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Clin Med: Final Material > Hemodynamics > Flashcards

Hemodynamics Flashcards

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
Q

Cirrhosis

A

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

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26
Q

Blood Vessel Obstruction

A

Tumor pushing on a vein or artery

Back up of blood

Leakage of fluid into the interstitium

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27
Q

Edema & High sodium levels

A

over time -> hypertension

Leads to high BP, atherosclerosis, cardiac dysfunction, CAD, PAD, stroke, MI

Leaches calcium from bone -> osteopenia -> osteoporosis

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28
Q

Edema: causes of decreased plasma osmotic pressure

A

Decreased production of albumin by the liver

Increased loss of protein by the kidney or gut

29
Q

Decreased production of albumin by the liver

A

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
Q

Increased loss of protein by the kidney or gut

A

Decrease in plasma protein pulling fluid into the vessels

31
Q

Edema: caused by Lymphatic obstruction and inflammation

A

Lymphoma = compression of thoracic duct or lymph vessels

Increased vascular permeability = response to inflammation

32
Q

Effects of edema on soft tissue:

A

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
Q

Effects of edema on lungs:

A

Fluid fills the alveoli

Pleural effusion

Creates distension of the lung tissue

Impairing the ability to oxygenate the RBC

34
Q

Effects of edema on brain:

A

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
Q

cytotoxic edema

A

cerebral edema

intracellular accumulation of fluid

extracellular water passes into cells, resulting in their swelling

36
Q

Vasogenic edema

A

defined as extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB) and extravasations of serum proteins

37
Q

Transudate

A

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
Q

Exudate

A

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
Q

Dependent Edema:

A

Occurs in the extremities and areas of the body where accumulation of fluid is dependent upon gravity

40
Q

Pitting Edema:

A

Skin and underlying soft tissue remain compressed with pressure

Commonly associated with heart failure

41
Q

Grading pitting edema

A

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
Q

Anasarca:

A

Generalized edema

Commonly associated with glomerular protein loss by the kidneys

Causes include:

*Nephrotic Syndrome

*Congestive Heart Failure

*Liver Disease

43
Q

Hyperemia =

A

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
Q

Congestion =

A

Passive accumulation of blood in the vessels

Lungs = Due to left-sided heart failure

Liver or extremities = Due to right-sided heart failure

45
Q

Clinical manifestation of hyperemia and congestion

A

Hyperemia = redness, warmth

Congestion = SOB, coughing, edema, fatigue, tachycardia

D/Dx DVT = swelling, redness, pain, warmth

46
Q

Types of Hemorrhage

A

Petechiae
Purpura
Ecchymosis

47
Q

Petechiae:

A

pinpoint hemorrhage

Platelet dysfunction

Increased vascular pressure

<3 mm

48
Q

Purpura:

A

larger than petechiae and usually raised

Vasculitis

Platelet Dysfunctions

Coagulation Disorders

3-10 mm

49
Q

Ecchymosis:

A

larger than purpura >1.0 cm

Trauma

Associated with bruising

50
Q

hemorrhage =

A

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
Q

Hemorrhage vs thrombosis:

A

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
Q

Factors predisposing to thrombus formation:

A

stasis of blood
hypercoagulability
endothelial damage

53
Q

Stasis of blood =

A

stoppage or slowing of blood flow

Congestive heart failure, obesity, immobilization

Venous stasis is predisposing factor for venous thrombi

54
Q

Hypercoagulability =

A

increased propensity to coagulate

Hereditary conditions: factor V gene mutation and prothrombin gene mutation

Acquired state: Myocardial infarction, trauma, cancer

55
Q

Endothelial Damage =

A

particularly artery vessel walls

56
Q

Thrombus Complications:

A

Occlusion of blood vessels -> Ischemia -> Necrosis -> Infarct

57
Q

Embolus =

A

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
Q

Emboli: Pulmonary thromboembolus

A

Source: Deep Venous Thrombosis

Risk Factors:
Immobility due to obesity, injury, surgery
Hereditary hypercoagulable states
Age
Pregnancy
Smoking
Oral contraceptives
Neoplasms

59
Q

Pulmonary thromboembolus
Complications:

A

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
Q

Pulmonary thromboembolus
Clinical presentation:

A

Sudden onset of chest pain

Dyspnea = shortness of breath

Tachypnea = increased respiratory rate >20 breaths/minute

Cough

Hypoxia = SpO2 <85%

61
Q

Necrotic tissue =

A

result of an infarct

62
Q

Mechanisms of infarct:

A

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
Q

Generalized hypoperfusion of the body =

A

not enough blood circulating to supply tissue and organs with oxygen required = Shock

64
Q

Cardiogenic shock =

A

failure of the heart to pump = failure to meet the body’s oxygen needs

Myocardial Infarction

65
Q

shock Clinical Manifestation:

A

Low blood pressure, cool skin, jugular vein distention (right heart condition)

66
Q

Hypovolemic shock =

A

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
Q

Septic Shock =

A

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
Q

shock stages:

A

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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