heart disease present but no symptoms
- Stage C: Structural heart disease with prior or current symptoms
- Stage D: Refractory HF requiring specialized interventions
What is the NYHA Functional Classification of Heart Failure?
- Class I: No limitation of physical activity
- Class II: Slight limitation of physical activity
- Class III: Marked limitation of physical activity
- Class IV: Symptoms at rest
True or False: The ACC/AHA stages focus on functional limitations.
False
What are key takeaways regarding Heart Failure?
- Heart Failure is a complex syndrome
- Stages track the evolution of disease
- Left HF manifests with pulmonary symptoms
- Right HF features systemic venous congestion
What is Cardiac Remodeling?
A spectrum of molecular, cellular, and structural adaptations in the heart in response to chronic injury or hemodynamic stress.
Includes changes in size, shape, and function of the myocardium affecting myocytes and the extracellular matrix.
What is the difference between Physiological and Pathological Remodeling?
Physiological remodeling occurs with regular exercise or pregnancy, while pathological remodeling is triggered by sustained pressure or volume overload, ischemia, or toxic insults.
Physiological remodeling typically preserves or improves cardiac function, whereas pathological remodeling impairs it.
What are some underlying molecular/chemical mediators of Cardiac Remodeling?
- Neurohormonal Activation
- Growth Factors and Cytokines
- Genetic Reprogramming of Myocytes
Examples include TGF-β and Endothelin-1 influencing gene expression.
What are the causes of Cardiac Remodeling?
- Pressure Overload
- Volume Overload
- Myocardial Infarction (MI)
- Neurohormonal Factors
Each cause leads to specific structural and functional alterations in the heart.
What is Pressure Overload in the context of Cardiac Remodeling?
Long-standing hypertension or aortic stenosis requiring the ventricle to generate higher pressures.
This prompts changes in cardiomyocyte architecture, such as adding sarcomeres in parallel.
What is Volume Overload in the context of Cardiac Remodeling?
Chronic valvular regurgitation or chronic anemia leading to chamber dilation.
The ventricle accommodates greater blood volume, adding sarcomeres in series.
What is Concentric Remodeling?
A pattern where ventricular wall thickness increases, often resulting in reduced chamber diameter or volume due to pressure overload.
This is characterized by wall thickening and increased wall-to-cavity ratio.
What are the complications of Concentric Remodeling?
- Diastolic Dysfunction
- Progression to Systolic Dysfunction
- Increased Myocardial Oxygen Demand
These complications can lead to heart failure with preserved ejection fraction (HFpEF).
What is Eccentric Remodeling?
A pattern where the ventricular chamber dilates, often with relative wall thinning or normal wall thickness due to volume overload.
It is characterized by increased internal diameter of the ventricle.
What are the complications of Eccentric Remodeling?
- Systolic Dysfunction
- Increased Wall Stress and Valvular Compromise
- Arrhythmias
These complications can lead to reduced ejection fraction (HFrEF) and disrupt normal electrical conduction.
How does Concentric Remodeling differ from Eccentric Remodeling?
Concentric remodeling is associated with pressure overload and diastolic dysfunction, while eccentric remodeling is linked to volume overload and systolic dysfunction.
The progression of heart failure symptoms can occur in both types of remodeling.
What role does neurohormonal blockade play in cardiac remodeling?
Therapies like ACE inhibitors, beta-blockers, and ARNI can slow or partially reverse remodeling by reducing chronic RAAS and sympathetic stimulation effects.
Understanding these therapies is critical for managing heart failure progression.
What is the hallmark symptom of heart failure?
Dyspnea (shortness of breath) on exertion
Dyspnea is a key indicator of heart failure severity.
What does orthopnea refer to in heart failure patients?
Dyspnea when lying flat, often measured by the number of pillows needed to sleep comfortably
This symptom indicates worsening heart failure.
What is Paroxysmal Nocturnal Dyspnea (PND)?
Sudden nighttime episodes of severe shortness of breath
PND often occurs during sleep due to fluid redistribution.
What are common signs of fluid retention in heart failure?
Edema or weight gain, especially swelling in ankles, legs, or abdomen
Fluid retention is a direct consequence of heart failure.
What does Jugular Venous Distension (JVD) indicate?
Elevated right-sided filling pressures
JVD is assessed during physical examination for heart failure.
What do pulmonary crackles (rales) signify in heart failure?
Fluid in the alveolar spaces from pulmonary venous congestion
Crackles are indicative of heart failure-related pulmonary issues.
What does an S3 Gallop indicate?
Volume overload and reduced left ventricular function
The S3 sound is often found in patients with heart failure.
What is the gold standard diagnostic test for heart failure?
