Patho Chapter 34

valvular insufficiency

systolic dysfunction

orthopnea

Shortness of breath when supine

cardiogenic shock

Caused by alteration in cardiac function

distributive shock

Caused by excessive vasodilation with maldistribution of blood flow

obstructive shock

Caused by obstruction of blood flow through the circulatory system

_____ can be described as an acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply, resulting in cellular hypoxia.

Circulatory Shock

pulmonary congestion

Common sign of left ventricular failure

Inotropy

Contractile performance of the heart

____ is the percentage of blood pumped out of the ventricles with each contraction.

Ejection fraction

Systolic dysfunction

Ejection fraction less than 40%

A major effect of right-sided heart failure is the development of ______.

peripheral edema

Ascites is a common manifestation associated with _____ ventricular failure and long-standing elevation of systemic venous pressures.

right

Heart failure can be classified according to the _____ of the heart that is primarily affected.

side

The _____ is a function of preload, afterload, and myocardial contractility.

stroke volume

The heart rate is regulated by a balance between the activity of the _____ nervous system, which produces an increase in heart rate, and the ____ nervous system, which slows it down.

sympathetic, parasympathetic

Diastolic dysfunction can be aggravated by _____ and can be improved by a reduction in heart rate.

tachycardia

In persons with ventricular dysfunction, sudden death is caused most commonly by ____ tachycardia or fibrillation.

ventricular

Cardiac asthma

Bronchospasm due to congestion of the bronchial mucosa

_____ is an uncommon type of heart failure that is caused by an excessive need for cardiac output.

High-output failure

____ dyspnea is a sudden attack of dyspnea that occurs during sleep.

Paroxysmal nocturnal

Endothelin

Potent vasoconstrictors

_____ heart defects are the most common cause of heart failure in children.

Structural

afterload

The force that the contracting heart muscle must generate to eject blood from the filled heart

What are the signs and symptoms of heart failure? Mark all that apply. a. Fluid retention b. Ruddy complexion c. Fatigue d. Bradycardia e. Chronic productive cough

a. Fluid retention c. Fatigue

With both systolic and diastolic ventricular dysfunction, _____ are usually able to maintain adequate resting cardiac function until the later stages of heart failure.

compensatory mechanisms

Anaphylactic shock results from an _____ mediated reaction in which vasodilator substances such as histamine are released into the blood.

immune

Dyspnea

labored breathing

Endurance athletes have ____ cardiac reserves.

large

Central cyanosis is caused by conditions that impair _____ of the arterial blood.

oxygenation

Cheyne-Stokes respiration

periodic breathing characterized by gradual increase in depth followed by a decrease resulting in apnea

hypovolemic shock

Caused by a decrease in blood volume

cardiac reserve

Ability to increase cardiac output during increased activity

_____ is the most dramatic symptom of acute heart failure syndromes.

Acute pulmonary edema

_____ is associated with impaired left ventricular filling that is due to changes in myocardial relaxation and compliance.

Aging

cardiac output

Amount of blood the ventricles eject each minute

circulatory shock

An acute failure of the circulatory system to supply the peripheral tissues and organs of the body with an adequate blood supply

Elevated________levels have been shown to be predictive of the development of heart failure.

C-reactive protein

____ can be expressed as the product of the heart rate and stroke volume.

Cardiac output

high output failure

Failure that is caused by an excessive need for cardiac output

The rise in preload seen in systolic dysfunction is thought to be a compensatory mechanism to help maintain stroke volume via the _____ mechanism despite a drop in ejection fraction.

Frank-Starling

____ has been defined as a complex syndrome that results from any functional or structural disorder of the heart that results in decreased pumping.

Heart failure

circulatory failure

Hypoperfusion of organs and tissues

_____ shock is characterized by diminished blood volume such that there is inadequate filling of the vascular compartment.

Hypovolemic

_____ is the most common cause of right ventricular failure.

Left ventricular failure

_____ is caused by disorders that impair the pumping ability of the heart, such as ischemic heart disease and cardiomyopathy.

Low-output failure

cor polmonale

Right heart failure occurs in response to chronic pulmonary disease

aortic or mitral stenosis

Right ventricular dysfunction

hydrothorax

Transduction of fluid into the pleural cavity

ascites

Transudation of fluid into the pleural cavity

_____ shock is characterized by loss of blood vessel tone, enlargement of the vascular compartment, and displacement of the vascular volume away from the heart and central circulation.

