Pathophysiology Exam 3 Flashcards
(101 cards)
1
Q
BP =
A
CO x SVR
2
Q
MAP
A
mean arterial pressure
3
Q
MAP =
A
DBP + 1/3 (SBP-DBP)
4
Q
Pulse pressure
A
SBP-DBP
5
Q
Minimum MAP
A
60 mmHg
6
Q
Vasodilation
A
decrease SVR
7
Q
Vasoconstriction
A
increase SVR
8
Q
CO =
A
SV x HR
9
Q
What influences SV?
A
BV & contractility
10
Q
low BP
A
hypotension
11
Q
Hypotension parameters
A
BP < 90/60 mm
12
Q
Only treat hypotension if it is what?
A
symptomatic
13
Q
In Cardiogenic hypotension what is impacted?
A
Cardiac output (CO)
14
Q
How is cardiogenic hypotension treated?
A
increase CO
- Epi/dobutamine
15
Q
Epi/dobutamine are what?
A
(+) inotropes
16
Q
(+) inotropes do what?
A
increase contractility
17
Q
drug that raises blood pressure
- many are vasoconstrictors
A
pressor agent
18
Q
Hypotension caused by Sepsis
A
vasodilation (decreases SVR)
19
Q
How is sepsis hypotension treated?
A
Increase SVR
- NE/Vasopressin (ADH)/Epi/Phenylephrine
20
Q
NE/Vasopressing (ADH)/Epi/Phenylephrine are all what?
A
vasoconstrictors (pressor agents)
21
Q
Hypovolemia
A
decrease BV
22
Q
How to treat hypotension caused by hypovalemia
A
increase IV fluids -> increase BV -> increase SV -> increase CO
23
Q
high BP
A
hypertension (HTN)
24
Q
Stage 1 hypertension
A
- systolic 130-139
OR - diastolic 80-89
25
Stage 2 hypertension
- systolic >/= 140
OR
- diastolic >/= 90
26
Resistance heart pumping against
afterload
27
hypertension caused by what?
increased heart workload
28
effect of heart having to pump against increase resistance (effect of HTN)
ventricular hypertrophy.
29
ventricular hypertrophy
ventricular layer thickens
- ventricle holds less blood & pumps less blood
30
How to treat hypertension
decrease CO, decrease SVR or both
31
how to decrease CO
decrease SV by either decreasing BV or contractility
32
how to decrease SVR
vasodilation
33
Drugs that decrease CO
- diuretics (thiazide - HCTZ)
- Beta blockers
- ACE inhibitors/ARBs/Renin inhibitors
- Calcium channel blockers (CCBs)
34
Drugs that decrease SVR (vasodilators)
- ACE inhibitors/ ARBs/ Renin inhibitors
- CAlcium channel blockers
35
Drugs that are (-) inotropes and (-) chronotropes
Beta blockers & Calcium channel blockers. (CCBs)
36
Vasodilations decreases SVR and what?
LV afterload
37
atherosclerotic plaque
Coronary artery disease
38
chest pain caused by myocardial ischemia
Angina pectoris
39
angina with exertion; relieved with rest
- increase demand (exertion)
- decrease demand (at rest)
Stable Angina
40
Angina at rest
- decrease supply
Unstable Angina
41
CAD -> Myocardial ischemia -> ?
