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small animal medicine > cardio > Flashcards

cardio Flashcards

1
Q

located in the right atrium & contains clusters of pacemaker (P) cells

A

SA node

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2
Q

what is the setup for lead ii

A

right front leg (-) compared to left hind leg (+)

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3
Q

paper speed Multiply by 10 to determine bpm

A

25

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4
Q

Multiply by 20 to determine bpm

A

50

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5
Q

atrial depolarization

A

P wave

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6
Q

ventricular repolarization

A

T wave

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7
Q

ventricular depolarization

A

R wave

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8
Q

time between the end of

ventricular depolarization & the beginning of repolarization, normally isoelectric

A

ST interval

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9
Q

normal ms for QRS complex for dogs and for cats

A

dog <60ms, cat <40ms

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10
Q

what species is sinus arrhythmia normal for

A

brachycephalics

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11
Q

what is sinus arrhythmia

A

shorter on inspiration

longer on expiration

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12
Q

ECG with variable p wave amplitudes

A

wandering pacemaker

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13
Q

what are the 3 mechanisms of arrhythmia formation

A
  1. disturbances of impulse formation
  2. disturbances of impulse transmission
  3. both
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14
Q

breeds that get SSS

A

miniature schnauzer, West Highland white terrier, dachshund, cocker spaniel

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15
Q

T/F

small breeds get A. FIB more commonly

A

FALSE - large breeds

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16
Q

cause of atrial standstill

A

hyperkalemia

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17
Q

what class drug is lidocaine

A

type 1 - sodium blocker

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18
Q

what class drug is atenolol

A

2 - beta blockers

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19
Q

sotalol is what type of drug

A

class 3 - potassium blocker

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20
Q

class 4 drug that is most common

A

diltiazem - ca channel blocker

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21
Q

first choice drug for supraventricular tachycardia

A

diltiazem

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22
Q

first choice drug for atrial fibrillation

A

diltiazem

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23
Q

first choice drug for VT

A

lidocaine - IV unstable patients

sotalol per os if stable

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24
Q

T/F

rhythm control is most common for tx of A fib

A

FALSE - rate control is

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25
Q

what is rate control

A

Slow conduction in the AVN to reduce the # of impulses reaching the ventricles

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26
Q

drug used for rate control

A

diltiazem

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27
Q

T/F

rate control Restores AV synchrony

A

FALSE - rhythm control does

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28
Q

what is the purpose of the atropine response test

A

To differentiate bradyarrhythmias caused by high vagal tone from bradyarrhythmias caused by structural heart disease

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29
Q

what does a positive atropine response test indicate

A

– you will see sinus tachycardia, no pauses and no AV block

• Bradyarrhythmia was likely due to high vagal tone

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30
Q

what does a negative atropine response indicate

A

STRUCTURAL HEART DZ

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31
Q

what arrhythmias can be treated with a pacemakers

A

AVB: Atrioventricular Blocks (AVBs)
▪ High grade 2nd degree AV Block ▪ 3rd Deg AV Block

Sick Sinus Syndrome (the bradycardia requires Pacemaker)

PRIMARY Atrial standstill

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32
Q

a syndrome in which the heart is unable to meet the metabolic needs of tissues despite adequate venous return (VR)

A

heart failure

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33
Q

refers specifically to cardiac malfunction resulting in markedly increased
pulmonary venous and/or systemic venous pressures

A

CHF

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34
Q

backward HF patients are ___

A

wet – due to effusion/edema

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35
Q

forward HF patients are ___

A

cold – hypoperfusion

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36
Q

specifically to severe ventricular dysfunction resulting in poor tissue perfusion & arterial hypotension

A

low output heart failure

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37
Q

T/F

increased ventricular filling pressures will lead to pulmonary congestion and edema

A

TRUE

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38
Q

T/F

low output HF is always before CHF

A

FALSE – other way

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39
Q

The amount of stretching of ventricular myocytes prior to contraction

A

preload

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40
Q

Determined by the quantity of blood that fills the ventricle (ie, end-diastolic volume)

A

preload

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41
Q

when preload increases contractility _____

A

increases

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42
Q

The tension acting on ventricular myocytes after the onset of myocyte shortening

A

afterload

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43
Q

what happens to stroke volume if the afterload increases

A

SV will decrease

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44
Q

The inherent ability of cardiomyocytes to contract

A

inotropy - contractility

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45
Q

when contractility increases – stroke volume ??

