BMS 200 - Shock and Ischemic Heart Disease
45 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition

Podcast

Play an AI-generated podcast conversation about this lesson

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</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</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</p> Signup and view all the answers

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

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

    Which of the following describes the appearance of white infarcts?

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

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

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

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

    <p>Peripheral edema</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.</p> Signup and view all the answers

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

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

    What characterizes Stage II of shock?

    <p>Tachycardia accompanied by hypotension</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.</p> Signup and view all the answers

    Which factor is NOT associated with septic shock?

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

    Which of the following describes Stage III shock?

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

    Which factor indicates a more severe stage of septic shock?

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

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

    <p>Compensatory mechanisms functioning well</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.</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</p> Signup and view all the answers

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

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

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

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

    What indicates irreversible myocyte injury after continued ischemia?

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

    What is referred to as 'stunned myocardium'?

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

    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

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    BMS 200 Shock and Ischemic Heart Disease PDF

    Description

    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.

    More Like This

    Shock Pathophysiology Quiz
    5 questions

    Shock Pathophysiology Quiz

    SubsidizedLucchesiite avatar
    SubsidizedLucchesiite
    Anaphylactic Shock: Pathophysiology and Prevention
    12 questions

    Anaphylactic Shock Pathophysiology Quiz and Flashcards

    NoiselessBiography4328 avatar
    NoiselessBiography4328
    Pathophysiology of Shock
    10 questions

    Pathophysiology of Shock

    GlisteningLynx avatar
    GlisteningLynx
    Circulatory Shock: Types and Pathophysiology
    17 questions

    Circulatory Shock: Types and Pathophysiology

    FavoriteBluebell avatar
    FavoriteBluebell
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser