BMS 200 - Shock and Ischemic Heart Disease
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Questions and Answers

Which factor is primarily responsible for the most common cause of ischemic heart disease?

  • Coronary artery aneurysms
  • Vasospasm episodes
  • Peripheral vasodilation
  • Atherosclerosis of the coronary arteries (correct)

What is a key distinguishing symptom of septic shock compared to hypovolemic and cardiogenic shock?

  • Weak, rapid pulse
  • Warm, flushed skin (correct)
  • Cool, clammy skin
  • Hypotension

Which chain of events describes the pathogenesis of ischemic heart disease after an atherosclerotic plaque ruptures?

  • Acute clot formation blocks the artery or leads to embolism. (correct)
  • Narrowing of coronary arteries leads to reduced blood flow and tissue healing.
  • Inflammation reduces blood viscosity, increasing flow through the artery.
  • Plaque rupture releases cholesterol, causing arterial vasospasm.

Which of these represents a physiological indication of organ dysfunction related to shock?

<p>Decreased level of consciousness (D)</p> Signup and view all the answers

What triggers the progressive narrowing of the coronary arteries in ischemic heart disease?

<p>Inflammation leading to plaque buildup (D)</p> Signup and view all the answers

Which condition is characterized by engorgement of pulmonary capillaries and leads to specific respiratory symptoms?

<p>Mitral stenosis (D)</p> Signup and view all the answers

The term 'nutmeg liver' is associated with which type of venous congestion?

<p>Hepatic congestion (C)</p> Signup and view all the answers

Which of the following describes the appearance of white infarcts?

<p>Pale, well-defined areas of necrosis (D)</p> Signup and view all the answers

What clinical feature is most commonly associated with hepatic congestion due to right heart failure?

<p>Jugular venous distension (C)</p> Signup and view all the answers

What is typically seen in the advanced stages of chronic passive hepatic congestion?

<p>Fibrosis and dilated sinusoids (D)</p> Signup and view all the answers

What is most likely to be a consequence of deep vein thrombosis (DVT)?

<p>Pulmonary embolism (C)</p> Signup and view all the answers

Which of the following organs is most commonly affected by red infarcts due to its dual blood supply?

<p>Lung (D)</p> Signup and view all the answers

What symptom is generally associated with congestive failure of the right ventricle?

<p>Peripheral edema (D)</p> Signup and view all the answers

What is the main distinction between transmural and subendocardial infarcts?

<p>Transmural infarcts involve the full thickness of the heart muscle, whereas subendocardial infarcts affect only a portion of the muscle. (B)</p> Signup and view all the answers

Which of the following is NOT considered a type of acute coronary syndrome?

<p>Stable angina (C)</p> Signup and view all the answers

What factor is least likely to contribute to the development of coronary artery disease (CAD) related to atherosclerosis?

<p>Excessive hydration (A)</p> Signup and view all the answers

What stage of shock is characterized by cellular dysfunction despite adequate blood volume and cardiac output?

<p>Decompensated stage (B)</p> Signup and view all the answers

In the context of ischemic heart disease, what does stable angina typically signify?

<p>Predictable chest pain that is triggered by exertion (D)</p> Signup and view all the answers

What is the primary physiologic mechanism contributing to cardiac ischemia?

<p>Reduced oxygen supply relative to myocardial demand (B)</p> Signup and view all the answers

Which medication type is most commonly prescribed for managing ischemic heart disease, particularly for its antiplatelet effects?

<p>Antiplatelet agents (B)</p> Signup and view all the answers

Which symptom is least likely associated with an unstable angina episode?

<p>Constant pain that does not improve with rest (D)</p> Signup and view all the answers

What characterizes Stage II of shock?

<p>Tachycardia accompanied by hypotension (D)</p> Signup and view all the answers

Which of the following best explains the significance of tachycardia in shock?

<p>It is a compensatory mechanism for reduced cardiac output. (C)</p> Signup and view all the answers

Which factor is NOT associated with septic shock?

<p>Isolated low heart rate (B)</p> Signup and view all the answers

What is a common consequence of multi-organ dysfunction in septic shock?

<p>Failure of multiple organ systems (D)</p> Signup and view all the answers

Which of the following describes Stage III shock?

<p>Death is likely without immediate intervention. (B)</p> Signup and view all the answers

Which factor indicates a more severe stage of septic shock?

<p>Presence of hypotension along with tachycardia (C)</p> Signup and view all the answers

Which option does NOT contribute to cellular death in septic shock?

