Hypotension

Front 1

List the differential diagnosis for hypotension that correlates with LV preload, LV contractility, HR< and systemic vascular resistance.

Back 1

LV preload:
preload, right ventricular infarct, mitral stenosis, cardiac tamponade, pulmonary embolism, tachycardia

LV contractility:
primary myopathy (MI, myocarditis, trauma), medications (beta and Ca blockers), valvular defects

Heart Rate:
bradycardia, medications, pathologic tachycardia

SVR: sepsis, anaphylaxis, medications (Ca blocker overdose)

Front 2

List possible physical exam findings frequently associated with LV preload, contractility, and systemic vascular resistance changes

Back 2

1) LV preload:
VITALS-
- 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
1) VITALS:
- tachycardia, tachypnea, low O2 saturation

- Skin = cool, clammy
- Lungs = pulmonary edema
- Cardiac exam = displaced/diffused PMI, abnormal thrills, S3 murmurl

Front 3

Explain the roles of chest x-ray, ECG, echocardiogram, and lab tests in assessing hypotension etiologies.

Back 3

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.

Front 4

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.

Back 4

Normal Measurements

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

Front 5

Explain how changes in CO and SVR are associated with preload dependent shock, cardiogenic shock, and distributive shock.

Back 5

look at chart!

Front 6

Qualitatively descrive treatments for the different types of shock

Back 6

Preload: increase CVP
Cardiogenic: increase CO
Distributive: increase SVR