cardio Flashcards
what is preload
volume; how%much%blood%coming%back
what is afterload
pressure;how hard the heart works to get blood out
explain the frank sterling rule
what.goes.in.must.come out./.move in.=.squeeze.
harder;ability of heart to contract in response to changes in venous return
increase in venous return-increase in sv
heart first priority
1.=.maintain.normal.systemic.arterial.pressure%
(#2.maintain.normal.tissue.blood.flow,.#3.maintain.normal.
systemic.and.pulmonary.capillary.pressure),
decrease in contractibility results in decreased ability to get rid of the preload–⇒failed starling
heart dz in texas u should suspect in a dog with heart failure
trypanosome/chagis
signs of CHF
backwardsfailure,
respiratory signs,
ascites
signs of decreased CO (late onset)
forward failure (exercise intolerance,syncope,prerenal azotemia,cyanosis)
- Exercise.intolerance.may.be.first.sign
what is CHF
- end stage for many heart .diseases,
- pulmonary edema (dogLIside backwards fail common),
- pleural effusion(catL/R fail),
hepatic.congestion/ascites.(RFside.backwards.fail),
.jug. vein.distention(can see%quickly),
cachexia
APPARENCE OF A PATIENT WITH CHF
- Appearance: anxious, open mouth breathing,orthopnea, tachypnea, hyperpnea
- Syncope:exertion/excitement,stiff forelimbs, pee, wake up fine
- Seizure:tonic clonic, defecate, can happen at rest
- Cough:mainstem.bronchi.compression,with CHF or heart fail, pneumonitis.and.vascular.Dz.2°.to.HWD,.non cardiac.(airway,.parenchymal,.pleural.space)
⇒doesnt indicate CHF necessarily
- PE: check mm, CRT (anemia, poor perfusion, differential cyanosis), ab palpate (fluid wave), jug%pulse, chest palpate (precordium),
arterial pulse abnormal (pulse pressure difference, auscultate
define grade 1 murmur
very faint,heard only after lister has turned inmay not be heard in all positions
describe type 2 murmur
quite but heard immeiately after placing a stethoscope on the chest
describe a type 3 murmur
moderate loud
discribe type 4 murmur
loud with palpable thrill (tremor or vibration felt on palpation)
describe grade 5 murmur
very loud with thrill,may be heard when the stethoscope is partly off the chest
describe grade 6 murmur
very loud with thrill .may be heard with the stephoscope entirely off the chest
describe the jug pulse and list causes
- increase in the venous P (RFside.fail(tricuspid dz, pulmonary increase in BP, carval syndrome),
- pericardial.Dz,.
- volume.overload,.
- Cr..mediastinal.mass)
describe concentric hypertrophy
its due to increase in bp
parallel fibers
describe eccentric hypertrophy
increase in volume
outward series fibers
escribe neurohormonal activaion in any cardiac failure
compensatory in any heart failure
- increase in symphathetic tone
- decrease in PNS tone
- activate RAAS and ADH
LIST THE ACE INHIBITORS
- ENALPRIL
- BENAZEPRIL
- LISINOPRIL
WHAT ARE THE CHARACTERISTICS OF ACE INHIBITORS
- VASODILATE (SOME MAY ARTERIO-DILATE)
- MODERATE NEUROHOMONAL ACTIVITY(INHIBIT RAAS)
- DECREASE RESISTANCE IN BLOOD VESSELS (DECREASE PRELOAD AND AFTERLOAD)
- DECREASED WATWER RETENTION (CAUTION IN RENAL FAILURE)
- DCM
- DECREASE BP
LIST THE DIURETICS USED TO TREAT HEART FAILURE
- FUROSEMIDE
- SPIRONOLACTONE
- CHLOTHIAZIDE
- HYDROCHLOROTHIAZIDE
- FIRST LINE OF DEFENSE IN CHF
- ONCE CONTROLLED, GRADUALLY DECREASE THE DOSE
- +/- ANOTHER DRUG (BENAZAPRIL,ENALAPRIL)
- DECREASE PRELOAD
LIST THE POSITIVE IONOTROPES
- DIGOXIN
- PIMOBENDAN
- DOPAMINE
- DOBUTAMINE
*
DISCUSS THE CHARACTERISTICS OF POSITIVE INOTROPHES
- INCREASES MYOCARDIAL CONTRACTILITY
- GOOD IF YOU HAV MYOCARDIAL FAILURE (MEASURE SHORTENED FRACTION)
- MODERATE EXCESS NEUROHORMONAL ACTIVITY
- DCM
*
DISCUSS DIGOXINE
- IT IS A WEAK INOTROPH
- IT DECREASES CONDUCTION VELOCITY THRU AV