<p>Compensatory mechanisms functioning well (C)</p> Signup and view all the answers

Why are scoring systems important in the assessment of septic shock?

<p>They help to identify patients at higher risk. (D)</p> Signup and view all the answers

What is the primary purpose of administering antiplatelet agents like ASA in IHD treatment?

<p>To prevent thrombus enlargement (A)</p> Signup and view all the answers

Which imaging technique is most effective for assessing ischemic cardiac tissue using isotopes?

<p>Nuclear medicine imaging (C)</p> Signup and view all the answers

What differentiates NSTEMI from STEMI in terms of treatment options?

<p>NSTEMI does not use thrombolytic drugs like tissue plasminogen activator (C)</p> Signup and view all the answers

What is a significant risk associated with myocardial infarction within the days following the event?

<p>Cardiac rupture (A)</p> Signup and view all the answers

Which treatment option is NOT typically indicated for patients with stable angina?

<p>Stenting for survival benefit (A)</p> Signup and view all the answers

What is a common cause of acute mortality in myocardial infarction cases?

<p>Dysrhythmias such as ventricular fibrillation (C)</p> Signup and view all the answers

Which of the following treatments is used to decrease myocardial preload and is also a coronary vasodilator?

<p>Nitroglycerine (B)</p> Signup and view all the answers

What outcome is primarily sought by managing glucose and serum lipid levels in patients with ischemic heart disease?

<p>Reducing the risk of future myocardial infarctions (C)</p> Signup and view all the answers

What physiological process occurs primarily during diastole that affects oxygen delivery to the heart muscle?

<p>The heart muscle relaxes and receives oxygenated blood (C)</p> Signup and view all the answers

What characterizes the difference between STEMI and NSTEMI regarding blood vessel occlusion?

<p>STEMI is always associated with complete blockage of major epicardial vessels (D)</p> Signup and view all the answers

Which pathological change is NOT observed during the first few minutes following myocardial ischemia?

<p>Immediate cell necrosis (C)</p> Signup and view all the answers

Which statement best describes stable angina in terms of blood flow conditions?

<p>Blood flow is adequate during rest but inadequate during exertion (B)</p> Signup and view all the answers

What indicates irreversible myocyte injury after continued ischemia?

<p>Mitochondrial swelling and nuclear chromatin clumping (C)</p> Signup and view all the answers

Which condition is most likely to result in unstable angina or an acute coronary syndrome (ACS)?

<p>A severely narrowed lumen that may cause angina at rest (C)</p> Signup and view all the answers

What is referred to as 'stunned myocardium'?

<p>Cells that are still alive but unable to contract (C)</p> Signup and view all the answers

Which factors contribute to the threat of subendocardial vessels during systole?

<p>Higher oxygen demand compared to supply (B), The last relaxation of subendocardial muscle (D)</p> Signup and view all the answers

Flashcards

Shock Types

Shock is a life-threatening condition caused by inadequate blood flow to the body's organs, leading to a variety of physiological responses.

Ischemic Heart Disease

Conditions where the heart doesn't receive enough oxygen due to blocked or narrowed coronary arteries.

Acute Coronary Syndromes

A sudden blockage of blood flow in the coronary arteries, which can lead to heart attack (MI).

Stable Angina

Chest pain related to exertion or stress, usually predictable and treatable by rest and medication.

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Unstable Angina

Chest pain that is worsening or new, unpredictable and requiring immediate medical attention.

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Edema Mechanisms

Swelling caused by fluid buildup; various mechanisms involve changes in capillary pressure, permeability, or lymphatic obstruction.

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Subendocardial Infarct

Heart attack affecting the inner layer (endocardium) of the heart.

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Transmural Infarct

Heart attack that involves the full thickness of the heart muscle.

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Nutmeg Liver

A liver showing a reddish-brown appearance due to congestion, especially in chronic passive congestion.

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Chronic Passive Congestion

A late stage of venous congestion, characterized by dilated sinusoids, and fibrosis.

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Hepatic Congestion

Venous congestion in the liver, often caused by right heart failure.

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Pressure Atrophy

Cellular shrinkage due to prolonged pressure from congestion in organs like the liver.

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Pulmonary Congestion

Venous congestion in the lungs, often caused by left heart failure.

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White vs Red Infarct

Different types of tissue death due to lack of blood supply, distinguished by color and location.

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Infarct

An area of tissue death due to lack of blood supply.

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Deep Vein Thrombosis (DVT)

Blood clot formation in deep veins, leading to swelling, pain, and potential for a thrombus.

