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6 Cards in this Set
List the differential diagnosis for hypotension that correlates with LV preload, LV contractility, HR< and systemic vascular resistance.
preload, right ventricular infarct, mitral stenosis, cardiac tamponade, pulmonary embolism, tachycardia
primary myopathy (MI, myocarditis, trauma), medications (beta and Ca blockers), valvular defects
bradycardia, medications, pathologic tachycardia
SVR: sepsis, anaphylaxis, medications (Ca blocker overdose)
List possible physical exam findings frequently associated with LV preload, contractility, and systemic vascular resistance changes
1) LV preload:
- Tachycardia, tachypnea, low O2 saturation, pulsus paradoxus
- Elevated JVP, presence or absence of pulmonary edema, distant heart "rub" sounds due to pericardial effusion
2) LV contractility
- tachycardia, tachypnea, low O2 saturation
- Skin = cool, clammy
- Lungs = pulmonary edema
- Cardiac exam = displaced/diffused PMI, abnormal thrills, S3 murmurl
Explain the roles of chest x-ray, ECG, echocardiogram, and lab tests in assessing hypotension etiologies.
Chest x-ray: pulmonary edema seen in cardiogenic shock. x-ray will be normal in preload and distributive shock
ECG: identify MI and therefore identify cardiogenic shock
Echocardiogram: best test to differentiate between all three types of shock.
1) preload dependent: accurate estimation of RV volume and contraction. Right heart pressures can also be estimated. Pericardial effusion and cardiac tamponade can also be distinguished.
2) Cardiogenic shock: myocardial contractile function, as well as valvular defects can be seen with echo
3) distributive shock: high CO can be estimated with an otherwise normal heart.
Lab tests: Lab tests are useful for diagnosing and managing shock. A basic set of lab tests consisting of CBC (anemia), electrolytes, chemistry, and troponin I (MI) can help identify underlying shock condition.
List the information about hypotension that can be gathered from a Swan-Ganz catheter and list normal right atrial, right ventricular, pulmonary arterial and pulmonary capillary wedge pressures.
Right atria: mean = 1-5mmHg
Right ventricle: systolic = 15-30mmH; diastolic = 1-7mmHg
Pulmonary Artery: systolic = 15-30mmHg; diastolic: 4-12mmHg
Pulmonary Capillary Wedge Pressure (LV preload): mean = <12mmHg
Explain how changes in CO and SVR are associated with preload dependent shock, cardiogenic shock, and distributive shock.
look at chart!
Qualitatively descrive treatments for the different types of shock
Preload: increase CVP
Cardiogenic: increase CO
Distributive: increase SVR