Hemodynamics and Shock

Question 1

Thombus vs thrombosis vs embolus

Answer 1

Thrombus: Wanted blood clot
Thrombosis: Unwanted clot
Embolus/thromboembolism: Moving clot/dislodged in veins or arteries

Question 2

Most common location of thrombosis

Answer 2

*Atherosclerotic bifurcation

Question 3

Thrombosis causes

Answer 3

*Endothelial damage
Blood flow irregularity
Hyper coagulability

Question 4

Result of thromosis

Answer 4

Ischemia or infarction

Question 5

Virchow’s Triad- three categories that can increase the risk of thrombosis

Answer 5

Stasis (blood flow irregularity)
Vessel wall injury to endothelium
Hypercoaguability

*maybe inflammation (chronic and acute)

Question 6

How does endothelial damage lead to thrombosis formation? Risk factors?

Answer 6

Endothelial breakdown/damage= exposed collagen where pro-clotting factors can bind= thrombosis formation

Risk factor: Atherosclerosis* (DM, HTN, hyperlipidemia)
Anything that damages endothelium

Question 7

How does circulatory stasis lead to thrombosis formation? Risk factors?

Answer 7

Slow, irreg, turbulent, or stationary blood flow causes local accumulation of pro-clotting factors= thrombosis

Risk: Immobility or paralysis*, arrhythmia, heart failure, aneurysm.

Question 8

How does hypercoagulability lead to thrombosis formation? Risk factors?

Answer 8

Predisposition towards clotting (congenital or acquired) alters blood chemistry and causes increased risk of thrombosis.

Congenital: Sickle cell
Acquired: Dehydration, pregnancy, malignancies, thombophilia, sepsis.

Risk factors: Any that promote thrombus formation. Smoking, age, obesity

Question 9

Arterial thrombosis 
Cause
Effect
Risk factors
Tx

Answer 9

Cause: *atherosclerosis, atrial fib, valvular disease
Effects: *MI, *Stroke, peripheral artery disease
Risk factors: *Smoking, *HTN, *high cholesterol, *Diabetes
Tx: Lifestyle changes, medications, surgery (angioplasty, graft)

Question 10

Venous thrombosis
Associations: 
Location: 
effects:
Treatment: 
Risk factors:

Answer 10

Associations: *Venous stasis, *hypercoagulability
Location: *deep vein. Big veins= slow flow
effects: Local pain and swelling or pulmonary edema
Treatment: Anticoagulants
Risk factors: *Immobilization, orthopedic surgery, oral contraceptives.

Question 11

Deep veins in legs

Answer 11

Saphenous, popliteal, femoral

Question 12

Deep vein thrombosis labs/tests

Answer 12

Elevated d dimer

ultrasound angiography

Question 13

3 possible outcomes to venous thrombosis

Answer 13

Resolution
Embolism to lungs
Organized and recanalized–> organized and incorporated into wall.

Question 14

Venous thrombosis can lead to-

Answer 14

Thromboembolism (dislodged thrombus) Can be fatal. Coronary or pulmonary embolism or stroke.

Question 15

Pulmonary embolism is associated with

Answer 15

Deep vein thrombosis

Question 16

Pulmonary embolism symptoms and tx

Answer 16

*Shortness of breath
Hemoptysis- coughing up blood
Sharp chest pain

Tx: Anticoagulation meds

Question 17

Hemoptysis

Answer 17

Coughing up blood. Happens in pulmonary embolism

Question 18

Venous thrombosis ocular manifestations

Answer 18

Papilledema: Venous sinus thrombosis. Bilateral swollen ON due to CSF not being able to drain.

BRVO, CRVO

Question 19

3 types of aneurysms

Answer 19

Saccular- berry (most common)
Fusiform- spindle like
Dissecting (Inner wall of blood vessel tears and forms false channel. = turbulent blood flow. Could also occur inside fusiform)

Question 20

Risk factor for aneurysm

Answer 20

*Tobacco use
Connective tissue disorders (marfans, ehlers danlos- lots of elastic tissue= weak arteries) 
Trauma 
HTN
M>F
Age
Atherosclerosis

Question 21

Aneurysm. What is it?

Answer 21

Localized thinning of arterial wall- high pressure vessels.

