USMLE Cardiovascular 13: Heart Failure and Shock

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/ lymed Welcome to LY Med, where I go over everything you need to know for the USMLE STEP 1, with new videos every day.
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This video is going to discuss congestive heart failure and shock. Heart failure is the failure of the heart to pump out blood. Normally we talk about it as left and right heart failure. In right heart failure, fluid will back up and we get signs that include pitting edema, JVD, and hepatomegaly and nutmeg liver. In left heart failure, fluid will back up into our lungs and show as orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema with heart failure cells. LHF is much more common and most RHF comes from left heart failure. Isolated RHF is called cor pulmonale. We treat it by reducing fluid with ACE/ARB/spironolactone and beta blockers. Loop diuretics reduce symptoms but not mortality.
Another way to separate heart failure is by either systolic dysfunction or diastolic dysfunction as measured by an echocardiogram. We measure this by measuring the ejection fraction. In systolic dysfunction, stroke volume falls and end diastolic volume increases. In diastolic dysfunction, ejection fraction is preserved.
Let's talk about shock! This is when your tissue is not perfused. The different types of shock include hypovolemic shock, cardiogenic, obstructive, distributive (septic shock, neurogenic etc). In hypovolemic shock, skin is cold and clammy, preload (PWCP) is decreased, cardiac output is decreased and afterload is increased. Cardiogenic shock leads to increased preload, decreased cardiac output, and increased afterload. Distributive shock from sepsis leads to increased cardiac output and high output failure. Neurogenic shock leads to lower cardiac output and heart rate and massive decrease in afterload.

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Much love, -Mike

[@Pakistanmylove1]

From a medical student in Texas to you: this is a gem of a channel and I am glad to have found it!!

[@luvafn]

Just amazing! Thank you so much :)

[@edgarlozano6534]

Awesome vid! Easy to understand and to the point! Keep it up!!

[@dr.hkhawar]

Thank YOU!!

[@sonialilly5688]

I was born with heart disease. My cardiologist told me recently that my right ventricle needs to be replaced & my right side of my heart is enlarged. Waiting on MRI to see how bad it is 😥

[@davidleigh9560]

😞🙏

[@samphonnetgamgee5625]

Right or left Atrium not atria. Otherwise great videos!