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Circulatory Shock + Heart Disease
Wacker 3/17/11 lecture - 2hrs
54
Physiology
Undergraduate 4
03/07/2011

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Term
arteriosclerosis
Definition
hardening of the arteries (loss of elasticity)
Term
1)aging
2)damage (diffuse distribution along vessels)
3)collagen replaces elastic fibers
4) increase in systolic pressure
Definition
what are the causes of arteriosclerosis?
Term
atherosclerosis
Definition
development of plaques
Term
cholesterol buildup
calcified plaques
high glucose(diabetes) damaging arteries
LDL (fatty materials)
high pressure damaging arteries
inflammatory response
Definition
what are the causes of atherosclerosis?
Term
alter flow, rupture and cause clots, ischemia, infarction
Definition
what can plaques do?
Term
lipoproteins (LDL, HDL)
Definition
transport lipids in plasma, composed of various amounts of cholesterol, triglycerides, phospholipids, and proteins
Term
inflammation
Definition
causes fibrosis, calcification, clot formation
Term
high sat fat diet (high LDL/cholesterol)
lack of excercise
obesity
diabetes
HTN
Definition
risk factors for atherosclerosis
Term
HDL
oat bran (sucks up cholesterol to be excreted)
statins (decreased cholesterol by increasing LDL receptors)
Definition
inhibits atherosclerosis
Term
systole
Definition
when is a murmur heard for aortic valve stenosis?
Term
diastole
Definition
when is a murmur heard for aortic regurgitation?
Term
diastole
Definition
when is a murmur heard for mitral valve stenosis?
Term
systole
Definition
when is a murmur heard for mitral regurgitation?
Term
aortic valve stenosis
Definition
narrowing of the aortic valve, slow to open, LV hypertrophy
Term
aortic regurgitation
Definition
blood flow back into the LV, LV chamber enlargment, LV hypertrophy
Term
mitral valve stenosis
Definition
obstruction of blood moving from LA to LV, LA expands, pulmonary edema
Term
mitral regurgitation
Definition
blood flows back into the LA from the LV, LA expands
Term
arteriosclerosis: increase in P(cannot distend to compensate with volume)
aortic stenosis: cannot get blood out of the valve, so less blood out to aorta, less pressure
aortic regurgitation: pressure increases normally, but drops down low because blood squirts back in (backflow)
Definition
what happens to aortic pressure in arteriosclerosis? aortic stenosis? aortic regurgitation?
Term
atherosclerosis (plaques) -> thrombus
coronary vasospasms
Definition
list the causes of coronary ischemia
Term
collateral circulation of the coronary arteries
Definition
what helps prevent damage in MILD ischemic attacks (according to wacker but not rinaldi)
Term
1)heart failure
2)hypertrophy
3)cardiac shock
4)ventricular fibrillation
Definition
list the problems associated with myocardial ischemia/infarction
Term
heart failure
Definition
heart is not pumping so blood backs up into atria and veins
Term
hypertrophy
Definition
areas around infarction do this which is pathological over time
Term
cardiac shock
Definition
if bad enough damage, heart cannot pump enough blood to the rest of the body
Term
ventricular fibrillation
Definition
areas of the heart become hyperexcited, increased extracellular K+, ishcemic area is negatively charged and doesnt repolarize, sympathetic response, dilation of injured muscle-circus movements of depolarization
Term
hypertrophy
Definition
increase in size of heart muscle (HW to BW ratio)
Term
physioligcal is good like lance armstrong
pathological is bad because the muscle is big and weak
Definition
what is the difference between physiological hypertrophy and pathological hypertrophy?
Term
1) decreased calcium sensitivity and release
2) decreased ejection fraction (cardiac output)
3) shift in myosin isoform type
4) shift to a fetal gene program
5) use more glucose than fatty acids for metabolism
Definition
what are the changes associated with heart muscle that has undergone pathological hypertrophy
Term
infarction, pathological hypertrophy
Definition
typical causes of acute, moderate, heart failure
Term
1)sympathetics strongly stimulated to increase cardiac output
2)fluid retention in the kidneys
Definition
compensated (acute) heart failure involves what 2 things?
Term
digoxin to increase calcium, and contraction strength hopefully

