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Small Animal (Poppy) > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Primary causes of dysrhythmias

A

Structural heart disease
Metabolic disease
Electrolyte disorders
Trauma
Drugs and toxins
Sepsis
Neoplasia (especially ventricular)

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2
Q

If ECG shows a long pause and then ventricular escape, should dysrhythmia medication be given?

A

No

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3
Q

If ECG should very early VPC landing on top of a T wave should dysrhythmia medication be given?

A

Yes (make ventricle unstable as asked to depolarise as it repolarises, may fibrillate)

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4
Q

Specialist procedures for dysrhythmias other than antidysrhythmic drugs

A

Pacing
Ablation with catheters
Implantable cardiovertors

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5
Q
A

Brady dysrhythmia
Marked sinus arrythmia with regularly irregular rhythm, pauses terminated by P wave so no need for concern

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6
Q
A

Brady dysrhythmia
Persistent atrial standstill with no P waves, always significant so look for primary cause

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7
Q
A

Brady dysrhythmia
Third degree AV block, P wave unrelated to QRS complex which are wide and bizarre as P wave not conducting (blocked at AV node)

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8
Q
A

Supraventricular tachydysrhythmias
Narrow complex

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9
Q

Causes of tachydysrhythmias

A

Structural heart disease
Systemic disease
Sympathetic nervous system activation
Drugs and toxins

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10
Q

Commonly used anti-dysrhythmic drugs

A

Lidocaine (class 1, sodium channel blocker)
Sotalol (class 3, potassium channel blocker)
Diltiazem (class 4, calcium channel blocker)
Digoxin

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11
Q

Treatment of supraventricular tachycardia

A

Treat underlying primary condition (especially CHF)
Treat clinical signs of poor output: digoxin +/- diltiazem

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12
Q

Problem and treatment

A

Fast supraventricular tachycardia
Frequently in heart failure so treat and rate may drop
If still fast: diltiazem and/or digoxin

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13
Q

Treatment of primary supraventricular tachycardia causing clinical signs (cold extremities/collapse)

A

Diltiazem +/- sotalol

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14
Q

Vagal maneuver for supraventricular tachycardias

A

Increase vagal tone by pushing eyeballs in/massaging carotid

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15
Q

Conditions associated with ventricular premature complexes

A

Structural cardiac disease (congenital/aquired)
Drugs (digitalis glycosides, anaesthetics etc.)
Hypoxia
Autonomic tone
Systemic disease

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16
Q

Indications for antidysrhythmic therapy with VPCs

A

Short coupling interval (‘R on T’ phenomenom)
Clinical signs of dysrhythmia

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17
Q

Medical treatment of critical ventricular dysrhythmias

A

IV lignocaine

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18
Q

Medical treatment of stable/episodic ventricular dysrhythmias

A

Solatol (oral)

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19
Q
A

Normal sinus arrhythmia

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20
Q
A

Normal but seen secondary to high vagal tone (abolished by exercise/atropine)

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21
Q
A

No QRS after P wave
Secondary AV block, not significant

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22
Q
A

Ventricular escape complex
May be vagal, try atropine
Collapsing: treatment
No primary disease: pacemaker

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23
Q

Secondary to thoracic trauma

A

Improved by next day
Atropine to increase rate

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24
Q
A

Second degree AV block (P not followed by QRS)

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25
Q
A

Ventricular rate really low so almost certainly clinical
Pacemaker

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26
Q
A

Third degree AV block (P waves not producing QRS waves)
Needs treatment as probably clinical

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27
Q
A

Wide QRS complex

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28
Q
A

Supraventricular premature complex
If frequent will be poor filling with weak pulses/no pulse as aortic valve not opened (pulse deficit)

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29
Q
A

Supraventricular rhythm
P waves abnormal in middle = not coming from SAN = atrium is ‘sick’

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30
Q
A

Supraventricular tachycardia
Could be sinus or atrial as P waves with every QRS
Narrow complex = conducted through normal system

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31
Q

Dysrhythmia present and likely clinical signs

A

Very fast supraventricular tachycardia
Animal weak and collapsed with high HR

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32
Q

What commonly causes supraventricular tachycardia with atrial fibrillation (no P waves)?