Echocardiogram
It evaluates ejection fraction, chamber sizes, and valvular function.
What does an elevated BNP or NT-proBNP level indicate?
Presence of heart failure; levels correlate with disease severity
These biomarkers help differentiate cardiac from non-cardiac causes of dyspnea.
What is the significance of a Chest X-Ray in diagnosing heart failure?
Assesses cardiac silhouette for cardiomegaly and signs of pulmonary congestion
CXR is a quick, non-invasive method to evaluate fluid overload.
What does the presence of Kerley B lines on CXR indicate?
Interstitial edema in the interlobular septa
These lines are characteristic of heart failure.
What is the relationship between heart failure and renal impairment?
Hypoperfusion leads to reduced glomerular filtration rate (GFR) and fluid retention
This condition is known as cardiorenal syndrome.
What is congestive hepatopathy?
Hepatic congestion due to elevated central venous pressure from right-sided heart failure
It can lead to liver dysfunction and coagulopathy.
What arrhythmia is commonly associated with advanced heart failure?
Atrial fibrillation
It exacerbates heart failure symptoms and can lead to rapid ventricular rates.
What complication can arise from chronic pulmonary congestion in heart failure?
Increased risk of infections or impaired gas exchange
Chronic congestion can lead to significant pulmonary complications.
What does a reduced cardiac output in severe heart failure lead to?
Hypotension and end-organ hypoperfusion
This condition may result in cardiogenic shock.
What is a key diagnostic feature of heart failure on an echocardiogram?
Measurement of ejection fraction (EF)
EF is crucial for classifying heart failure into HFrEF and HFpEF.
True or False: An ECG is definitive for diagnosing heart failure.
False
While helpful, ECG is not definitive but guides further evaluation.
Fill in the blank: Elevated BNP levels can differentiate cardiac causes of dyspnea from _______.
[non-cardiac causes]
BNP aids in distinguishing between cardiac and non-cardiac dyspnea.
What findings on a chest radiograph may indicate elevated pulmonary venous pressures?
Alveolar edema, upper lobe diversion, cardiomegaly, pleural effusions
These findings are characteristic of heart failure.
What is acute decompensated heart failure (ADHF)?
ADHF typically manifests with worsening congestion, hypoperfusion, or both.
What are the principal goals in the acute management of ADHF?
Stabilize the patient, relieve symptoms, restore adequate tissue perfusion.
What does the acronym ABCs stand for in acute management?
Airway, Breathing, Circulation.
When should non-invasive positive pressure ventilation be considered?
If the patient is significantly hypoxic or in severe respiratory distress.
What positioning is recommended to reduce pulmonary congestion?
Upright positioning.
What are loop diuretics used for in ADHF?
Provide rapid volume reduction by promoting diuresis.
Name three examples of loop diuretics.
- Intravenous furosemide
- Bumetanide
- Torsemide
What is the mechanism of action of vasodilators in ADHF?
Reduce preload and afterload, improving cardiac output.
What are two examples of vasodilators used in ADHF?
- Nitroglycerin
- Sodium nitroprusside
What is the indication for oxygen and non-invasive ventilation in ADHF?
If the patient is hypoxic (O₂ saturation <90–92%).
When are intravenous inotropes used in ADHF?
In patients with low output and poor end-organ perfusion.
What should be monitored during diuretic therapy?
- Renal function
- Electrolytes
- Blood pressure and hemodynamics
True or False: Intravenous morphine is commonly used in ADHF management.
False
What is the primary goal of chronic heart failure management?
Slow disease progression, reduce morbidity and mortality, improve quality of life.
What are two lifestyle modifications recommended for chronic heart failure?
- Sodium restriction
- Regular moderate exercise
Name two classes of pharmacological agents used in chronic heart failure.
- ACE Inhibitors (or ARBs)
- Beta-Blockers
What is the mechanism of action of ACE inhibitors?
Reduce afterload and ventricular remodeling by inhibiting angiotensin II.
What is an example of an Angiotensin Receptor-Neprilysin Inhibitor?
Sacubitril/valsartan (Entresto).
What is the clinical benefit of beta-blockers in chronic heart failure?
Improved survival, especially in systolic heart failure.
Fill in the blank: Mineralocorticoid Receptor Antagonists (MRA) block _______’s effects.
aldosterone
What is the indication for hydralazine and isosorbide dinitrate?
Beneficial in African American patients with HFrEF.
What is the rationale for Cardiac Resynchronization Therapy (CRT)?
Improves synchrony of contraction and cardiac function in patients with conduction delays.
What is the indication for an Implantable Cardioverter-Defibrillator (ICD)?