Vasoldilatory

preload

Volume or loading conditions of the ventricle at the end of diastole

What are the physiologic signs and symptoms of cardiogenic shock? Mark all that apply. a. Decreased mean arterial blood pressures b. Increased urine output related to increased renal perfusion c. Increased central venous pressure d. Hypercapnic lips and nail beds e. Increased extraction of O2 from hemoglobin

a. Decreased mean arterial blood pressures c. Increased central venous pressure e. Increased extraction of O2 from hemoglobin

Neurogenic shock, or spinal shock, is a phenomenon caused by the inability of the vasomotor center in the brain stem to control blood vessel tone through the sympathetic outflow to the blood vessels. In neurogenic shock, what happens to the heart rate and the skin? a. Heart rate slower than normal; skin warm and dry b. Heart rate faster than normal; skin cool and moist c. Heart rate slower than normal; skin cool and moist d. Heart rate slower than normal; skin warm and dry

a. Heart rate slower than normal; skin warm and dry

When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs, and the body goes into shock. What are the causes of shock in the human body? Mark all that apply. a. Maldistribution of blood flow b. Hypovolemia c. Excessive vasoconstriction d. Obstruction of blood flow e. Hypervolemia

a. Maldistribution of blood flow b. Hypovolemia d. Obstruction of blood flow

Sepsis is a growing incidence in the United States. Its pathogenesis includes neutrophil activation that kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis? a. Release nitric oxide b. Vasoconstrict the capillary bed c. Cause bradycardia d. Activate erythropoiesis

a. Release nitric oxide

A gradual or rapid change in heart failure signs and symptoms resulting in a need for urgent therapy is defined as _____ syndrome.

acute heart failure

What is the primary physiologic result of obstructive shock? a. Left ventricular hypertrophy b. Elevated right heart pressure c. Right atrial hypertrophy d. Decreased right heart pressure

b. Elevated right heart pressure

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis? a. Uterine smooth muscle relaxation b. Laryngeal edema c. Bronchodilation d. Gastrointestinal relaxation

b. Laryngeal edema

What is the primary cause of heart failure in infants and children? a. Idiopathic heart disease b. Structural heart defects c. Hyperkalemia d. Reaction to medications

b. Structural heart defects

cyanosis

bluish discoloration of the skin

In acute or severe left-sided failure, cardiac output may fall to levels that are insufficient for providing the ____ with adequate oxygen.

brain

Measurements of ______ are recommended to confirm the diagnosis of heart failure to evaluate the severity of left ventricular compromise and estimate the prognosis, and predict future cardiac events such as sudden death, and to evaluate the effectiveness of treatment.

brain natriuretic peptide (BNP)

The pathogenesis of multiorgan dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS? a. Advanced age b. Alcohol abuse c. Respiratory dysfunction d. Infarcted bowel

c. Respiratory dysfunction

An important factor in the mortality of severe shock is acute renal failure. What is the degree of renal damage related to in shock? a. Loss of perfusion and duration of shock b. Loss of perfusion and degree of immune- mediated response c. Severity and duration of shock d. Severity of shock and degree of immune- mediated response

c. Severity and duration of shock

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock? a. Surgery b. Administration of IV fluids and blood c. Vasoconstrictive drugs d. Infusion of blood and blood products

c. Vasoconstrictive drugs

Among the conditions that cause diastolic dysfunction are those that ______ the ventricle (e.g. pericardial effusion, constrictive pericarditis), those that ____ wall thickness and reduce chamber size (e.g. myocardial hypertrophy, hypertrophic cardiomyopathy), and those that ____ diastolic relaxation (e.g. aging, ischemic heart disease).

compress, increase, delay

Systolic dysfunction commonly results from conditions that impair the ____ performance of the heart (e.g. ischemic heart disease and cardiomyopathy), produce a ______ (e.g. valvular insufficiency and anemia), or generate a _____ (e.g. hypertension and valvular stenosis) on the heart.

contractile, volume overload, pressure overload

Among the most common causes of heart failure are _____, ______, dilated cardiomyopathy, and ____ heart disease.

coronary artery disease, hypertension, valvular

Diastolic ventricular dysfunction is characterized by a _____ ejection fraction but impaired diastolic ventricular relaxation leading to a decrease in ventricular filling, which ultimately causes a decrease in preload, stroke volume, and cardiac output.

normal

In systolic ventricular dysfunction, myocardial contracility is impaired, leading to a _____ in the ejection fraction and cardiac output.

decrease

In _____ dysfunction, cardiac output is compromised by the abnormal filling of the ventricle.

diastolic

ischemic heart disease

diastolic dysfunction

As venous distention progresses in right-sided heart failure, blood backs up in the ____ veins that drain into the inferior vena cava, and the liver becomes engorged.

hepatic

paget disease

high output failure

The most common causes of _____ ventricular dysfunction are acute myocardial infarction and cardiomyopathy.

left

Beta-adrenergic receptor blocking drugs are used to decrease _____ dysfunction associated with activation of the sympathetic nervous system.

left ventricular

acute myocardial infarction

left ventricular dysfunction

cardiomyopathy

low-output failure

The development of _____ constitutes one of the principle mechanisms by which the heart compensates for an increase in workload.

myocardial hypertrophy

The most common cause of cardiogenic shock is _____.

myocardial infarction

A defect in the vasomotor center in the brain stem or the sympathetic outflow to the blood vessels is known as ______.

neurogenic shock