A

Heart failure

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33
Q

Why in this ventricular tachycardia as some complexes normal?

A

Captured by P wave

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34
Q

Why does this dog have ventricular tachycardia?

A

P wave not associated with QRS

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35
Q

How can a dysrhythmia be diagnosed?

A

Paper ECG
5 min ECG
Holter monitor

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36
Q

Sedation for thoracic radiographs

A

Butorphanol
GA if stable

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37
Q

Identify species, enlarged cardiac chambers and evidence of cardiac failure

A

Dog
No cardiac chamber enlargement
Alveolar pattern and border obliteration (pulmonary oedema?)

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38
Q

Identify species, enlarged cardiac chambers and evidence of cardiac failure

A

Dog
Increased sternal contact = right sided enlargement
Ascites in abdomen

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39
Q

Identify species, enlarged cardiac chambers and evidence of cardiac failure

A

Dog
Right sided enlargement
Abdominal ascites

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40
Q

Identify species, enlarged cardiac chambers and evidence of cardiac failure

A

Cat
Heart looks like a heart = both atria enlarged = HCM likely
Bronchial pattern with beginning of an alveolar pattern
Abdominal ascites? Pulmonary oedema?

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41
Q

Clopidogrel

A

Prevent blood clots, high risk in heart disease

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42
Q

What is your top differential?
6y MN Dobermann, some weight loss, 2w history of coughing (worse at night, soft cough), exercise intolerance and tripping on walks, BAR, tachypnoea/tachycardia, occasionally irregularly irregular heart rate and weak, bilateral femoral pulses with occasional pulse deficits

A

Dilated cardiomyopathy
(Echo, ECG, radiograph, bloods)

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43
Q

Treatment for dilated cardiomyopathy

A

Pimobendan (helps heart contract more strongly)
Diuretics (prevent congestive heart failure)

44
Q

Meaning of positive hepatojugular reflex

A

Gentle cranial abdominal pressure causes jugular vein to become more prominent
Signifies that right ventricle cannot accomodate the augmented venous return

45
Q

What does this DV thoracic radiograph show?

A

Pleural effusion

46
Q

Cardiac tamponade

A

Increased pressure around the heart (pericardial disease)

47
Q

Presentation and prognosis of acute pericardial effusion

A

Sudden onset of exercise intolerance, collapse, shock and rapid death if untreated
Poor prognosis

48
Q

Presentation and prognosis of chronic pericardial effusion

A

More common than acute
Typical signs of right sided heart failure (ascites, progressive exercise intolerance, lethargy, GI signs, collapse)

49
Q

Differentials for pericardial disease in dogs

A

Cardiac neoplasia (haemangiosarcoma, heart base tumour, mesothelioma, lymphosarcoma)
Idiopathic (haemorrhagic)
Left atrial rupture
Coagulopathies (DIC, IMHA)
Uraemic
Infection (bacterial and fungal)

50
Q

Differentials for pericardial disease in cats

A

CHF
FIP

51
Q

Pericardial effusion ECG

A

Tachycardia, small complexes

52
Q

Treatment of pericardial effusion

A

(Drugs e.g. diuretics not effective)
Oxygen, IVFT, pericardiocentesis (therapeutic and diagnostic), pericardial strip

53
Q

Pericardiocentesis technique

A

Monitor via ECG
Ultrasound guided
Catheter between 4th and 6th intercostal space at level of costochondral junction
Check for blood clots (iatrogenic damage, blood in pericardial effusion will have exhausted clotting factors)

54
Q

Indications for pericardiectomy

A

Mesothelioma
Idiopathic pericardial disease, 3rd recurrence
Constrictive pericardial disease

55
Q

What is the arrow pointing to?

