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Clin Med: Final Material > Hemodynamics > Flashcards

Hemodynamics Flashcards

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1
Q

hemodynamics =

A

blood flows through the vessels which arises from difference f hydrostatic pressure in different parts of blood circulatory system

blood always moves from areas with high pressure to areas of low pressure

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2
Q

Hemodynamics is the study of

A

flow and distribution of blood and fluids within the body

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3
Q

intravascular and extravascular volumes are maintained by

A

hydrostatic pressure

osmotic pressure

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4
Q

illness and injury =

A

disruption of hemodynamic balance

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5
Q

arterial end

A

hydrostatic pressure = fluid pushed out

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6
Q

venous end

A

osmotic pressure = fluid pulled back in

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7
Q

Hydrostatic pressure =

A

within the vessels = pushing fluid out into the interstitial tissue

in the interstitial tissue = pushing fluid into the vessels

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8
Q

Osmotic pressure =

A

dissolved solutes pull fluid into the vessels or into the interstitial tissue

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9
Q

imbalances in pressures =

A

abnormal distribution of fluid in the cells or interstitial tissue

edema

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10
Q

integrity of blood vessel walls =

A

key role in maintaining normal distribution of fluid in the vessels and interstitial tissue

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11
Q

endothelial damage ->

A

accumulation of lipids, macrophages, and coagulation/fibrous material -> fatty streak -> plaque with fibrous cap -> inflammation

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12
Q

coagulation =

A

mechanism to maintain vascular integrity when there is disruption in the vascular walls = short term band-aid, long term issue

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13
Q

consistent adequate blood supply to tissue is crucial =

A

provides oxygen and nutrients to cells and removes toxins

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14
Q

Ischemia =

A

Inadequate blood flow to tissue

Leads to cell dysfunction and cell death

Localized ischemia due to occlusion of blood vessels

Systemic ischemia causes hypoperfusion of the body

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15
Q

Necrosis =

A

tissue death

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16
Q

Infarct =

A

areas of necrotic tissue due to ischemia

localized area of necrotic cells within an organ due to inadequate blood supply

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17
Q

Generalized Hypoperfusion = Shock

A

Generalized hypoperfusion resulting in organ damage

causes: hypovolemic due to blood loss

decreased cardiac output = life threatening condition

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18
Q

conditions that lead to hypoperfusion:

A

sepsis

cardiogenic shock

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19
Q

Abnormal fluid distribution:

A

edema

accumulation of fluid

intracellular

extracellular = interstitial tissue, body cavities (effusion)

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20
Q

Mechanisms of edema

A

Increased vascular hydrostatic pressure = typically due to decreased venous return due to atherosclerosis, heart failure, liver cirrhosis, blood vessel obstruction, high sodium levels

Decreased plasma osmotic pressure = decreased pull of fluid back into the venous side of circulation = albumin and sodium

Lymphatic obstruction

Inflammation = endothelial retraction and contraction

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21
Q

Edema: CAUSES OF increased ___ pressure

A

hydrostatic

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22
Q

Heart Failure Cascade:

A

High BP -> increased cardiac work -> compensates with tachycardia

-> Left Ventricle Hypertrophy -> decreased LV volume -> decrease cardiac out -> decreased efficiency of the heart -> Systemic back up of blood

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23
Q

Edema and heart failure:

A

decreased ability of the heart to pump blood effectively

back up of blood into the circulatory system

increased vascular hydrostatic pressure

pushes fluid to the interstitial tissue

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24
Q

circulation of blood through the heart:

A

superior and inferior vena cava
right atrium
tricuspid valce
right ventricle
pulmonary valve
pulmonary artery
lungs
left atrium
left ventricle
aorta
rest of the body