Patients with significantly reduced ejection fraction (<35%) at high risk for life-threatening arrhythmias.
What is essential for titration and monitoring of ACE inhibitors and ARBs?
Monitor renal function and potassium.
What is the focus of management in acute decompensated heart failure?
Stabilization, rapid relief of congestion, inotropic support if perfusion is low.
What are the long-term therapies emphasized in chronic heart failure management?
- Neurohormonal blockade
- Diuretic use
- SGLT2 inhibitors
- Lifestyle modifications
- Device therapy
What should be tailored to patient comorbidities in heart failure management?
Therapies should be individualized.
What is the definition of shock?
Shock is a pathophysiological state of inadequate tissue perfusion leading to cellular hypoxia and organ dysfunction.
What is the primary issue shared by all forms of shock?
Impaired oxygen delivery to tissues.
What are the major types of shock?
- Hypovolemic Shock
- Cardiogenic Shock
- Distributive Shock
- Obstructive Shock
What causes hypovolemic shock?
Insufficient intravascular volume due to hemorrhage, severe dehydration, or third-spacing of fluids.
What is the pathophysiology of hypovolemic shock?
Reduced preload → decreased stroke volume and cardiac output → hypotension and poor tissue perfusion.
What compensatory mechanisms are activated in hypovolemic shock?
- Tachycardia
- Intense peripheral vasoconstriction
- RAAS activation to retain sodium and water
What causes cardiogenic shock?
Cardiac pump failure due to conditions like myocardial infarction or severe arrhythmias.
What is a key feature of cardiogenic shock?
Pulmonary edema, elevated jugular venous pressure, and hypotension.
What is the pathophysiology of distributive shock?
Marked vasodilation and inappropriate blood distribution cause a relative hypovolemia.
What are the subtypes of distributive shock?
- Septic Shock
- Anaphylactic Shock
- Neurogenic Shock
What triggers septic shock?
Systemic infection and inflammatory response.
What is the cause of obstructive shock?
A mechanical obstruction to cardiac filling or ejection.
What are examples of conditions that cause obstructive shock?
- Pulmonary embolism
- Tension pneumothorax
- Cardiac tamponade
What are the three stages of shock?
- Initial (Compensated) Stage
- Progressive (Decompensated) Stage
- Irreversible (Refractory) Stage
What physiological changes occur in the initial stage of shock?
- Sympathetic activation
- RAAS stimulation
- Sodium and water retention
What clinical presentations are seen in the initial stage of shock?
Blood pressure may be normal or slightly reduced; cold, clammy extremities; mild tachypnea.
What occurs during the progressive stage of shock?
Worsening hypoperfusion leads to tissue hypoxia and organ dysfunction.
What are the clinical features of the progressive stage of shock?
- Marked tachycardia
- Hypotension
- Confusion or lethargy
- Cool/clammy skin
What characterizes the irreversible stage of shock?
Severe cellular and tissue damage; multiple organ dysfunction syndrome (MODS).
What are the clinical presentations in the refractory stage of shock?
- Profound hypotension
- Rapid deterioration in mental status
- Multi-organ failure
What is the primary mechanism of cardiogenic shock?
Primary cardiac dysfunction leading to low cardiac output and poor end-organ perfusion.
What are the clinical hallmarks of cardiogenic shock?
- Pulmonary edema
- Elevated jugular venous pressure
- Marked hypotension
What are key clinical features of the compensatory stage of cardiogenic shock?
- Tachycardia
- Cool/clammy skin
- Mild hypotension
What occurs during the progressive stage of cardiogenic shock?
Marked hypotension and confusion; signs of metabolic acidosis.
What are the clinical features of the refractory stage of cardiogenic shock?
- Profound hypotension
- Severe organ failures
- Risk of arrhythmias or cardiac arrest
What is an important aspect of managing cardiogenic shock?
Improving cardiac output and restoring coronary perfusion.
What types of fluids are used cautiously in the management of cardiogenic shock?
IV Fluids.
What are examples of inotropes used in cardiogenic shock management?
- Dobutamine
- Milrinone
What is the role of vasopressors in cardiogenic shock?
Used if hypotension is profound and not responsive to inotropes.
What is necessary for monitoring patients in cardiogenic shock?
Continuous monitoring of ECG, invasive blood pressure, and urine output.
What is the purpose of mechanical circulatory support in cardiogenic shock?
To provide support to the failing ventricle or to improve coronary perfusion.
What does shock represent in clinical terms?
A life-threatening condition where tissue perfusion is inadequate to sustain normal cellular metabolism.
What are critical aspects of managing shock?
Timely intervention and definitive treatment of the underlying cause.