- IT DECREASES THE HEART RATE
- BETER AS AN ANTIARRHYMIC DRUG
- NA/K/ATPASE INHIBITOR
- INCREASE CA
*
WHAT ARE THE DISADVANTAGES OF DIGOXIN
EVENTHOUGH IT IS GOOD AT DECREASING THE SUPRAVENTRICULAR ARRHYTHMIAS, IT CAUSES VENTRICULAR ARRTHMIAS
IT INCREASES CA IN THE INTRAVENTRICULAR CELLS
DISCUSS PINOBENDAN
IONOTROPH AND VASODILATOR
IT WORKS BY ENHANCEING MYOCARDIAL CELL SENSITIVITY TO ICF CA CAUSING INOTROPIC EFFECTS, INHIBITS PHOSPHOSTERASE 111, ARTERIAL AND VENOUS DILATION,
IT PROLONGS THE SURVIVAL OF THE DCM DOG
IT WORKS IN TWO WAYS;
- IT SENSITISE THE MYOCARDIUM CAUSING THE HEART TO CONTRACT HARDER AND WORKS ON THE PHERIPHERY TO DILATE THE BV
- it decreases the afterload so making the heart work less while increasing contractility to help the heart get the blood out
LIST THE CA CHANNEL BLOCKERS
DILTIAZEM%
DISCUSS THE CHARACTERISTICS OF CA CHANNEL BLOCKERS
- control%rhythm%%
- promote myocardial relaxation with HCM
- slows A-fiber in dogs
- decrease BP
- amlodipine=peripheral (CHF)
- diltiazemI=central (HCM)
list the B blockers
- ATENOLOL
- PROPRANOLOL
- CARVEDILOL
- SOTALOL
list the characteristics of b blockers
- antagonize SNS
- decreases HR and BP
- DECREASE HEART O2 DEMAND
- control rhythm (AIfib,ARVC/Boxers)
- digoxin to decrease HR with A-fiber in dogs
- HCM,DCM
- congenital malformations
- caution with myocardial failure
- n.b it is fantastic in kitty cards with myocardial dz
- it chills stuff up.
the only thing keeping the dog alive is the crazy heart so if u give the b blocker then u might kill the dog
characteristics of vasodilators
- increases the venous capacitance
- decrease preload
- dilate veins
- reduce congestion
- volume redistribution
list the arteriodilators
- NITROPRUSSIDE
- HYDRALAZINE
- AMLODIPINE
discuss the characterists of arteriodilators
- severe decrease in BP (do not use with P overload i.e subaotic stenosis
describe pulmonary edema in dogs
canine left sided backward heart failure
describe pleural effusion in cats
either left or right sided heart failure
give an example of a right sided backward heart failure
hepatic congestion/ascites
clinical signs of CHF
- end stage for many cardiac dz
- pulmonary edema-dogs-left sided….
- pleural effusion in cats (both left and right)
- hepatic congestion/ascites
- jajular vein distension
- cachexia
appearance of a dog with CHF
- anxious
- tachypnea-shoort and shallow breaths due to pulmonary edema
- orthopnea and elbow ubducted
- hyperapnea-increased depth ue to hypoxia and hypercarbia
- inspiration vs expiration–upper airway vs lower airway
signs of syncope
- exertion or excitement
- rear limb weakness
- sudden collapse
- lateral recumbency
- stiffness of the forelimbs and epistotonos
- micturition
- vocalization\
- hypoxia
possible causes of coughing
- CHF
- mainstem bronchi compression
- pneumonitis and vascular disease secondary to HWD
- non cardiac dz
- airway dz
- parenchymal z
- pleural space dz
causes of right side heart failure
- tricuspid dz
- pulmonary hypertension
- caval syndrome
causes of increased venous pressure
- right sided cardiac failure
- pulmonary hypertension
- caval syndrome
- tricuspid dz
- pericardial dz
- volume overload
- cr. mediastinal mass
concentric hypetrophy
- increases in P
- fibers added in parallel
eccentric hypertrophy
- increase in volume
- dibers adde in series
causes of decreased cardiac output
- dilated cardiomyopathy
dicuss the neurohormonal activity that compenate for cardiac failure
- increased sympathetic tone
- decreased parasympathetic tone
- activation of the RAAS AND ADH/VP
CONSEQUENCE OF SYSTOLIC MYOCARDIAL FAILURE
CANNOT GET BLOOD OUT OF THE HEART
DISCUSS DIASTOLIC MYOCARDIAL FAILURE
- hypertrophic cadiomyopathy-probem in diastole.
