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Patho Test 3: 2
Cardiac
| Question | Answer |
|---|---|
| What is Heart Failure | to maintain sufficient cardiac output to meet metabolic needs of tissues and organs; it is the end point of all serious heart disease, you die |
| What is the first sign of heart failure? | Kidney's failing |
| compensated heart failure | early on the compensatory mechanisms can help the body with demands |
| decompensated heart failure | gradually the compensatory can't keep up with the needs of the body and you die |
| Frank-Starling Mechanism | hearts ability to increase its force of contraction and stroke volume in times of need |
| Compensatory mechanisms | Increased sympathetic nervous system activity; norepenephrine and epinephrine increase the heart rate to maintain organ perfusion |
| Renin- angiotensin mechanism | causes the kidneys to release renin which makes Angiotensin I to angiotensin II. causes vasoconstriciton |
| INcreased Renin long term will do what? | Overwork the heart |
| What does aldosterone do? | holds water and sodium |
| Mydocardial hypertrophy | a long term mechanism, cells themself enlarge not multiply, the heart has more work, the heart looses its ability to stretch and fill |
| causes of heart failure | MI, CAD, hypertension, valvular heart disease, excessive work load |
| types of heart failure | high or low |
| high OP faliure | uncommon, causes annemia, treatable |
| low OP failure | impaired pumping, |
| systolic failure | low Op failure, impaired ejection of blood, decrease in contractility and EF, results from decrease contractility, FVE and increase pressure(excess fluid) |
| diaslolic failure | impaired feeling of the ventricles, smaller ventricles, hypertrophy, aging, and tachecardia may also cause this.many people are between sytolic and diastole |
| types of congestive heart failure | right or left |
| right sided heart failure | blood from system not being able to get to lungs, blood accumulates in body, increase RA and RV pressure, peripheral edema |
| Left sided Heart failure | Blood cannot get in to lungs, INcrease pressure in LA LV, peripheral edema at night, can't get output to system |
| Right sided heart failure, S/s | gain of 2 or more pounds a day and 5 or more pounds a week.. liver gets large and eventually spleen will enlarge, impaired digestion due to enlargement of GI |
| left sided heart failure s/s | causes MI, Aortic valve stenosis, rugurgitation of aorta, may occur with rapid fluid volume replacement. due to decreased reserve |
| Causes of right sided heart failure | tricuspid or pulmonic stenosis regurg, right ventricle infarction, cardio myopathy, persistant left sided Heart failure |
| Chronic (cor pulmonae) | right ventricular hypertrophy and right ventricle failure as the lung disease worsens (pulmonary disorder) |
| acute Cor Pulmonae | right heart strain or overload due to pulmonary HTN |
| Chronic Cor pulmonae | due to diseases of pulmonary tissue |
| S/S of heart failure | depends on extent and type of heart failure, assoc diseases include, CVD, HTN, DM, CAD, dysthrymia, renal failure, pulmonary disease, can be brougt on my infection, emotional stress, uncontrolled HTN, IV fluid admin, and excessive Na intake |
| CONT'D heart failure s/s | fluid retention and edema, due to increased cappilary pressures and a result from increased fluid volume, nocturia occurs becasue of fluid return from laying down, oliguria late s/s due to long standing |
| S/S of respiratory manifestations | SOB, DOE,orthopenia due to all the blood return back to heart when lying down and overlaoding the lungs, PND, sudden SOB at night, cardiac asthma, cardiac dry, non productive cough, worsening when lying as a result of bronchiospasms and wheezing |
| Cheyne-Stokes | characterized by deep breathing when CO2 is high, followed by shallow breathing when CO2 fails, puckerked lips |
| S/S of heart failure cont'd with fatigue and limited excercise tolerance | due to decreased cardiac output, progress is activity increased during day, decrease oxygenation can lead to confusion, behav changes, memory impairment adn anxiety in elderly |
| Cachexia and malnutrution | tissue wasting adn the congeestion makes them feel full sooner |
| S/S cyanosis | Late sign |
| 2 types of cyanosis | Central and peripheral |
| Central cyanosis | caused by impaired oxygenation of arterial blood, seen in lips, and mucous membranes |
| peripheral cyanosisq | caused by decarease delivery of oxygen adn blood to tissue |
| how do you diagnose Cyanosis in heart failure | History and physical, classification system (1-5 decreasing in severity) EKG, echo, lab tests, (electrolytes) CXR, heart cath, invasive hemodynamic monitoring: 1-4 most severe |
| BNP | brain neutremic peptide: tells us severity and how well tx is working |
| TX of HEart failure | Beta blockers, Lots of meds, relieve s/s to relieve quality of life, correct anemia, or thyrotoxcosis, surgically repair ventricular defects, meds to decrease afterload, exe a diuretic, improve cardiac function, limit Na and water |
| Cardiogenic Shock | severe failure of the heart pumping, causes MI's (most common), dysrthmia's, aneurysms, valvular defects, open heart surgery, CAD, cardio myopathy, big decrease in ejection fraction |
| CVP | central renal preload |
| S/S of cardiogenic shock | same as heart failure, cyanosis in lips nails and skin, increase CVC and PCWP |
| PCWP | pulomary capillary wedge pressure |
| Tx of cardiogenic shock | vasodilators, catecholimines, intra aortic baloon pump, ventricular assist devices, heart transplant |
| SHOCK | failure of circulatory system to supply the peripheral tissue and organs with an adequete blood supply |
| first type of schock | Hypovolemic |
| Hypovolemic | blood volume is not adequate to fill the vascular system |
| S/S of hypovolemic | HTN is a late sign, thirst, tachycardia, cool and clammy skin, decrease urine output, change in mental status, decrease CVP, diff starting IV |
| Tx of hypovolemic | trendelinburg's position, Feet up head down, Give O2, blood products, vaso active meds like dopamine |
| Obstructive shock | mechanical obstruction of blood flow in central circulation |
| Causes of obstructive shock | aneurysm, cardiac tamponade, pneumothorax (collapsed lung), atrial myxoma (evisceration of abdominal contents into thoracic cavity) |
| Distributive shock | loss of vessel tone, enlargment of vascular space, displacement of blood away from the heart, in the central circulation aka: normovolemic shock |
| Causes of distributive shock | Decrease in sympathetic vessel tone, control and vasodilators, decrease venous return and cardiac output |
| Types of distributive shock | Neurogenic and anaphylactic, and septic |
| neurogenic shock | head, brain or spinal cord injury, decreased sypathetic control |
| causes of neurogenic shock | brain injury, depressents, general anethesia, hypoxmia, lack of glucose, spinal shock, skin warm and dry, |
| anaphalactic shock | massive vasodialation, severe allergy response, pulling of blood in the perephiral, immune immediated |
| septic shock | associtated with severe infection like a blood infection, |
| complication of septic shock | DIC, acute respiratory distress, muli system organ failure, inflamatory response, very common |
| septic shock CONT'D | over release of interleukins may indicate bacterial toxins, can also play a role |
| S/S of septic shock | fever, vasodiolation, warm flushed skin, mild hyperventilation, personality of behavioral changes, hypovolemia |
| TX of septic shock | treat causitive agent, ABT, fluid replacement and vaso pressures |
| ARDS | acute respiratory distress syndrome |
| ARDS | life threatening repiratory failure, develops 24-48 hours after trauma |
| ARDS | unknown cause, neutophils are a key player causing fluid acculalation and aveoli collapse, |
| TX of ARDS | O2, mechanical ventilation with PEEP(positive end expiratory pressure), keeps the aveoli from collapsing |
| Acute renal failure with Shock | impaired renal fuction due to eschemia due to decrease cardiac OP, monitor urine output, creatinine and BUN levels |
| GI lesions | form as a result of ischemia, bleeding is common, ulcers, give pepcid, previcid(gives acid refulx)mucousal agents, NG tube with intermitent suction |
| complication of shock | DIC (mediated by the inflamatory mediators), |
| multiple organ dysfunction syndrome | life threatening- conditions of organ failure , |
| tX of multiple organ dysfunction syndrome | support failing organs |
| heart failures in infants and children | usually acute, chronic may be seen in chronic anemia, inflamatory heart disease and some end stage heart disease |
| S/S heart failure in children | usually do not see edema or ascities unless CVC is extremely high, repiratory disstress is the first sign |
| DX of heart failure in children | H&P, CXR, EKG, Echo, ABGs, lab for anemia and electrolytes imbalances, treatment is similar as adults |
| heart failure in elderly | extremely common, most common call of disability |
| S/s heart failure in elderly | usually masked by other dieases,noctoria is a early sign, increased larthargic and confusion, restlessness, anorexia and weight loss |
| DX of heart failure in elderly | S/S are hard to assess |
| TX of heart failure in elderly | restict activity but not bed rest, watch drug dosage because they are at high risk for toxcity |
| What do you treat Renin angiotensin with? | Ace inhibitors |
| Heart failure is overall what? | pump failure |
| Sympathetic nervous system increases what? | PVR and afterload, which leads to no perfusion to skin, abdominal organs, and kidneys |
| what is myocardial hypertrophy? | Enlargement of the cells not in number! puts extra work on heart and can't stretch and fill, heart gets thick |
Created by:
JoeNLind
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