A

Pericardial cyst

56
Q

Radiographic views for heart

A

Dorsoventral
Right lateral

57
Q

Normal size heart

A

Lateral: 3.5 rib spaces max
DV: 2/3 of width at thorax at rib 6 max

58
Q

Whole cardiac silhouette grossly enlarged, globular appearance, outline distinct, secondary signs of right sided failure

A

Pericardial effusion

59
Q

Trachea pushed up

A

Generalised heart enlargement, hard to differentiate from pericardial effusion

60
Q

What causes this bulge (rather than cardiac waist) and big pulmonary vessel (compared to artery)?

A

Left sided heart enlargement

61
Q

What causes this displaced trachea, less sternal contact and alveolar pattern (pulmonary oedema, arrows)?

A

Left heart failure

62
Q

What causes sternal contact (arrows), pulmonary oedema, ascites and backwards D curve?

A

Right sided heart enlargement

63
Q

What is wrong with the heart in this dog thorax radiograph?

A

Microcardia (looks like cat heart)

64
Q

Where is the right and left side of the heart on radiograph? (Clock)

A
65
Q

Normal size of heart in a cat

A

DV: 2/3 width of thorax at 5th rib
Lateral: 2 IC spaces

66
Q

How does the feline heart change with age?

A

Moveable thorax so more horizontal heart and prominent aortic arch

67
Q

Causes of central cyanosis (desaturation of arterial blood or presence of Hb derivative)

A

Reduced inspired oxygen
Alveolar hypoventilation (high carbon dioxide)
Diffusion impairment
Anatomic R to L shunting
Haemaglobinopathy

68
Q

Causes of peripheral cyanosis (desaturation of blood due to a regional reduction in blood flow)

A

Central cyanosis
Decreased arterial supply
Peripheral vasoconstriction
Arterial thromboembolism
Low cardiac output
Obstruction of venous drainage

69
Q

Cardiac causes of cyanosis

A

Congenital heart disease
Tetralogy of fallot (pulmonic stenosis, VSD, over-riding aorta, right ventricular hypertrophy/dilation)

70
Q

What view is this?

A

Right parasternal long axis 4 chamber view

71
Q

What view is this?

A

Right parasternal long axis 5 chamber view

72
Q

What view is this?

A

Right parasternal short axis view, LV at pap. mm. level

73
Q

What view is this?

A

Right parasternal short axis at chorda tendinae

74
Q

What view is this?

A

Fish mouth/right parasternal short axis at mitral valve

75
Q

What view is this?

A

Right parasternal short axis at aortic valve

76
Q

How do you know is the left atrium is enlarged?

A

Ao:LA </= 1.5 in dogs, 1.4 in cats

77
Q

RPLA LV:LA

A

~1:1

78
Q

Settings to measure chamber sizes

A

M-mode in dogs
2DE in cats

79
Q

Secondary myocardial disease

A

Infective myocarditis
Deficiency diseases (e.g. taurine)
Toxic causes (e.g. some chemotherapy drugs)

80
Q

Dilated cardiomyopathy

A

Impaired myocardial contractility with dilation of LV (+/- RV)
Tachyarrhythmias common
Dobermann, Newfoundland, IWH etc., middle aged
Occult phase (Holter monitor) and symptomatic phase (CHF, syncope, weight loss, cough, death)
Pimobendan +/- diltiazem (if arrhythmia remains)

81
Q

Boxer cardiomyopathy

A

Arrhythmogenic right ventricular cardiomyopathy
Myofibre atrophy, fibrosis and fatty infiltration
Asymptomatic (v. arrhythmias), symptomatic (syncopal/weak from v. arrhythmias, normal heart size/LV function), CHF
Holter monitor: >500VPCs/24h
Treat LCHF if necessary and solatol (beta blocker)

