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Hypovolemic/cardiogenic Shock - Bp & Pulse Pressure, Stroke Volume


joyagh

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I posted something similar before, but I continue to be dismayed by how similar my symptoms are to hypovolemic and cardiogenic shock.

If I'm not on my BB's, I get either tachy (110-130) with high BP, or tachy with low systolic and high diastolic (narrow pulse pressure) and hyperpnea. My symptoms are exact to the following articles about hypovolemia and cardiogenic shock.

EMT's are trained in this but my cardio EP did not seem concerned. I have had cardiac/pulmonary work ups and no pathology is present.

my questions is: HOW CAN THIS BE?????

"A narrow pulse pressure in a hypovolemic shock patient indicates a decreasing cardiac output (stroke volume) and an increasing peripheral vascular resistance. The decreasing venous volume from blood loss and the sympathetic nervous system attempt to increase or maintain the falling blood pressure through systemic vasoconstriction. This increase in heart rate and myocardial contractility is reflected in the decreasing systolic BP, the increasing diastolic BP and the narrowing pulse pressure. Thus, a blood pressure of 102/88 mmHg no longer appears to be “normal” and requires further assessment of heart rate, respiratory rate and other signs of perfusion, such as the skin color, temperature, condition and the patient’s mental status."

http://www.ems1.com/ems-products/education/articles/479223-Blood-Pressure-Assessment-in-the-Hypovolemic-Shock-Patient/

"Early signs include increased heart rate with maintenance of blood pressure even
though cardiac output has decreased. As compensatory mechanisms fail, the systolic
blood pressure falls and the diastolic pressure increases, causing a narrowed pulse
pressure.

• Other signs include increased tachycardia; cool, clammy skin; rapid, deep
respirations;
pulmonary edema (crackles); an S3 gallop; decreased urine output; and
impaired level of consciousness."

and

"Cardiogenic shock occurs primarily as a result of severe left and/or right
ventricular dysfunction that results in inadequate cardiac pumping. The most
common cause is myocardial infarction; other causes include cardiomyopathy,
ventricular rupture, and congenital heart defects.

PATHOGENESIS
• Decreased contractility results in decreased cardiac output, which causes decreased
tissue perfusion that is inadequate to meet basal metabolic requirements.
The sympathetic nervous system and renin-angiotensin system are stimulated as
compensatory mechanisms to increase cardiac output.
The net result of the activation
of compensatory mechanisms is to increase myocardial oxygen demand. This may
precipitate further myocardial damage, resulting in a progressive decline in cardiac
output."

https://docs.google.com/viewer?a=v&q=cache:4FIzEuUFsWsJ:faculty.ksu.edu.sa/73717/Documents/cardiogenic%2520Hypovolemic%2520Shock.doc+&hl=en&gl=us&pid=bl&srcid=ADGEESgBbthiu6qhm-R_NbKX1KeZHRIrHSwgq9Fki7TqhIy5UMXV4Tcvesr9o0knLRogXi2W-uCDefJ0oQsoE2qG3KfeQu55wSuJ7tzxOcLqpD7WI-GWV_zCL39iUWPqzbBkV6j7I_Mw&sig=AHIEtbRKaLcj1eerGMlsc8BdWNL94ms0bg

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hmmm..after researching this a little with you, I am a bit perplexed myself, I hope someone can explain this to us both because the simialrities are eery...=( I have the high diastolic an dlow systolic sometimes and I know this is happening because my pulse will seem weak. It happens everyday off and on....HELP...lol <nervous laughter> for instance today my bp originally was 90/60 ...then after feeling my pulse weaken I checked it again and it was 84/70...i dont get the high bps but def the low pp is consistant for me.....very concerning with the ventricular dysfunctions involved

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Not that I have an answer for you on this. But, I have the same thing happen. When I first got my DX of POTS about 5 years ago - it wasn't as bad as it got. Now, I'm DX'd with diastolic dysfunction. As my diastolic is tending to stay high most of the time. Most of my issues are with standing though. I'm HyperPOTS with high NE levels and I tend to vasoconstrict. There is a fine line for me with how much to dilate my veins - though. I have had extreme swings in bp ---from both being too low ---to being too high ---to narrow pressure. None of the docs have really come up with an answer on this. I figure, so far, it hasn't killed me ---so it's probably just an odd subset type of POTS and maybe some day we will find the answer. I do have EDS and MCAS and both of those things affect the bp too.

Issie

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Maybe I can help. I am a paramedic, and a pots patient.

Our vitals appear the same ad hypovolemic shock because hypovolemic simply means low blood volume. -POTS is a hypovolemic issue. We do not have enough blood in our bodies, that is why we need the extra salt and water, the density of salt water is the same as blood so our bodies use the salt water as blood volume.

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Our symptoms do look a lot like hypovolemic shock. But it's not because we are actually in shock. We have low blood pressure and high heart rate and our breathing can go all over. Those are the 'signs of shock' -what shock looks like.. You have to have those 3 things to call it shock, but just because you have those 3 things does not mean it is shock. -understand better?

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thanks for the info! I guess what I'm thinking is, though, is that maybe we ARE in shock without the blood loss. I mean, the sx/sy are shock, and the aftereffects are draining. Almost like recovering from shock. So it's not like we're going to continue to decline like in shock, unless we continue to do whatever is creating the symptoms (mine are always from mild-mod exertion), but we may be experiencing shock. hence the exhaustion.

I am also Hyper-POTS with paroxymal BP - high and low swings with variation in PP. Finally getting EPI levels checked next week.

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Despite the doctors knowing/thinking I'm hypovolumic - I've been told because of my kidney dysfunction that I can not take the drugs to correct this. I'm to "try" to stay hydrated - but, can not be offered anything else to help with this. I'm not to salt load----NaDa! My sodium levels stay too high with a serum blood draw. Despite this - I'm dehydrated. Water does not seem to go into my cells properly.

Issie

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So our vitals look like those of a person who is in a state of shock that might occur after having an accident, trauma etc.... Except we're up walking around trying to function like this?

yes, exactly. messed up up, right?!

We have the vitals of someone who's bleeding out, or internally, and all the disabling symptoms. but yah, hey, go to work! do chores! get up and pretend to be normal every day! :(

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I used the analogy of hypervolemic shock once and the doctor told me I didn't have any proof to back it up. However, I still think it is a good analogy. In my case I eventually reach a point where I should stop doing what I am doing and go lie down. If I keep pushing it I find it hard to breath, get smothery and I start to black out from my blood pressure falling way too low. I use to do this to myself a lot and end up crawling back to the house yelling for someone to come help me. I guess I was trying to prove something although I don't know what.

But what I describe above is a perfect example of what happens when someone is bleeding out. One of the last signs to go on a person who has hypervolemic shock is the blood pressure. The body tries every trick it has to keep the bp going and when it can no longer keep up it crashes. They also get anxious due to the hormones the body is pumping out trying to maintain blood pressure.

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Thx for the discussion and explanations...i geuss if dysfunction is ruled out and heart structure is sound therectically we are "trying" to adapt to this state are bodies are in....no wonder we struggle so....its still concerning, i cant seem to trust my body ( especially my heart.) would think if we can send a man to the moon someone could figure this out and fix it!!!!

Angelaintexas, since u are a paramedic, how is someone treated who has traumic hypovulemic shock? (Obviously stopping the cause, ie stopping blood loss etc but after? If u know ? =))

Thx and tc

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