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CVS 12 (Shock) Flashcards

1
Q

List some symptoms of Peripheral Artery Disease:

A
  • Intermittent claudication
  • Cold extremities
  • Weak pulse in legs/feet
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2
Q

Which arteries are usually affected in Peripheral Artery Disease?

A
  • Femoral

- Iliac

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3
Q

Define varicose veins:

A

Dilated torturous superficial veins

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4
Q

Where is the most common location of venous ulcers, due to varicose veins?

A

Over the medial malleolus (great saphenous vein)

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5
Q

Define shock:

A

Acute circulatory failure with either inadequate or inappropriately distributed tissue perfusion, resulting in generalised lack of oxygen supply to cells.
= Decreased MaBP due to decreased CO or TPR

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6
Q

Name the 4 types of shock:

A

1) Distributive/Normovolaemic shock
2) Hypovolaemic shock
3) Cardiogenic shock
4) Mechanical shock

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7
Q

Which types of shock are caused by a decreased cardiac output?

A
  • Hypovolaemic
  • Cardiogenic
  • Mechanocal
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8
Q

Which type of shock are caused by a decreased total peripheral resistance?

A

Distributive

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9
Q

Define cardiogenic shock:

A

Inability of heart to eject enough blood = decreased cardiac output

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10
Q

Name some possible causes of cardiogenic shock:

A
  • Myocardial infarction
  • Arrhythmias
  • Acute heart failure
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11
Q

What are the 2 types of mechanical shock, and name a common cause of each:

A

1) Due to restricted filling of heart
- Cardiac tamponade (infection/trauma/cancer/MI)

2) Due to obstruction to blood flow through lungs
- Pulmonary embolism (from DVT or surgery)

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12
Q

Define hypovolaemic shock:

A

Decreased MaBP due to loss of circulating volume

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13
Q

Name some possible causes of hypovolaemic shock:

A
  • Haemorrhage due to trauma
  • Severe burns
  • Severe diarrhoea/vomiting (massive loss of Na+)
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14
Q

What percentage of blood must be lost for body to go into severe shock?

A

~ 30-40% of normal blood volume lost

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15
Q

What type of receptors detect shock?

A

High pressure baroreceptors (in arteries)

Low pressure baroreceptors (in veins and heart)

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16
Q

How do the high pressure baroreceptors respond when shock is detected?

A

Cause increase in SNS activity =

  • Tachycardia
  • Increased force of contraction (heart)
  • Peripheral vasoconstriction
  • Venoconstriction
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17
Q

How do the low pressure baroreceptors respond when shock is detected?

A

Renal reflex (RAAS) activated:

  • Increased Angiotensin II = vasoconstriction
  • Increased aldosterone = increased H2O reabsorption
  • Increased ADH = increased H2O reabsorption
18
Q

Define ‘transcapillary refill’:

A

Movement of interstitial fluid into the vasculature (autoinfusion)

19
Q

What factor limits transcapillary refill during shock?

A

Haemodilution:

Movement of fluid from interstitium into the capillaries reduces the capillary oncotic pressure

20
Q

Decreased cerebral perfusion occurs at what MaBP?

21
Q

What is the compensatory response during shock, when decreased cerebral perfusion is detected?

A

Massive increase in SNS innervation

22
Q

What are the classic symptoms of shock due to decreased CO?

A
  • Tachycardia
  • Weak pulse
  • Pale skin
  • Cold and clammy extremities
23
Q

Name the 2 types of distributive/normovolaemic shock:

A

1) Toxic/Septic

2) Anaphylactic

24
Q

List some risk factors for toxic/septic shock:

A
  • Diabetes
  • Immunocompromised
  • Catheter
  • Leukaemia/lymphoma
  • Long-term antibiotic use
  • Recent infection
  • Recent surgery
  • Recent steroid use
  • Transplant
25
How does toxic/septic shock cause decrease in MaBP?
Endotoxins cause: 1) Vasodilation = decreased TPR 2) Increased vascular permeability = blood volume
26
What are the classic symptoms of toxic/septic shock?
- Tachycardia | - Warm and red extremities
27
What are the symptoms of a pulmonary embolism?
- Shortness of breath - Sharp, stabbing chest pain - Peripheral oedema - Cough - Cyanosis
28
List some common causes of anaphylactic shock:
- Medication ie Penicillin - Food ie Nuts/peanuts/wheat/shellfish - Insect stings - Latex
29
What immune cell is responsible for an allergic reaction? What is the main mediator it releases?
Mast cell | Histamine
30
Which mediators released in anaphylactic shock cause bronchoconstriction and laryngeal oedema?
- PGD2 | - Leukotrienes
31
What are the classic symptoms of anaphylactic shock?
- Tachycardia - Difficulty breathing - Red, warm extremities - Lightheaded/collapse/unconscious - Itchy skin/rash
32
What is the treatment for anaphylactic shock?
Adrenaline shock ie EpiPen
33
Define hypertension:
Sustained arterial BP > 140/90 mmHg
34
What are some non-pharmacological treatments for hypertension?
- Increase exercise levels - Weight loss - Decreased salt intake
35
Name some commonly used drugs used to treat hypertension:
- Diuretics (Usually Thiazide, if due to Conn's syndrome use Aldosterone antagonists) - ACE inhibitors - DHP Ca2+ channel blockers - Alpha-1 antagonists - ARBs (Angiotensin II Receptor Blockers)
36
What is the most common type of hypertension, and what is the cause?
Primary/essential hypertension | Unknown cause, associated with increased TPR
37
How can renovascular disease cause secondary hypertension?
Can causes renal artery stenosis: - Decreased perfusion pressure activates RAAS - Vasoconstriction and Na+ retention at other kidney
38
How can renal parenchymal disease cause secondary hypertension?
Damage to renal parechyma may reduce amount of vasodilators released: - Decrease GFR = Na+ and H2O retention
39
What is Conn's syndrome?
Hypertension and hypokalaemia due to an Aldosterone-secreting adenoma
40
How can Cushing's syndrome cause secondary hypertension?
Excess cortisol acts on aldosterone receptors in late DCT and CD = H2O retention
41
How can a Phaeochromocytoma cause secondary hypertension?
Tumour secretes catecholamines, which bind to alpha-1 adrenoceptors on vasculature = vasoconstriction
42
What is the body's major compensatory mechanism to shock?
Reabsorption of tissue fluids into plasma (transcapillary refill)

ESA2 (27 decks)

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