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Septic Shock

A life-threatening condition caused by the body's overwhelming inflammatory response to an infection.

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Tachycardia in Shock

Rapid heart rate, a compensatory response to a decrease in blood flow to vital organs.

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Compensated Shock

Initial stage of shock where the body tries to maintain blood flow by increasing heart rate while blood pressure remains normal.

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Decompensated Shock

Shock stage where the body's compensatory mechanisms fail, leading to low blood pressure along with tachycardia.

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Multi-Organ Dysfunction

A severe complication of shock where multiple organs fail due to inadequate blood flow.

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Inadequate Tissue Perfusion

Insufficient blood flow to tissues, leading to cellular death.

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Pro-inflammatory Cytokines

Molecules that cause inflammation, potentially damaging organs.

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Irreversible Shock

Final stage of shock where organ damage is severe and likely fatal, despite intervention.

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Shock clinical findings

Hypotension, weak rapid pulse, tachypnea, cool/clammy/cyanotic skin. Septic shock might initially have warm flushed skin due to vasodilation.

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Ischemic Heart Disease cause

Inadequate blood supply to the heart muscle (myocardium) due to blocked or reduced coronary arteries, often from atherosclerosis.

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Ischemic Heart Disease pathogenesis

Developed through progressive narrowing of coronary arteries leading to reduced blood flow in the heart, or sudden occlusion (blockage) caused by a rupturing plaque forming a clot.

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IHD metabolic demand

The balance between blood supply and the heart's metabolic needs; exacerbated by activities that increase heart work requiring more oxygen.

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Shock prognosis

Poor prognosis (outcomes) usually associated with this condition.

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Subendocardial vessels

Small blood vessels in the inner layer of the heart.

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STEMI

Heart attack affecting the whole heart wall due to a major epicardial vessel blockage.

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NSTEMI

Heart attack where infarcted tissue is limited to the subendocardium due to unstable plaques or partial blockages.

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Stable angina

Chest pain due to reduced blood flow, usually triggered by exertion but resolves with rest.

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Unstable angina

Chest pain that worsens, is new, or unpredictable, needing immediate medical attention.

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Myocyte Injury (First Few Minutes)

Myocyte (heart muscle cell) reversible damage - swelling, decreased glycogen.

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Irreversible Myocyte Injury (30-60 mins)

Severe mitochondrial damage, chromatin clumping, and sarcolemma disruption in heart muscle.

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Blood flow to heart during diastole

Heart receives oxygenated blood during relaxation phase (diastole), majorly in sub-endocardial areas

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IHD Diagnosis: ECG Patterns

Electrocardiogram (ECG) can show patterns associated with ischemic heart disease, but more details are discussed in dysrhythmias.

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MI Treatment: Clot-Busting Drugs

In STEMI (ST-elevation myocardial infarction), thrombolytic drugs (e.g., alteplase) are used to dissolve blood clots. NSTEMI doesn't involve this.

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IHD Treatments: Anti-platelets

Anti-platelet agents, like ASA, prevent new thrombus formation and existing thrombi from growing, reducing IHD risk.

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IHD Complications: Acute Death

In 25-35% of myocardial infarction (MI) cases, death happens quickly due to dysrhythmias, heart failure, or cardiac arrest.

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IHD Treatment: Revascularization

Angioplasty or stenting can restore blood flow. This is effective but needs special medical teams.

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Cardiac Enzymes in Diagnosis

Troponin (T and I) and CK-MB are heart-specific markers, useful in diagnosing cardiac conditions, including MI.

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Myocardial Infarction Complications

A significant complication of MI is death (in some cases) from dysrhythmias, heart rupture or heart failure in the days to months post-attack.

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IHD Treatment: PCI & CABG

Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) are used in some cases of IHD, but are not a standard response in stable angina.

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Study Notes

BMS 200 - Shock and Ischemic Heart Disease

  • Objectives: Categorize edema by pathophysiology, contrast hyperemia and congestion, differentiate hypotension, heart failure, and shock, describe major shock stages, apply shock to interventions, and distinguish ischemic heart disease entities (ACS, stable angina, unstable angina, NSTEMI, STEMI, sudden cardiac death, vasospastic angina).

  • Edema: Excess fluid in interstitial spaces, caused by increased blood hydrostatic pressure, decreased blood oncotic pressure, increased vascular permeability, or lymphatic blockage. Transudate (low protein, low cells) and exudate (high protein, high cells) are subtypes.

