swanz-ganz catheter
balloon is lodged into pulmonary artery and measures the pulmonary capillary wedge pressure which is an indirect measurement of left ventricular end-diastolic pressure
what are the implications of a high wedge pressure?
too much volume in left ventricle, caused either by too much preload or not enough stroke volume
what are the implications of a P2 “knock”?
right ventricular volume or pressure overload
differences between “dry” and “wet”
dry: wedge pressure 18 and right atrial pressure >8 (high pressures, congestion at rest)
differences between “warm” and “cold”
warm: cardiac index >2.2
cold: cardiac index <2.2 (low perfusion at rest)
treatment regimen for cold and wet
vasodilators (or inotropes if very hypotensive) to “warm them up (increase perfusion)”, then diuretics to “dry them out (decrease congestion)”
treatment regimen for warm and wet
diuretics and vasodilators to “dry them out (decrease filling pressures)”
describe the 4 stages of shock
- initial: tissue hypoxia, lactic acidosis
- compensatory: cytokine release, hyperventilation, endogenous catecholamine release (norepinephrine and epinephrine)
- progressive: failing compensatory mechanisms, worsening metabolic acidosis, worsening organ dysfunction (MODS)
- refractory: irreversible organ damage, cell death, degradation of ATP to adenosine
systemic response to shock: progressive vaso______, _____ in cardiac output, _____ in respiratory rate
constriction, increase, increase
SIRS symptoms (4)
- tachypnea
- WBC: less than 4000 or greater than 12,000
- HR greater than 90 bpm
- temperature: fever or hypothermia
sepsis symptoms (4)
- altered mental staet
- hypoxemia
- elevated plasma lactate level
- oliguria (hypouresis)
difference between severe sepsis and sepsis
severe includes organ dysfunction or tissue hypoperfusion
septic shock definition
persistent arterial hypotension despite adequate fluid resuscitation
first 4 steps of sepsis campaign bundle
within 3 hours:
- measure lactate level
- obtain blood cultures
- administer broad spectrum antibiotics
- crystalloids for hypotension
difference between primary and secondary MODS
primary: direct result of insult
secondary: consequence of host response
which type of shock causes increased wedge pressure?
cardiogenic
which types of shock have low cardiac output?
cardiogenic and hypovolemic (hemorrhagic)
which types of shock have increased total peripheral resistance?
cardiogenic and hypovolemic (hemorrhagic)
what kind of cardiomyopathy is associated with a X-linked inheritance of a mutation in the dystrophin gene?
dilated cardiomyopathy
when does peripartum cardiomyopathy happen?
late in pregnancy or several weeks to months postpartum
risk factors for idiopathic dilated cardiomyopathy
male, Black, hypertension, 20-50 years
cardiomyopathy caused by beta-myosin heavy chain mutation (a sarcomeric protein)
hypertrophic cardiomyopathy
symptoms of obstructive hypertrophic cardiomyopathy
mitral regurgitation, exertional dyspnea, possible syncope (fainting)
first-line therapy for hypertrophic cardiomyopathy
beta-blockers