- the heart receicve blood in diastole.if the heart is fast,less blood goes to the heart
DIURETIC DRUG USED IN CHF
- FUROCEMIDE
- IT DECREASE PRELOAD
WHICH DRUGS ARE USED TO CAUSE VOLUME REDISTRIBUTION IN CHF
- VENODILATORS
- NITROGLYCERINE OITMENT
- NITROPRUSSIDE ICU
ANXIOLYTIC DRUGS USED TO TREAT CHF
- OPIODS
- DIAZEPAM
- ACEPROMAZINE
DRUGS THAT MINIMISE BRONCHOCONSTRICTION IN CHF
- AMINOPHYLLINE
DRUGS THAT DECREASE AFTERLOAD IN CHF
- ARTERIODILATORS
- HYDRALAZINE
- ENALAPRIL
- AMLODIPINE
DDX FOR CRACKLES
- PNEUMONIA
- PLEURAL FLUID
DRUGS THAT INCREASES MYOCARDIAL CONTRACTION IN MYOCARDIAL FAILURE
- PIMOBENDAN
- DOBUTAMINE
- AMRINONE
DRUGS FOR TREATING HYPERTOPHIC CARDIOMYOPATHY IN CATS
- B BLOCKERS
- THEY ARE Ca. channel blockers
discuss diet for animals wth chronic CHF
- salt restricitions
- L-carnitine
- taurine
what should u be concerned about when tx a patient with CHf with spironolactone
- monitor K levels
- its an aldosterone antagonist diuretic
which diuretic should u not used in CHF patients with kidney dz
- thiazides
list the ace inhibitors used to tx CHF
- enalapril
- used in patients with proteinuria
- benazepril
- Mainly for neuroendocrine modulating effects
- Arterial dilator–decrease artetial bp
- caution in renal failure
list the vasodilatic drugs used in CHF
- hydralazine–arterial effects
- amlodipine
- ca channel blocker.better than hydralazine
amlodipine - it is a very good vasodilator
works on the periphery
- ca channel blocker.better than hydralazine
list the positive ionotrophs use to tx chf
- pimobendan
- Phosphodiesterase III inhibitor
- ionodilator
- sensitice the heart to ca and makes it beat harder.
- it also acts on the periphery to dilate bv
it decreases the afterload so making the heart work less while increasing contractility to help the heart get the blood out
-
digoxin
- Also anti-and pro-arrhythmic
- Na+/K+ATPase inhibitor
- increases ca
discuss mechanism of action for pimobendan
- it is a positive inotroph
- Phosphodiesterase III inhibitor
- ionodilator
- it sensitice the heart to ca and makes it beat harder.
- it also acts on the periphery to dilate bv
it decreases the afterload so making the heart work less while increasing contractility to help the heart get the blood out
* decreases the afterload and increase the heart contractability
discuss the mechanisms of digoxin
- Also anti-and pro-arrhythmic
- Na+/K+ATPase inhibitor
- ↑Ca++
- it has lots of side effects
- it decreases the supraventricular arrrhythmias ( good)
- while causing ventricular arryhythmia.it fix 1 and cause the other
- it increeases ca in the intraventricular cells
iscuss use of b blockers
- for kitty cat.fantastic for arrrhymias
- Caution with myocardial failure—it chills stuff up.
the only thing keeping the dog alive is the crazy heart so if u give the b blocker then u might kill the dog - HCM
- Arrhythmias
- Atrial fibrillation
- ARVC/Boxers
CA CHANNEL BLOCKER WORKING ON THE HEART
- DILTIAZEM
CA CHANNEL BLOCKER USED TO TX CHF AND WORKING ON THE PERIPHERY
AMLODINE
PRIMARY HEART DZ OF CATS
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy–COMMON IN DOGS
- Congenital
- Ventricular Septal Defects VSD
- Valve malformations
SECONDARY CARDIAC DISEASES IN CATS
- THYROTOXIC CARDIOMYOPATHY
- SYSTEMIC CARDIOMYOPATHY
- cause heart dz due to increase in afterload.
heart gets bigger coz iT has to work harder
it is secondary hypermyopathy
- cause heart dz due to increase in afterload.
