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27 Cards in this Set
- Front
- Back
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What are the two factors that differentiate compensated hypovolemia from hypovolemic shock? Pick from the following
-End Diastrolic Pressure -Lactate -Cardiac Output -Systemic Vascular Resistance -Systemic Blood Pressure |
Systemic BP, lactate:
In hypovolemic shock, blood pressure is low and lactate is high |
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How much blood volume can you lose before hypertension becomes refractory to volume resuscitation?
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about 45%
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How should you manage a patient in hypovolemic shock? Assume that any other problems (like a big hemorrhage) have been taken care of and you're just dealing with hypovolemia now.
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Restore volume first! You can do this with crystalloid (isotonic saline), or colloids (saline with albumin, $$$).
Second, restore hemoglobin with packed RBCs. |
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What kind of heart failure would be characterized by a baggy loose heart?
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Systolic failure
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What kind of heart failure would be characterized by a hypertrophic, non-compliant heart (or tamponade)?
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Diastolic failure
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How do you manage a cardiogenic shock caused by MI?
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Dopamine* or dobutamine - it will boost CO and SVR through alpha, beta adrenergic receptors.
Also consider intra-aortic balloon pump *Remember that dopamine is dose-dependent. 5-10 is the cardiac dose, after this, you get vasoconstriction in kidneys = bad news bears. |
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What are synonyms for "cold" vs "warm" shock?
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Cold = hypovolemic
Warm = vasogenic, because high cardiac output and low vascular resistance |
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How do you manage vasogenic shock?
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#1 Volume resuscitate (like in hypovol)
#2 alpha agonist (E or NE) to vasoconstrict #3 Steroids (for septic shock only - allows better uptake of catecholamines) |
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What can cause Torsade de pointes VTach?
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diarrhea, hypokalemia, alcohol related malnutrition, LOTS of drug side effects or interactions
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You have a patient with a congenital abnormality pre-disposing to arrhythmia. What does a slurred Q-R complex (delta wave) indicate on her EKG? What is the abnormality?
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Wolff-Parkinson-White syndrome:
Patients have an accessory pathway (Bundle of Kent) that does not slow conduction like the AV node. That slurred Q-R (delta wave) is the ventricle near the Bundle of Kent being pre-excited, and sometimes, this can re-enter via AV node creating circus movement (SVtach). |
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What does pulsus paradoxus* indicate?
*PP is a big drop in BP on inspiration |
Cardiac tamponade or pericarditis
-Inspiration decreases IT pressure, filling the right heart well, but impinging on the left heart. Normal patients will experience ~5mm pressure drop in SBP on inspiration, but >10mm is paradoxus and indicates that left heart is seriously been impinged on inspiration. |
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What does Kussmaul's sign* indicate?
*Kussmaul's sign is a rise in JVP on inspiration |
High JVP means the right heart isn't filling, but on inspiration only, indicates:
Pericarditis, tamponade or constrictive cardiomyopathy. Less likely: tricuspid stenosis |
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How can you tell from jugular venous pressure whether someone has tamponade vs. pericarditis? Refer to JVP tracings with a,x,v,y to indicate ascents and descents in pressure.
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In tamponade, blunted or missing y descent
In pericarditis, exaggerated x AND y descents |
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How do you estimate max HR?
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220 - age, +/- 45
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Through what mechanisms does your brain immediately meet increased oxygen demand in exercise?
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Withdraw vagal town, increase sympathetic tone
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If you have increased sympathetic tone, how do you have decreased peripheral vascular resistance overall in the acute exercise response?
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The muscles dilate their vessels to get more O2 out.
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What happens to systolic and diastolic blood pressure during exercise?
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Systolic rises a lot, diastolic stays relatively constant
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If peripheral resistance is down, why does systolic blood pressure rise in exercise?
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Peripheral resistance is down, but CO is way up. CO wins.
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How does exercise training increase VO2 Max?
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Increases vasculature, and increases O2 extraction
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What is takotsubo heart?
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"Broken heart syndrome" cardiomyopathy, in which only the base of the heart contracts, leaving the apex bulging out during systole. stress-related, probably catecholaminergic mechanism. Higher incidence in women. EKG looks like an octopus trap (tako-tsubo).
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What happens in arrhythmogenic RV dysplasia?
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The lateral (free) RV wall is replaced by fibrofatty tissue, reducing function.
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What is the Venturi effect on the mitral valve in hypertrophic cardiomyopathy?
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The narrowed LV outflow tract causes blood to "catch" against the anterior mitral leaflet, causing regurgitation into the LA.
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What does the myocardium of a short axis slice of isolated LV non-compaction look like?
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Hamburger meat
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What is dyslipidemia characterized by on a lipid panel?
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High TC
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What is Familial Hyperlipidemia characterized by on a lipid panel?
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High LDL
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What might you see in the mouth of someone with Tangier's disease, an HDL disorder?
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Orange tonsils
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What is a characteristic lipid panel finding for someone with remnant-receptor disease (Familial Dysbetalipoproteinemia)?
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SKY high triglycerides (>500)
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