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Questions and Answers
Which factor is primarily responsible for the most common cause of ischemic heart disease?
Which factor is primarily responsible for the most common cause of ischemic heart disease?
What is a key distinguishing symptom of septic shock compared to hypovolemic and cardiogenic shock?
What is a key distinguishing symptom of septic shock compared to hypovolemic and cardiogenic shock?
Which chain of events describes the pathogenesis of ischemic heart disease after an atherosclerotic plaque ruptures?
Which chain of events describes the pathogenesis of ischemic heart disease after an atherosclerotic plaque ruptures?
Which of these represents a physiological indication of organ dysfunction related to shock?
Which of these represents a physiological indication of organ dysfunction related to shock?
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What triggers the progressive narrowing of the coronary arteries in ischemic heart disease?
What triggers the progressive narrowing of the coronary arteries in ischemic heart disease?
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Which condition is characterized by engorgement of pulmonary capillaries and leads to specific respiratory symptoms?
Which condition is characterized by engorgement of pulmonary capillaries and leads to specific respiratory symptoms?
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The term 'nutmeg liver' is associated with which type of venous congestion?
The term 'nutmeg liver' is associated with which type of venous congestion?
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Which of the following describes the appearance of white infarcts?
Which of the following describes the appearance of white infarcts?
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What clinical feature is most commonly associated with hepatic congestion due to right heart failure?
What clinical feature is most commonly associated with hepatic congestion due to right heart failure?
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What is typically seen in the advanced stages of chronic passive hepatic congestion?
What is typically seen in the advanced stages of chronic passive hepatic congestion?
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What is most likely to be a consequence of deep vein thrombosis (DVT)?
What is most likely to be a consequence of deep vein thrombosis (DVT)?
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Which of the following organs is most commonly affected by red infarcts due to its dual blood supply?
Which of the following organs is most commonly affected by red infarcts due to its dual blood supply?
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What symptom is generally associated with congestive failure of the right ventricle?
What symptom is generally associated with congestive failure of the right ventricle?
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What is the main distinction between transmural and subendocardial infarcts?
What is the main distinction between transmural and subendocardial infarcts?
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Which of the following is NOT considered a type of acute coronary syndrome?
Which of the following is NOT considered a type of acute coronary syndrome?
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What factor is least likely to contribute to the development of coronary artery disease (CAD) related to atherosclerosis?
What factor is least likely to contribute to the development of coronary artery disease (CAD) related to atherosclerosis?
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What stage of shock is characterized by cellular dysfunction despite adequate blood volume and cardiac output?
What stage of shock is characterized by cellular dysfunction despite adequate blood volume and cardiac output?
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In the context of ischemic heart disease, what does stable angina typically signify?
In the context of ischemic heart disease, what does stable angina typically signify?
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What is the primary physiologic mechanism contributing to cardiac ischemia?
What is the primary physiologic mechanism contributing to cardiac ischemia?
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Which medication type is most commonly prescribed for managing ischemic heart disease, particularly for its antiplatelet effects?
Which medication type is most commonly prescribed for managing ischemic heart disease, particularly for its antiplatelet effects?
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Which symptom is least likely associated with an unstable angina episode?
Which symptom is least likely associated with an unstable angina episode?
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What characterizes Stage II of shock?
What characterizes Stage II of shock?
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Which of the following best explains the significance of tachycardia in shock?
Which of the following best explains the significance of tachycardia in shock?
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Which factor is NOT associated with septic shock?
Which factor is NOT associated with septic shock?
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What is a common consequence of multi-organ dysfunction in septic shock?
What is a common consequence of multi-organ dysfunction in septic shock?
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Which of the following describes Stage III shock?
Which of the following describes Stage III shock?
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Which factor indicates a more severe stage of septic shock?
Which factor indicates a more severe stage of septic shock?
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Which option does NOT contribute to cellular death in septic shock?
Which option does NOT contribute to cellular death in septic shock?
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Why are scoring systems important in the assessment of septic shock?
Why are scoring systems important in the assessment of septic shock?
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What is the primary purpose of administering antiplatelet agents like ASA in IHD treatment?
What is the primary purpose of administering antiplatelet agents like ASA in IHD treatment?
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Which imaging technique is most effective for assessing ischemic cardiac tissue using isotopes?
Which imaging technique is most effective for assessing ischemic cardiac tissue using isotopes?
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What differentiates NSTEMI from STEMI in terms of treatment options?
What differentiates NSTEMI from STEMI in terms of treatment options?
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What is a significant risk associated with myocardial infarction within the days following the event?
What is a significant risk associated with myocardial infarction within the days following the event?
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Which treatment option is NOT typically indicated for patients with stable angina?
Which treatment option is NOT typically indicated for patients with stable angina?
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What is a common cause of acute mortality in myocardial infarction cases?
What is a common cause of acute mortality in myocardial infarction cases?
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Which of the following treatments is used to decrease myocardial preload and is also a coronary vasodilator?
Which of the following treatments is used to decrease myocardial preload and is also a coronary vasodilator?
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What outcome is primarily sought by managing glucose and serum lipid levels in patients with ischemic heart disease?
What outcome is primarily sought by managing glucose and serum lipid levels in patients with ischemic heart disease?
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What physiological process occurs primarily during diastole that affects oxygen delivery to the heart muscle?
What physiological process occurs primarily during diastole that affects oxygen delivery to the heart muscle?
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What characterizes the difference between STEMI and NSTEMI regarding blood vessel occlusion?
What characterizes the difference between STEMI and NSTEMI regarding blood vessel occlusion?
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Which pathological change is NOT observed during the first few minutes following myocardial ischemia?
Which pathological change is NOT observed during the first few minutes following myocardial ischemia?
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Which statement best describes stable angina in terms of blood flow conditions?
Which statement best describes stable angina in terms of blood flow conditions?
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What indicates irreversible myocyte injury after continued ischemia?
What indicates irreversible myocyte injury after continued ischemia?
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Which condition is most likely to result in unstable angina or an acute coronary syndrome (ACS)?
Which condition is most likely to result in unstable angina or an acute coronary syndrome (ACS)?
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What is referred to as 'stunned myocardium'?
What is referred to as 'stunned myocardium'?
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Which factors contribute to the threat of subendocardial vessels during systole?
Which factors contribute to the threat of subendocardial vessels during systole?
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Study Notes
BMS 200 - Shock and Ischemic Heart Disease
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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).
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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.
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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).
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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.
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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.
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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).
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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.
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Categories of Shock: Cardiogenic (pump failure), hypovolemic (fluid loss), septic (immune response to infection), anaphylactic (allergic reaction), neurogenic (spinal cord injury).
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Shock Classification: Hypovolemic (too little fluid), obstructive (blood can't flow out of the heart), distributive (widespread dilation), cardiogenic (heart is not pumping efficiently).
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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.
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Factors Influencing Cardiac Demand: Heart rate, wall tension, contractility,
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Acute Infarct Pathology: Sub-endocardial vessels are most vulnerable to decreased blood flow.
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Types of Infarcts: Transmural (large vessel obstruction) vs. non-transmural (multiple smaller vessel obstructions, typically transient).
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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.
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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),
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Complications of MI: Death (acutely), high mortality post-MI, arrhythmias, cardiac rupture, poor wall motion, pericarditis
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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.
