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27 Cards in this Set

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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
How much blood volume can you lose before hypertension becomes refractory to volume resuscitation?
about 45%
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.
Restore volume first! You can do this with crystalloid (isotonic saline), or colloids (saline with albumin, $$$).

Second, restore hemoglobin with packed RBCs.
What kind of heart failure would be characterized by a baggy loose heart?
Systolic failure
What kind of heart failure would be characterized by a hypertrophic, non-compliant heart (or tamponade)?
Diastolic failure
How do you manage a cardiogenic shock caused by MI?
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.
What are synonyms for "cold" vs "warm" shock?
Cold = hypovolemic
Warm = vasogenic, because high cardiac output and low vascular resistance
How do you manage vasogenic shock?
#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)
What can cause Torsade de pointes VTach?
diarrhea, hypokalemia, alcohol related malnutrition, LOTS of drug side effects or interactions
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?
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).
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.
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
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.
In tamponade, blunted or missing y descent
In pericarditis, exaggerated x AND y descents
How do you estimate max HR?
220 - age, +/- 45
Through what mechanisms does your brain immediately meet increased oxygen demand in exercise?
Withdraw vagal town, increase sympathetic tone
If you have increased sympathetic tone, how do you have decreased peripheral vascular resistance overall in the acute exercise response?
The muscles dilate their vessels to get more O2 out.
What happens to systolic and diastolic blood pressure during exercise?
Systolic rises a lot, diastolic stays relatively constant
If peripheral resistance is down, why does systolic blood pressure rise in exercise?
Peripheral resistance is down, but CO is way up. CO wins.
How does exercise training increase VO2 Max?
Increases vasculature, and increases O2 extraction
What is takotsubo heart?
"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).
What happens in arrhythmogenic RV dysplasia?
The lateral (free) RV wall is replaced by fibrofatty tissue, reducing function.
What is the Venturi effect on the mitral valve in hypertrophic cardiomyopathy?
The narrowed LV outflow tract causes blood to "catch" against the anterior mitral leaflet, causing regurgitation into the LA.
What does the myocardium of a short axis slice of isolated LV non-compaction look like?
Hamburger meat
What is dyslipidemia characterized by on a lipid panel?
High TC
What is Familial Hyperlipidemia characterized by on a lipid panel?
High LDL
What might you see in the mouth of someone with Tangier's disease, an HDL disorder?
Orange tonsils
What is a characteristic lipid panel finding for someone with remnant-receptor disease (Familial Dysbetalipoproteinemia)?
SKY high triglycerides (>500)