  • Starling Forces: Describe fluid movement across capillary walls, through balance between two pushing (hydrostatic) forces and two pulling (oncotic) forces, affected by capillary permeability (Lp) and pressures (Pcap, PISF, πcap, ISF).

  • Edema Causes:

    • Increased Hydrostatic Pressure: Generalized increase in blood pressure (e.g., malignant hypertension), decreased venous drainage (regional or global).
    • Increased Sodium and Water Retention: Kidney pathologies, decreased kidney perfusion, endocrine issues (e.g., inappropriate ADH secretion, too much aldosterone).
    • Reduced Lymphatic Drainage: Malignancies, lymph node surgeries, infections.
    • Decreased Oncotic Pressure: Leakage of protein (e.g., nephrotic syndrome), hepatic failure, protein-losing enteropathies.
    • Damage to Endothelium: inflammation, and inability of tissues to handle excess fluid, especially pulmonary edema.

  • Hyperemia and Congestion: Both involve increased blood volume. Hyperemia (active process) is increased blood flow due to arteriolar dilation, often in inflammation or exercise sites (erythema). Congestion (passive process) is reduced blood outflow, leading to bluish discoloration (cyanosis) from deoxygenated blood. Can be systemic or local.

  • Congestion: Long-standing congestion (chronic passive congestion) leads to hypoxia, cell/tissue death and fibrosis, capillary rupture, and haemoglobin breakdown products (e.g., hemosiderin).

    • Pulmonary Congestion: Acute (blood-filled alveoli) and chronic (thickened septa, hemosiderin macrophages).
    • Hepatic Congestion: Acute (damaged hepatocytes, swollen cells).

  • Shock: A common final pathway for several fatal clinical events (e.g., severe hemorrhage, dehydration, extensive trauma, myocardial infarction, massive pulmonary embolism, sepsis, anaphylaxis). Characterized by profound hemodynamic and metabolic disturbance where the circulatory system fails to adequately supply microcirculation and vital organs.

  • Categories of Shock: Cardiogenic (pump failure), hypovolemic (fluid loss), septic (immune response to infection), anaphylactic (allergic reaction), neurogenic (spinal cord injury).

  • Shock Classification: Hypovolemic (too little fluid), obstructive (blood can't flow out of the heart), distributive (widespread dilation), cardiogenic (heart is not pumping efficiently).

  • Ischemic Heart Disease (IHD): Imbalance between the blood supply to the myocardium and the metabolic demands of the heart.

    • Definition: Inadequate blood supply, resulting from completely blocked or reduced blood flow. Most common: atherosclerosis of the coronary arteries. Other include: aneurysms, autoimmune attack, transient spasm.
    • Pathogenesis (IHD): Progressive narrowing of coronary arteries leading to hypoperfusion, sudden occlusion of a coronary artery (causing infarction), and potentially exacerbated by increased metabolic demand
    • Pathogenesis of atherosclerosis: Gradual narrowing of coronary arteries leading to ischemic heart disease or heart failure.

  • Factors Influencing Cardiac Demand: Heart rate, wall tension, contractility,

  • Acute Infarct Pathology: Sub-endocardial vessels are most vulnerable to decreased blood flow.

  • Types of Infarcts: Transmural (large vessel obstruction) vs. non-transmural (multiple smaller vessel obstructions, typically transient).

  • Clinical Presentation of Ischemic Heart Disease: Asymptomatic (angina pectoris), pain (chest / arm, consistent with previous episodes, relieved within short period by rest or nitroglycerin), dyspnea, fatigue, palpitations, diaphoresis, and possible congestive heart failure symptoms. Atypical presentations - pain as heart burn, pain occurring at rest, muscle discomfort, or more complex presentations.

  • Diagnosis and treatment: ECG patterns are evaluated, and cardiac enzymes (troponin) are measured. Treatments include:

    • Treatment: ASA, anti-platelet agents, ACE inhibitors, beta-blockers, calcium channel blockers, nitroglycerin.
    • Emergency Treatment (MI): “clot-busting” drugs (tissue plasminogen activators, thrombolytics) and revascularization (angioplasty, stenting),

  • Complications of MI: Death (acutely), high mortality post-MI, arrhythmias, cardiac rupture, poor wall motion, pericarditis

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BMS 200 Shock and Ischemic Heart Disease PDF

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Test your knowledge on shock and ischemic heart disease through this quiz. Explore concepts such as edema, Starling forces, and the distinctions between different types of acute coronary syndromes. This quiz covers critical pathophysiological mechanisms and clinical implications relevant to these conditions.

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