Chapter 11

The student understands the primary disturbances, compensatory responses, decompensatory processes, and possible therapeutic interventions that pertain to various abnormal cardiovascular situations:

• Defines circulatory shock.
• Identifies the primary disturbances that can account for cardiogenic, hypovolemic, anaphylactic, septic, and neurogenic shock states.
• Lists the compensatory processes that may arise during various types of circulatory shock.
• Identifies the decompensatory processes that may arise during shock and describes how these lead to irreversible shock states.
• Indicates how coronary artery disease may lead to abnormal cardiac function.
• Defines the term angina pectoris and describes the mechanisms that promote its development.
• Indicates the mechanisms by which various therapeutic interventions may alleviate angina and myocardial ischemia in association with coronary artery disease.
• Defines the term heart failure and differentiates between acute and chronic heart failure and between systolic and diastolic failure.
• Identifies the short-term and long-term compensatory processes that accompany chronic systolic heart failure.
• Describes the advantages and disadvantages of the fluid accumulation that accompanies systolic heart failure.
• Defines pulmonary and systemic arterial hypertension.
• Identifies the various factors that may contribute to the development of systemic hypertension.
• Describes the role of the kidney in establishing and/or maintaining systemic hypertension.

In this last chapter, some of the pathological situations that can interfere with the homeostatic functions of the cardiovascular system are introduced. It is not intended as an in-depth coverage of cardiovascular diseases but rather as an introductory presentation of how the physiological processes described previously are evoked and/or altered during various abnormal cardiovascular states. In each case, there is generally a primary disturbance that evokes appropriate compensatory reflex responses. Often, however, pathological situations also lead to inappropriate “decompensatory processes,” which tend to accelerate the deterioration of cardiovascular function. Therapeutic interventions may be required and are often designed to limit or reverse these decompensatory processes. Students are again encouraged to review the summary of cardiovascular variables and their determinants in Appendix C because a thorough knowledge of this material will greatly help to understand the physiological consequences of these abnormalities.

A state of circulatory “shock” exists whenever there is a generalized, severe reduction in blood supply to the body tissues and the metabolic needs of the tissues are not met. Even with all cardiovascular compensatory mechanisms activated, arterial pressure is usually (though not always) low in shock. In severe shock states of any etiology, inadequate brain blood flow leads to loss of consciousness often with sudden onset (called syncope). The approach to understanding the causes and selecting an appropriate treatment depends on determination of the underlying primary disturbance. Recall that arterial pressure is determined by cardiac output and total peripheral resistance, so any loss in blood pressure is a result of a decrease in either one or both of these variables.

### Primary Disturbances

In general, the shock state is precipitated by one of three cardiovascular crises: (1) severely depressed myocardial functional ability, (2) grossly inadequate cardiac filling due ...

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