main characteristics of HCM
- idiopathic L ventricular hypertrophy
- systolic murmur felt on sternum
- diastolic failure
- systolic anterior motion of mitral valve
- aotic thromboembolism
- sudden death
describe the mechanism/progression of HCM
- increase in LA and Pv pressure
- LA dilate,pulmonary congestion, edema→ thrombus→SAM/Dynamic outflow obstruction→AF
DISCUSS TX FOR HCM
- B BLOCKERS( ATENOLOL)
- CA CHANNEL BLOCKERS (DIALTIAZEM)
- ACE INHIBITORS (BENZEPRIL)
WHAT IS THE CAUSE OF RESTRICTIVE CARDIOMYOPATHY
- IDIOPATHIC
- LV ENDOMYOCARDIAL FIBROSIS
- GALLOP RHYTHM
CHARACTERISTICS OF HCM
- IDIOPATHIC IV HYPERTROPHY
- SYSTOLIC MURMUR HEARD ON THE STERNUM
- GALLOP RHYTHM
- LEFT/BIVENTRICULAR CHF
- DIASTOLIC FAILURE
- SAM→OUTFLOW OBSTRUCTION
- ATE-OBSTRUCTIVE AOTIC EMBOLISM
- ATRIAL FIBRILLATION
- SUDDEN DEATH
BJECTIVES FOR TX HCM
- VENTRICULAR FILLING
- RELIEVE CONGESTION
- CONTROL ARRTHMIAS
- MINIMISE ISHEMIA
- PREVENT TBE
CAUSE OF RESTRICTIVE CARDIOMYOPATHY
- IDIOPATHIC
- LEFT VENTRICULAR ENDOMYOCARDIAL FIBROSIS
SIGNALMENT FOR RESTRICTIVE CARDIOMYOPATHY
MIDDLE AGE TO OLDER CATS
CS OF RESTRICTIVE CARDIOMYOPATHY
- SAME AS HCM
- Systolic murmur HEARD ON Sternum
- Gallop rhythm
- Left/biventricular CHF
- •ATE
- •Ventricular arrythmias
- Sudden death
DEGENERATIVE VALVE DZ
ENDOCARDIOSIS
UP TO PG 55
what is the prognosis for dobbermans with DCM
IF DX WITH DCM WITH CONCURENT CHF THEN WE DIE QUICKLY
WHICH SIDE OF THE HEART IS MOSTLY AFFECTED WITH PERICARIAL DZ
- RIGHT SIDED CHF COZ THE RIGHT VENTRICLE IS WIMPY.
- THE LEFT SIDE IS MUCH STRONGER
- THINK ABOUT IT AS A HEART INSIDE A BOX WITH WATER AROUND IT PUSHING ON IT
causes of pericardial effusion
- hemorrhage
- exudate
- transdudate
- coagulopathies
- trauma
list all the things that cuase transdudate which altimately results in pericardial effusion
- hypoproteinemia
- heart base mass
- CHF
- HERNIA
*
list all the things that cuase EXUDATION which altimately results in pericardial effusion
- PERFORATION-FB
- FIP-CATS, NORCARDIA-RARE
- DOG-FUNGUAL
which valves likes to regurgitate
mitral and tricuspid
which valves likes to stenose
- pulmonic and
- aotic
combination of ventricular and atrial septal defect
fallot of tetralogy
what kind of a murmur is subaotic stenosis
crescendo-decrescendo murmur
where do u hear subaotic stenosis( sas) the loudest
- loudest over the heart base
- musical
- can radiate anywhere
- you can hear the murmur on top of their heads
what kind of a murmur is pulmonic stenosis
crescendo/decrescendo
where do u hear pulmonic stenosis the most
over left heart base
the best way to tx PA
- ballon valvuloplasty
- u gonna blow the valve and creat pulmonic insufficiency which is much better than PA
when do u fix pda vs ps
- pda= right away
- ps=can wait
ich animals arelikely to get vsd
cats more than dogs
which conditions gives u systolic plateau murmur on the right side
- vsd
- tricuspid valve
why do u get a functional ps with concurent left sided murmur when u have vsd
this is because more blood is shunted to the right side and more blood means there is going to be a lot trying to pass through the pulmonic valve hence ctreating a functional ps
which type of atrial septal defect is more common dogs
fossa ovalis
main reason why we hav mitral insufficiency
endocardiosis
primary ddx on a poodle with a murmur
endorcardiosis
heard dz due to trypanosoma
- acute endocardiosis
- leads to dcm
discuss changes in lefet sided backward failure
- increase in capillary hydrostatic p
- blood backs into lungs
discuss right sided heart failure
ascites
portal hypertension
which murmurs like to do crwscendo decreshendo
aotic and pulmonic stenosis
which valves like to do holosystolic plateau murmurs
- mitral and tricuspid and vsd
most common canine cardiac dz
valvular endocardiosis
sequela of valvular endocardiosis
- volume overload
- endocardial fibrosis
- chf–usually before miocardial pump function decrease
- left bronchial compression
- chordae tendinae rupture
- left atrial tears and rupture
- atrial fibrillation
valves mostly affected by endocarditis
aotic and mitral
which endocardiosis predispose the dogs to endocarditis
- mitral insufficiency
- sas