(sympathomimetics may not help much because they are already active to increase CO)
Definition
what do you treat compesated heart failure with?
Term
blood backs up in the circulation
excess fluid retention (overstretch heart, pulmonary edema, systemic edema)
Definition
what happens in chronic or severe (Decompensated) heart failure?
Term
diuretics to get rid of fluid to help the heart pump
Definition
what can you give a person with decompensated heart failure?
Term
1)low contractility
2)reduced calcium transients during systole
3) decreased SERCA action (less Ca in SR)
4) increased Na/Ca exchanger (depolarizes cell easier, more Na+ in, but also more Ca++ out-bad) increased arrhythmias
5) decreased K+ channels (longer action potentials, cannot relax)
Definition
what happens to cardiac myocytes in heart failure?
Term
circulatory shock
Definition
generalized severe circulatory failure
-characterized by inadequate blood flow throughout the body, cant supply tissues with nutrients, O2, or remove waste
Term
hyopvolemic
cardiogenic
septic shock
neurogenic
anaphylactic
Definition
list the types of shock
Term
hypovolemic shock
Definition
type of shock characterized by: decreased circulatory blood volume
Term
cardiogenic shock
Definition
type of shock characterized by: failure to maintain cardiac output
Term
septic shock
Definition
type of shock characterized by: bacterial toxins
Term
neurogenic shock
Definition
type of shock characterized by: loss of vasomotor tone
Term
anaphylactic shock
Definition
type of shock characterized by: massive immune reactions
Term
it has a positive feedback loop which progressively decreases cardiac output
Definition
why is shock so bad if not treated immediately?
Term
hypovolemic shock
Definition
type of shock characterized by: low blood volume, decreased venous return, and decreased cardiac output
Term
1)increased sympathetic
2)baroceptor firing slows ->increase HR and increases SV
3)chemoreceptor reflex (if altered metabolism) -> increased HR, increased SV
4)increased sympathetics-especially in veins to maintain venous return and CO
5) increase in circulating hormones
Definition
what are the compensatory mechanisms for hypovolemic shock
Term
last ditch effort of the ishemic brain to increase CO
Definition
whats the bump at the end of the blood loss vs. cardiac output curve?
Term
cardiogenic shock
Definition
reduction in CO caused by inability of the heart to pump blood
-heart becomes weaker, or unable to properly beat
-CO falls, blood backs up in the system, pulmonary edema occurs
Term
septic shock
Definition
caused by spread of bacterial infection to many areas of the body (ruptures in the CO, strep/staph infection, gangrene)

causes vasodilation throughout the body, micro blood clots, and deterioration of capillaries due to release of cytokynes and immune factors (so capillaries leak blood and fluid)
Term
anaphylactic shock
Definition
CO and MABP drop drastically
antigen antibody reaction
release of histamines (inflammation)
vasodilation of arterioles and venules
increased capillary permeability
Term
drop it, vasodilation
Definition
what do all forms of shock do to blood pressure?
Term
neurogenic shock
Definition
loss of vasomotor tone-> massive dilation
lose pressure, reduce venous return to the heart
Term
deep general anesthesia (depress vasomotor center)
spinal anesthesia (block symp outflow)
brain damage (concussion/contusion in basal area of brain)
Definition
list the causes of neurogenic shock
Term
blood, plasma, or electrolyte transfusion (increase volume and pressure)
Dextran
Epi
Head below feet (temporary raise venouse return)
O2
glucocorticoids
Definition
list the treatments of shock
Term
helps replace plasma proteins to maintain/increase plasma colloid oncotic pressure
Definition
how does dextran work?
Term
prevent inflammatory response in septic shock
Definition
how do glucocorticoids treat shock?
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