14. Pre-existing Disease

Question 1

Most common heart conditions in dogs and cats?

Answer 1

*Mitral regurg in dogs
*HCM in cats
Also DCM

Question 2

Advanced heart failure (stage D) contraindicates anesthesia

T/F?

Answer 2

True

Question 3

MVO2?

why do we care?

Answer 3

myocardial oxygen consuption

- we don’t want to increase it / Don’t want severe tachycardia

Question 4

Mitral regurgitation main goal?

What type of problem is it?

Answer 4

reduce the regurgitant flow

Volume load problem

Question 5

How to change anesthetic plan for mitral regurg

Answer 5

• reduce preload
• peripheral vasodilation (avoid vasoconstricting drug)
• avoid depression of contractility
• prefer higher HR (less time in systole)

Question 6

How to use fluids in mitral regurgitation

Answer 6

• 3-5 ml/kg/hr; don’t bolus

- reduce sodium load, these patients retain sodium

Question 7

How to treat hypotension in mitral regurg patients?

Answer 7

CRI dopamine/dobutamine (dopamine also vasodilates)

NOT fluids!

Question 8

meds for mitral regurg

premed
induction
maintenance

Answer 8

premed: Ace if needed, opioids

induction:
1. Propofol or Alfaxalone (vasodilation but dec. contractility) Do a combo with benzo.
2. Ketamine
3. Etomidate (gagging, myoclonus)
4. benzo and opioid in depressed patient

maintain - iso

Question 9

avoid ___ and ____ in post-op mitral valve regurg patients

Answer 9

hypoxemia, hypercapnia

Question 10

HCM - thickened ________.

Answer 10

L ventrical and septum

Question 11

goal in treating hCM pt

Answer 11

increase diastolic filling

Question 12

prevent ______ in HCM

Answer 12

anterior systolic motion, vasodilation

Question 13

preload?
afterload?
contractility?
in HCM

Answer 13

• maintain preload
• increase afterload
• myocardial depression is acceptable

Question 14

drugs contraindicated in hcm

Answer 14

ketamine (inc. contractility and HR) Ace, atropine

Question 15

induction in hcm

Answer 15

induction:
- propofol with benzo
- etomitate
- benzo and opiod in depressed animals

Question 16

hypotension in hcm

Answer 16

not dobutamine bc. inc contractility

use phenylephrine for vasocontriction

Question 17

DCM and pulmonic stenosis are both ____ ____ problems

Answer 17

pressure loading (vs. other two were volume loading)

Question 18

DCM
preload?
afterload?
***contractility?

Answer 18

• reduce preload
• avoid vasoconstriction
• increase contractility (dobutamine)

Question 19

main goal for dcm

Answer 19

maintain and support contractility (dobutamine)