Myocardial Infarction (MI) = heart attack
42
- Unstable angina
- MI
Acute Coronary Syndrome (ACS)
43
MI's can be _ or _
STEMI or non- STEMI
44
Immediate compensatory response for MI
increase SNS activity (bororeceptor reflex)
- heart: increase HR & CTX -> increase CO
- Blood Vessels: Vasoconstriction -> increase SVR
45
Slower compensatory response for MI
increase fluid retention -> increase BP
46
Cardiac enzymes (MI markers)
Troponins ( not detected till 3 hrs after MI)
47
CO inadequate to meet metabolic demand
Congestive heart failure (CHF)
48
Compensatory responses:
- increased preload caused by fluid retention
- increased afterload caused by increase SNS activity
Overall, increases myocardial workload
Congestive heart failure
49
"stretch" on ventricle wall
preload
50
"Resistance" ventricle must pump against
afterload
51
A failing heart _ than a non failing heart
works harder
52
decrease CO below normal
low output failure
53
loss of contractility
systolic
54
filling problem - small, "stiff" ventricle
Diastolic
55
- increase myocardial workload
- increase preload
- increase afterload
- dilated heart
systolic CHF
56
Systolic CHF treatment
- increase contraction with (+) inotropes
- decrease workload with beta blockers
- decrease preload with diuretics (decrease BV)
- decrease afterload with vasodilators (ARBs, Renin inhibitors, ACE inhibitors)
57
Dilated heart =
cardiomegaly
58
decrease SNS effect
- (-) inotropes
- (-) chronotropes
- used to decrease workload
beta blockers
59
- often caused by poorly controlled HTN
- increase afterload
Diastolic CHF
60
Diastolic CHF treatment
- increase ventricle filling time by decreases HR with CCBs
- decrease workload with CCBs
61
Heart failure with reduced ejection fraction (HFrEF)
Systolic failure
62
Heart failure with preserved ejection fraction (HFpEF)
Diastolic factor
63
Ejection factor (EF) =
SV (stroke volume) /EDV (end diastolic volume)
64
normal EF
50-60%
65
normal SV
70 mL
66
normal EDV
120 mL
67
Ejection fraction is not the same as what?
CO
68
LV failure ->
pulmonary edema -> increased pulmonary hydrostatic pressure -> fluid retention -> increased BV
69
low RBC count or low Hgb or low hematocrit
Anemia
70
% of blood that is RBC
hematocrit
71
What do you rule out first with Anemia?
blood loss
72
What do you rule out next with Anemia?
- decreased RBC production (bone marrow)
- increased RBC destruction (sickle cell anemia, hemolytic anemia)
73
What is the typical presentation of Anemia?
- fatigue (less O2 transport)
- pallor
74
more pale than normal
Pallor
75
Whats the anemia test?
H/H test = hemoglobin/hematocrit
76
Normal RBC size
80-100 fL
77
RBC may indicate what?
cause of anemia
78
micrositic anemia
<80 fL
- iron deficiency / Hgb deficiency
79
macrositic anemia
>100 fL
- B12 deficiency
80
high WBCs (>10,000)
leukocytosis
81
Normal WBC count
5k-10k / uL
82
Potential causes of a WBC count of 15k
- infection present (rule out 1st)
- inflammation
83
Potential cause of a WBC count of 100k
Leukemia
- WBC are not function -> increased infection risk
84
low WBCs
Leukocytopenia or Leukopenia
85
WBC count of 1k has an increased what?
infection risk
86
low platelet count
thrombocytopenia
87
Normal platelet count
150k - 400k
88
Platelet count of 30k
increased bleeding risk
89
Platelet count of 15k
severe - may bleed spontaneously
90
Thrombosis
Deep vein thrombosis (DVT)
91
clot that has detached from the wall; now in circulation
thromboembolus
92
DVT -> thromboembolus ->
pulmonary embolus -> circulatory collapse
93
Virchow's triad
3 risk factors for DVT
94
What are Virchow's triad?
1) Hypercoaguability - blood clots easier
- pregnancy/OC (birth control)/cancer
2) Venous stasis - slow venous blood flow
- immobility/A-fib
3) Vessel wall damage (endothelial injury)
- smoking/ HTN
95
- life threatening
- cellular/tissue hypoxia
- If caught early, reversible
- If allowed to rapidly progress, irreversible
- most common presentation = hypotension
Circulatory shock
96
4 types of circulatory shock
1. Distributive
2. Cardiogenic
3. Hypovolemia
4. Obstructive
97
severe peripheral vasodilation
- septic, anaphylactic, neurogenic, toxic shock
Distributive circulatory shock
98
intracardiac cause of pump failure
- MI, CHF
cardiogenic circulatory shock
99
Low BV
- hemorrhagic vs non-hemorrhagic
Hypovalemia circulatory shock
100
extracardiac cause of pump failure
- PE
Obstructive circulatory shock
101
circulatory shock can lead to what?
Multiple Organ failure (MOF)