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25
Cirrhosis
Fibrous scarring of the liver that impairs return of blood through the portal vein Portal hypertension causes blood to redirect to smaller arteries and surrounding organs Leak into the peritoneal cavity = ascites
26
Blood Vessel Obstruction
Tumor pushing on a vein or artery Back up of blood Leakage of fluid into the interstitium
27
Edema & High sodium levels
over time -> hypertension Leads to high BP, atherosclerosis, cardiac dysfunction, CAD, PAD, stroke, MI Leaches calcium from bone -> osteopenia -> osteoporosis
28
Edema: causes of decreased plasma osmotic pressure
Decreased production of albumin by the liver Increased loss of protein by the kidney or gut
29
Decreased production of albumin by the liver
Albumin is produced by the liver - aids in balancing fluid in blood vessels and interstitium Due to cirrhosis and other liver damage Hypoalbuminemic Decrease vessel albumin level = decreased vessel osmotic pressure = decreased pull of fluid back into vessels = increase interstitial edema
30
Increased loss of protein by the kidney or gut
Decrease in plasma protein pulling fluid into the vessels
31
Edema: caused by Lymphatic obstruction and inflammation
Lymphoma = compression of thoracic duct or lymph vessels Increased vascular permeability = response to inflammation
32
Effects of edema on soft tissue:
Chronic edema = fibrotic skin changes Over time the skin can permanently change Tx: address the primary pathology, compression and elevation Complications = infection, ulcers, cellulitis
33
Effects of edema on lungs:
Fluid fills the alveoli Pleural effusion Creates distension of the lung tissue Impairing the ability to oxygenate the RBC
34
Effects of edema on brain:
causes the brain to swell within a rigid intracranial compartment danger of brain herniation inflammation is one of the first and most formidable responses - always causes swelling no room for swelling in the CNS
35
cytotoxic edema
cerebral edema intracellular accumulation of fluid extracellular water passes into cells, resulting in their swelling
36
Vasogenic edema
defined as extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB) and extravasations of serum proteins
37
Transudate
Clear Extracellular fluid as a result of hydrostatic osmotic pressure imbalance Protein-poor and cell-poor fluid, high fluid content Cardiac failure causes transudate = results in systemic edema Liver failure causes transudate
38
Exudate
Yellow Extracellular fluid as a result of inflammation = increased vessel permeability Protein rich and cell-rich fluid Seeps out of blood vessels as a result of inflammation and injury
39
Dependent Edema:
Occurs in the extremities and areas of the body where accumulation of fluid is dependent upon gravity
40
Pitting Edema:
Skin and underlying soft tissue remain compressed with pressure Commonly associated with heart failure
41
Grading pitting edema
0+ no pitting edema 1+ mild pitting edema, 2mm depression that disappears rapidly 2+ moderate pitting edema, 4mm depression that disappears in 10-15 seconds 3+ moderately severe pitting edema, 6mm depression that may last more than 1 minute 4+ severe pitting edema, 8mm depression that can last more than 2 minutes
42
Anasarca:
Generalized edema Commonly associated with glomerular protein loss by the kidneys Causes include: *Nephrotic Syndrome *Congestive Heart Failure *Liver Disease
43
Hyperemia =
Active accumulation of blood in the vessels supplying an organ or tissue Engorgement due to vasodilation resulting from: > Acute Inflammation – vasoconstriction, vasodilation, vascular permeability, transmigration > Exercise
44
Congestion =
Passive accumulation of blood in the vessels Lungs = Due to left-sided heart failure Liver or extremities = Due to right-sided heart failure
45
Clinical manifestation of hyperemia and congestion
Hyperemia = redness, warmth Congestion = SOB, coughing, edema, fatigue, tachycardia D/Dx DVT = swelling, redness, pain, warmth
46
Types of Hemorrhage
Petechiae Purpura Ecchymosis
47
Petechiae:
pinpoint hemorrhage Platelet dysfunction Increased vascular pressure <3 mm
48
Purpura:
larger than petechiae and usually raised Vasculitis Platelet Dysfunctions Coagulation Disorders 3-10 mm
49
Ecchymosis:
larger than purpura >1.0 cm Trauma Associated with bruising
50
hemorrhage =
250 mL blood loss due to a cut 5 mL blood loss in the brain stem Amount and location are important when discussing the severity Foot vs brainstem Loss of >40% of blood volume can be fatal
51
Hemorrhage vs thrombosis:
Hemorrhage: Leakage of blood from a vessel Hematoma: Space-occupying a hemorrhage Thrombosis (blood clot): Pathologic coagulation of blood - Resulting in the formation of a solid mass within a chamber or blood vessel Embolism: traveling thrombosis
52
Factors predisposing to thrombus formation:
stasis of blood hypercoagulability endothelial damage
53
Stasis of blood =
stoppage or slowing of blood flow Congestive heart failure, obesity, immobilization Venous stasis is predisposing factor for venous thrombi
54
Hypercoagulability =
increased propensity to coagulate Hereditary conditions: factor V gene mutation and prothrombin gene mutation Acquired state: Myocardial infarction, trauma, cancer
55
Endothelial Damage =
particularly artery vessel walls
56
Thrombus Complications:
Occlusion of blood vessels -> Ischemia -> Necrosis -> Infarct
57
Embolus =
A blood clot, air bubble, fatty deposit that forms within or enters the vascular system Carried through the blood stream to another area of the body Lodges in a blood vessel = thrombus Typically produces an infarct = localized area of necrosis due to ischemia
58
Emboli: Pulmonary thromboembolus
Source: Deep Venous Thrombosis Risk Factors: Immobility due to obesity, injury, surgery Hereditary hypercoagulable states Age Pregnancy Smoking Oral contraceptives Neoplasms
59
Pulmonary thromboembolus Complications:
Sudden death >60% obstruction, most often in bifurcation of pulmonary trunk Pulmonary Infarct = occlusion of the blood vessels with resultant lung parenchyma ischemia and tissue injury Pulmonary hypertension = obstruction of the pulmonary arterial circulation or left heart disease, increased work of the right ventricle
60
Pulmonary thromboembolus Clinical presentation:
Sudden onset of chest pain Dyspnea = shortness of breath Tachypnea = increased respiratory rate >20 breaths/minute Cough Hypoxia = SpO2 <85%
61
Necrotic tissue =
result of an infarct
62
Mechanisms of infarct:
Hypoxia: low oxygen to an organ Hypoxemia: low blood oxygen levels Ischemia: lack of blood flow to an organ = no oxygen or nutrients to tissue or toxic metabolites away from tissue Causes: Obstruction of vessel: atherosclerosis, thrombi, emboli, damage to vasculature, external compression
63
Generalized hypoperfusion of the body =
not enough blood circulating to supply tissue and organs with oxygen required = Shock
64
Cardiogenic shock =
failure of the heart to pump = failure to meet the body’s oxygen needs Myocardial Infarction
65
shock Clinical Manifestation:
Low blood pressure, cool skin, jugular vein distention (right heart condition)
66
Hypovolemic shock =
most commonly due to trauma < 20% blood loss – cool clammy skin with increased HR 20-40% blood loss – increase RR, orthostatic hypotension 40% blood loss – hypotension, oliguria, obtundation
67
Septic Shock =
vascular dilation caused by an infection, blood pools in the venous system and peripheral vasculature = decreased blood flow to the heart Clinical Manifestation: Increased RR, increased HR, low BP, fever, chills, oliguria, warm sin, confusion
68
shock stages:
Compensated: hypoperfused organs are able to maintain homeostasis without injury Progressive: Organs can no longer maintain homeostasis = organ damage begins Irreversible: Organ damage has occurred = even if source of shock is corrected the organs cannot repair themselves

Clin Med: Final Material (6 decks)

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