Question 22

Location of aneurysms

Answer 22

*cerebral arteries
*Brain stem
Aortic arch
Thoracic artery
Abdominal arteries

High pressure arteries. Not so much veins

Question 23

3 complications to aneuryssms

Answer 23

Rupture –> Hemorrhagic (bleeding) stroke
Dissection (tear/false valve in vessel) –> ischemic stroke
Thrombus –> secondary turbulent blood flow–> Clotting –> ishchemic stroke

Question 24

Tx of aneursysm

Answer 24

Stent
Clip- stops bleeding.
Coiling-fill out pouching so blood can’t enter. Promotes clotting that seals off.
Liquid embolic agents- fill out pouching with “glue” so blood can’t enter.
Blood thinner
HTN meds

Question 25

aneurysms are more likely to form where?

Answer 25

In high pressure vessels. Usually arteries over veins.

Question 26

Ocular manifestations of aneurysms

Answer 26

Aneurysmal 3rd nerve palsy. Could lead to hemorrhagic stroke and death. Life threatening. Posterior communicating artery has 20% of aneurysm that compresses CN III. VF changes

Question 27

3 required functioning organ systems for life

Answer 27

Cardiovascular Respiratory Renal

Question 28

Primary circulatory system component

Answer 28

Heart pump, fluid volume, closed circulatory system. Ideally no addition or removal.

Question 29

Shared feature of all shock

Answer 29

inadequate tissue perfusion (not enough O2 to necessary organs) Causes homeostasis to become compromised Result: Body wide shift to anaerobic metabolism. Fatal if untreated.

Question 30

Inadequate cell o2 --> anaerobic metabolism. What other two paths?

Answer 30

1. Inadequate energy production --> Metabolic failure of pumps --> Cell death 2. Lactic acid production --> Metabolic acidosis --> cell death.

Question 31

shock MOA (3)

Answer 31

1. Inadequate oxygen deliver* - respiratory failure - Anemia or hemorrhage - Fluid loss: vomit, diarrhea, dehydration - Cardiac pump failure 2. Impaired oxygen uptake due to biochem poisoning 3. Inadequate nutrient delivery - Malnutrition - GI absorption disorder - Lack of insulin (diabetes mellitus)

Question 32

Final common pathway of shock

Answer 32

Metabolic acidosis and cell death

Question 33

5 main types of shock | What do they all have in common

Answer 33

``` Hypovolemic shock * Cardiogenic shock Septic shock Hypotonic/anaphylactic Neurogenic ``` All involve reduced blood oxygen

Question 34

Hypovolemic shock *

Answer 34

Decreased blood volume due to trauma, child birth, dehydration.

Question 35

Cardiogenic shock

Answer 35

Ineffective cardiac pumping | MI, pulmonary embolus, cardiac tamponade

Question 36

Septic shock

Answer 36

Blood infection- systemic inflam response to secondary infection. Exo or endo toxin mediated ****Fever and peripheral thrombosis Ex: Candidia May lead to cariogenic or hypovolemic shock

Question 37

Hypotonic shock/ anaphylactic

Answer 37

Decreased peripheral vascular tone = Vasodilation = blood pools in peripheral tissues Due to type 1 hypersensitivity reaction

Question 38

Neurogenic shock

Answer 38

Brain and or spinal cord damage

Question 39

Two main signs of septic shock

Answer 39

Fever and peripheral thrombosis

Question 40

3 stages of shock

Answer 40

compensatory Progressive Refractory

Question 41

Stage 1 of shock: Compensatory. What happens? | Mechanisms to fix? Presents as what?

Answer 41

Normal BP Adequate tissue person No permanent damage Mechanisms to fix: vasoconstriction. Increase blood flow to major organs. Increase CO. Decrease urine. Presents as decreased skin perfusion, tachycardia.

Question 42

Stage 2 of shock: Progressive. What happens?

Answer 42

``` Body's mechanism starts to fail Failing BP, hypotension --> Tachycardia and tachypnea Acidosis reduced tissue perfusion Tissue damage ```

Question 43

Stage 3 of shock: Refractory period. What happens?

Answer 43

Very low BP Inadequate tissue perfusion Widespread organ failure Death occurs even with homeostasis restoration.

Question 44

Septic shock may lead to what other forms of shock?

Answer 44

May lead to cariogenic (loss of pumping power) or hypovolemic shock (Decreased blood vol and vasodilation)