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Shock and Hypertension

Cardiovascular shock
Inadequate supply of O₂ to the tissues
Results in loss of tissue function and loss of corrective reflexes
Note: especially the heart & nervous system

PROBLEMS PRESENTED BY SHOCK
�     decreased cardiac output
�     decreased VR !!!
�     loss of sympathetic reflexes
�     tissue dehydration (    BP)
�     renal failure

Shock
�     Anaphylactic
�     Cardiogenic
�     Emotional stress
�     Hemorrhagic
�     Also burns

SYMPTOMS:
�     Cold, clammy skin
�     Rapid shallow pulse
�     Dilated pupils
�     Loss of pupillary reflex
�     Edema

Treatments
�     Elevate feet
�     Keep warm
�     Plasma expanders
�     Epinephrine

Reversible � NonReversible Border:
Oxygen deficit of > 120 ml/Kg body weight

HYPERTENSION
see Box on page 450

�     Increased TPR
�     �Essential� or idiopathic
�     Atherosclerosis
        �     Decreased arterial compliance
�     Arteriosclerosis
        �     plaque deposit in major vessel

POSITIVE FEEDBACK
Increased TPR --> increased cardiac work
---> Increased cardiac muscle mass (hypertrophy)
---> Increased bv muscle mass & TPR
Increased cardiac O₂ demand !!!
Also
Decreased BV compliance over time
Made worse by �re-setting� of the baroreceptors as the BVs lose their compliance

Potential problems
�     Myocardial disease
�     Heart attack and infarct
�     ---> increased work for remaining healthy tissue
�     Decreased VR ----> edema
�     Liver
�     Lungs
�     Kidney
�     Edema
      Swelling of the tissues due to fluid accumulation from the capillaries
      Increased BP in tissues
      Decreased VR
      Increased TPR

Possible Treatments
�     Vasodilators
�     �False NTs� - methyl DOPA
�     Diuretics
� Blockers
�     Sedatives