AV Valve Disease

Question 1

RULE #1 of the heart

Answer 1

Arteries flow away from the heart,

Veins throw away towards the heart

Question 2

RULE #2 of the heart

Answer 2

The heart is a muscle. More pressure on the heart makes it bigger.

Question 3

RULE #3 of the heart

Answer 3

The heart has 3 main functions:

1. Conduct electricity to stimulate contraction
2. Systole
3. Diastole

Question 4

RULE #4 of the heart

Answer 4

water is LAZY! It flows from high pressure to low pressure

Question 5

RULE #5 of the heart

Answer 5

BP = CO x SVR
CO = SV x HR
SV depends on Preload, Afterload, Contractility

Question 6

RULE #6 of the heart

Answer 6

The heart has limited responses to disease.

• Systolic dysfunction, Volume overload ECCENTRIC HYPERTROPHY
• Diastolic dysfunction, Pressure overload CONCENTRIC HYPERTROPHY

Question 7

systolic dysfunction means:

Answer 7

failure to eject all of the blood from the ventricle

Question 8

Mitral Regurgitation
PMI: ?
Timing: ?
Quality: ?
Femoral pulse quality: ?

Answer 8

PMI: Left Apex
Timing: systole
Quality: regurgitant/plateau/band/flat
Femoral pulse quality: can be weak

Question 9

2 types/causes of Primary Systolic Dysfunction?

Answer 9

Dilated Cardiomyopathy (DCM)
Arrhythmic Right Ventricular Cardiomyopathy (ARVC)

Question 10

Processes/conditions that are causes of Secondary Systolic dysfunction? (5)

Answer 10

Toxin/Drug
Dietary deficiency
Tachycardia-induced cardiomyopathy
Hypothyroidism
Inflammation (leads to myocarditis)

Question 11

Effects of Thyroid hormones on the heart:
indirect effects?
direct effects?

Answer 11

Indirect effects: increase metabolic rate, thus increasing the oxygen demand of tissues (including the myocardium itself!)
direct effects: + intropy, + chronotropy

Question 12

Arrhythmias that occur with Tachycardia-induced cardiomyopathy? (2)

Answer 12

supraventricular tachycardia, atrial fibrillation

Question 13

Treatment for tachycardia-induced cardiomyopathy?

Answer 13

Stop the tachycardia! Antiarrhythmic meds: Beta-blocker, sotalol, diltiazem, digoxin.

Question 14

Dietary deficiencies that causes systolic dysfunction?

Answer 14

Taurine deficiency, L-carnitine deficiency.

Question 15

Cats and cocker spaniels are susceptible to ____ deficiency.

Answer 15

taurine

Question 16

treatment for taurine deficiency

Answer 16

Treat the CHF: furosemide, pimobendan, ACE inhibitors.

Give Taurine: Cat 250 mg/kg; dog 500 mg/kg

Question 17

taurine deficiency causes ___ and ____

Answer 17

secondary systolic dysfunction and central retinal degeneratoin

Question 18

who gets L-carnitine deficiency?

Answer 18

American Cocker Spaniel, Golden retrievers, boxers

Question 19

treatment for L-carnitine deficiency

Answer 19

Treat CHF: furosemide, pimobendan, ACE- inhibitor,

Give L-carnitine! 50-100mg/kg PO TID

Question 20

what nutritional deficiency can lead to systolic dysfunction in large animals? What is the disease called in horses/cows vs. pigs?

Answer 20

Selenium deficiency.

White muscle dz/ mulberry dz

Question 21

chemotherapeutic agent that can cause systolic dysfunction

Answer 21

doxorubicin

Question 22

who gets DCM?

Answer 22

DOBERMANS, irish wolfhounds, great danes, boxers, Cocker spaniels

Question 23

Treatment for DCM

Answer 23

mild/no CHF: drugs not necessary, monitor
moderate/severe, no CHF: pimobendan, +/- ACE inhibitor
Fulminant DCM with CHF: furosemide, pimobendan, ACE inhibitor, +/- spironolactone, +/- antiarrhythmics

Question 24

DCM -> CHF -> ? (Think RULE #1)

Answer 24

pulmonary edema

Question 25

arrhythmogenic right ventricular cardiomyopathy (ARVC) causes ___ and can lead to _____ &_____

Answer 25

arrhythmias. can lead to syncope and sudden death.

Question 26

histologic changes in the myocardium secondary to ARVC?

Answer 26

fibro-fatty replacement of myocytes

Question 27

how do you diagnose ARVC?

Answer 27

Holter monitor for 24hr, count the number of arrhythmias.

echocardiogram

Question 28

treatment for ARVC

Answer 28

treat CHF if present: furosemide, pimobendan, ACE inhibitors, +/- spironolactone

Question 29

ARVC -> CHF -> ?

Answer 29

Pleural effusion