joyagh Posted January 25, 2013 Report Share Posted January 25, 2013 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 eventhough cardiac output has decreased. As compensatory mechanisms fail, the systolicblood pressure falls and the diastolic pressure increases, causing a narrowed pulsepressure.• Other signs include increased tachycardia; cool, clammy skin; rapid, deeprespirations; pulmonary edema (crackles); an S3 gallop; decreased urine output; andimpaired level of consciousness."and"Cardiogenic shock occurs primarily as a result of severe left and/or rightventricular dysfunction that results in inadequate cardiac pumping. The mostcommon cause is myocardial infarction; other causes include cardiomyopathy,ventricular rupture, and congenital heart defects.PATHOGENESIS• Decreased contractility results in decreased cardiac output, which causes decreasedtissue perfusion that is inadequate to meet basal metabolic requirements.• The sympathetic nervous system and renin-angiotensin system are stimulated ascompensatory mechanisms to increase cardiac output. The net result of the activationof compensatory mechanisms is to increase myocardial oxygen demand. This mayprecipitate further myocardial damage, resulting in a progressive decline in cardiacoutput."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 Quote Link to comment Share on other sites More sharing options...
k&ajsmom Posted January 25, 2013 Report Share Posted January 25, 2013 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 Quote Link to comment Share on other sites More sharing options...
issie Posted January 25, 2013 Report Share Posted January 25, 2013 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 Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 25, 2013 Report Share Posted January 25, 2013 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. Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 25, 2013 Report Share Posted January 25, 2013 When you read and learn about cardiogenic shock or hypovolemic shock that's for acute problems or illnesses. Our bodies have adjusted and function accordingly. You worry about hypovolemic shock after like a major trauma where there is a lot of blood loss. It is sudden and unexpected. Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 25, 2013 Report Share Posted January 25, 2013 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? Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 25, 2013 Report Share Posted January 25, 2013 And Issie, you can not feel a pulse on your wrist when your systolic BP is less than 80. That's why it feels so faint when it drops. ) Quote Link to comment Share on other sites More sharing options...
joyagh Posted January 25, 2013 Author Report Share Posted January 25, 2013 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. Quote Link to comment Share on other sites More sharing options...
HopeSprings Posted January 25, 2013 Report Share Posted January 25, 2013 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? Quote Link to comment Share on other sites More sharing options...
issie Posted January 25, 2013 Report Share Posted January 25, 2013 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 Quote Link to comment Share on other sites More sharing options...
joyagh Posted January 25, 2013 Author Report Share Posted January 25, 2013 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! Quote Link to comment Share on other sites More sharing options...
vemee Posted January 26, 2013 Report Share Posted January 26, 2013 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. Quote Link to comment Share on other sites More sharing options...
k&ajsmom Posted January 26, 2013 Report Share Posted January 26, 2013 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 Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 27, 2013 Report Share Posted January 27, 2013 In the field hypovolemic shock is treated with fluid bolus' .... 2 large bore IVs and fluid going in as fast as we can get it to. -and with all types of shock you of course elevate the feet and keep them warm. Quote Link to comment Share on other sites More sharing options...
Angelaintexas Posted January 27, 2013 Report Share Posted January 27, 2013 They need surgical intervention.... Quote Link to comment Share on other sites More sharing options...
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