82
Q

Hypertrophic cardiomyopathy in dogs

A

Rare
Young to middle aged large breed dogs, M>F
Syncope/sudden death, CHF, dysrhythmias
Gallop heard if in sinus rhythm

83
Q

Most common heart disease in the cat

A

Hypertrophic cardiomyopathy

84
Q

Hypertrophic cardiomyopathy in the cat

A

Inappropriate myocardial hypertrophy of non-dilated left ventricle
Diagnosis of exclusion
Gallop sounds

85
Q

Feline restricted cardiomyopathy

A

Endocardial, subendocardial or myocardial fibrosis
Atrial enlargement , mild LV hypertrophy, diastolic failure

86
Q

Common cause of feline DCM (becoming rarer)

A

Taurine deficiency

87
Q

Feline DCM

A

Poor contractility
Dilation of all 4 chambers especially LV and LA
Arrhythmias and pleural effusion common, can have bradyarrhythmia
Older cats

88
Q

Murmur with PMI left apex, radiates dorsally and to right thorax

A

Murmur of mitral insufficiency (left apex: MV area)

89
Q

Indications of significant heart disease

A

Grade III murmur or louder (without anaemia)
HR >120bpm
Loss of sinus arrhythmia
Precordial thrill
Dysrhythmia +/- pulse deficits
Weight loss?

90
Q

What heart problem is not diagnosed by echocardiography?

A

Congestive heart failure

91
Q

M mode findings in chronic valve disease

A

Hypermotile (end stage has severe systolic dysfunction)

92
Q

Ruptured chordae tendonae

A

Mitral valve prolapses into atrium (flailing valve leaflet)
Acute emergency with LCHF (severe dyspnoea, cyanotic)

93
Q

Progression of valvular heart disease (overload of cardiac chambers)

A

Ruptured chordae tendonae
Intractable cough
Pulmonary hypertension
Left atrial tear
Tussive syncope

94
Q

Left atrial tear

A

Causes pericardial effusion
Can present with acute cardiac tamponade
Avoid pericardiocentesis (moving clot)

95
Q

Tussive syncope

A

Usually small breed dog (COPD, CDVD, brachycephalic, collapsing trachea)
Syncope, coughing, wretching/gagging
Increased intrathoracic pressure, decreased cerebral blood flow, tachyarrhythmias

96
Q

Endocarditis

A

Rare
Dog&raquo_space; cat
Continuous murmur
Systemic signs
Other systems involved? Blood culture/urine/teeth
CHF due to valve damage, can be years later

97
Q

Cause of heart failure

A

Cardiac output falls, detected as a fall in blood pressure
Compensatory mechanisms good in acute situation but long term make heart work harder and problem becomes worse

98
Q

Compensatory mechanism for reduced cardiac output

A

HR increased
Vasoconstriction
Contractility increased
Salt and water retained

99
Q

Heart failure treatment

A

Diuretics (reduce fluid build up)
ACE inhibitors +/- aldosterone antagonists (antagonise RAAS)
Pimobendan (vasodilate)

100
Q

Ideal surgical treatment of patent ductus arteriosus

A

Amplatz device (placed via jugular vein or femoral artery)

101
Q

Indications for a pacemaker

A

‘Symptomatic bradycardia
Advanced second/third degree atrioventricular block
Persistent atrial standstill
Sick sinus syndrome
Vasovagal syndrome

102
Q
A

Second degree atrioventricular block
P waves not always followed by QRS but still linked

103
Q
A

Third degree atrioventricular block
QRS not in any way related to P wave

104
Q
A

Atrial standstill
No P waves, just ventricles firing slowly and randomly

105
Q

Technique for putting a pacemaker in

A

Implanted transvenously using endocardial leads
(Rarely open surgery using epicardial leads)
Human pacemaker

106
Q

How do you carry out a pericardiocentesis?

A

Large bore cannula, 16-14G, three way stopcock
20/60ml syringe
Extension tube/giving set
4-6th intercostal space just below costochondral junction

Small Animal (Poppy) (20 decks)

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