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35 Cards in this Set
- Front
- Back
What is the clinical scenario for heart failure with "preserved ejection fraction?"
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Elderly patient
Long-standing hypertension (with obesity) and concentric left ventricular hypertrophy now with impaired compliance Bulking up for years and years against excess afterload until compliance finally gives way. |
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What is the pathway to systolic dysfunction heart failure with decreased ejection?
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Draw it!
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What is the spectrum of patients with heart failure?
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Draw it.
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True or false. Patients with large myocardial infarctions go straight to heart failure with systolic dysfunction and decreases ejection fraction.
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True! (they do not go through a phase of diastolic dysfunction, heart failure with preserved ejection fraction)
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What are the four classifications for acute heart failure hemodynamics?
What percentage of each die? |
Warm and dry (10%)
Warm and wet Cold and dry Cold and wet (40%) Warm = perfusion, cold = low perfusion Dry = no pulmonary edema, wet = pulmonary edema |
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What are the three general principles of heart failure?
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From the slide.
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What can septic, cardiogenic, and hypovolemic shock be classified as?
Common effects of each? |
Distributive shock
Vasodilation (capacitance too big for amount of blood available) |
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What is a cause of cardiogenic shock?
What is a cause of obstructive shock? |
1. Large pulmonary thromboembolus blocking pulmonary circulation
2. Hemopericardium causing cardiac tamponade |
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Label each.
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Distributive shock --> Hypovolemic shock --> Cardiogenic shock --> Obstructive shock
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What is the most common type of shock? Least common?
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Common = distributive
Least = Obstructive |
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What three things is the diagnosis of shock based on?
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Clinical, hemodynamic, and biochemical signs.
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What is the biochemical sign of shock?
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Elevated serum lactate from anaerobic metabolism required because the body is inadequately perfused
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What are the hemodynamic signs of shock?
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Hypotension (different for each patient)
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The clinical signs of shock are observed through which three windows of the body?
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Behavior, skin, urine
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What are behaviors that can be observed (clinical windown #1) in shock?
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Disorientation, confusion, obtundation (decreased level of alertness)
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What are the skin changes that can be observed in shock (clinical window #2)
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Mottled, cold, clammy, pale, or cyanotic
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What are unine changes that can be observed in shock (clinical window #3)?
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Decreased output
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We should probably know this slide.
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Draw it!
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Aortic regurgitation due to severe dilatation of aortic root.
Name and describe the microscopic pathology indicated by arrow. Can you name the disease that would cause this? |
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Why does she have mitral regurgitation? What is the reason?
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Ruptured papillary muscle
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Why does she have a ruptured papillary muscle? Here is the reason. Can you find it, describe and diagnose it?
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1. Posterior left ventricle
2. Area of mottled tan, red, light, and dark brown myocardium 3. Acute MI |
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A 90-year-old white male has a history of an old myocardial infarction. He presents with increasingly disabling dyspnea on exertion, waking up short of breath and needing three pillows to prop him up for sleep.
His temperature is 37, heart rate 110, blood pressure 110/70, respirations 20 and saturation 95%. He has a third heart sound, but no murmurs. He has pulmonary crackles one-third of the way up his back bilaterally. His abdomen is distended, but not tender. He has leg edema up to the knees. Why does he have leg edema? |
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