A

increases

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46
Q

what are the acute responses to lower co and bp

A

decreases PSNS and increases SNS

- increased vasoconstriction, contractility, HR

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47
Q

concentric hypertrophy

A

pressure overload

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48
Q

eccentric hypertrophy

A

volume overload

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49
Q

cleaves angiotensinogen into angiotensin 1

A

renin

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50
Q

converts ang 1 into ang 2

A

ACE - from the lungs

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51
Q

what does angiotensin II do

A

increase the blood pressure by increases vasocontriction and SNS tone

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52
Q

what is a chronic effect of low CO and BP

A

RAAS activated because renal blood flow is low and the kidney is like hey make more volume

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53
Q

increases water and sodium resorption

A

aldosterone

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54
Q

triggers aldosterone

A

ang II

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55
Q

T/F

aldosterone desreases blood volume

A

FALSE - increases

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56
Q

T/F

the first sign of L-CHF in cats is a cough

A

false - they rarely cough

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57
Q

3 goals of HF therapy

A
  1. relieve congestion
  2. improve cardiac out put
  3. prevent progression
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58
Q

how can congestion be relieved in HF

A

decrease ventricular filling pressure
diuretics - furosemide
venodilators to lower preload
increase forward flow - thoracocentesis

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59
Q

emergency dose furosemide in dog

A

2-4 mg/kg IV

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60
Q

emergency dose furosemide in cat

A

1-3mg/kgIV

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61
Q

Inhibit the Na/K/2Cl

cotransporter in the thick loop of Henle and helps excrete water

A

furosemide – loop diuretic

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62
Q

K sparing and Cardioprotective weak diuretic

A

spironolactone

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63
Q

moa of ace inhibitors

A

dont let ang 1 go to ang ii

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64
Q

what are enalapril and benazepril

A

ACE i

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65
Q

drug of choice for hypertension in dog

A

ACEi - benazepril

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66
Q

nitroprusside is ____

A

vasodilator

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67
Q

Hydralazine is drug of choice for ______

A

hypertensive cats

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68
Q

drug of choice for hypertensive cats

A

Hydralazine

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69
Q

Hydralazine, amlodipine and Sildenafil are all what type of drug

A

vasodilator

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70
Q

positive inotrope and vasodilator used in HF

A

pimobendan

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71
Q

Suppress VPCs & vent tachy with this anti-arrhythmic positive inortope

A

digoxin

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72
Q

used in severe HF and cardiogenic shock - strong beta 1 receptor agonist

A

dobutamine

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73
Q

diltiazam ER dosage

A

Acute ER- 0.1mg/kg IV SLOW over 5 min

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74
Q

lidocaine emergency dose in dogs and cats

A

DOGS: 2 mg/kg IV SLOW over 2-3 min

CATS: 0.2 mg/kg IV SLOW

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75
Q

Chronic management vent tachy & other complex vent tachy

A

sotalol

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76
Q

T/F

vasodilators increase the afterload on the ventricles

A

false – decrease

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77
Q

T/F

in HF patients should should restrict protein in the diet

A

FALSE – PATIENTS will get CACHEXIA: loss of lean body mass (muscle not fat)

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78
Q 
T/F 
drug class of choice for a stressed patient is beta blockers
A

FALSE – only use on stalble patients at home, not emergency cases

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79
Q

if split S2 is pathological what is it due to

A

it is due to pulmonary hypertension

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80
Q

what side of the heart is the tricuspid valve

A

RIGHT

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81
Q

what valve is at the apex beat

A

mitral

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82
Q

what are the valves doing at S1

A

AV closing while semilunar opening

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83
Q

What are the Valves doing at S2

A

Semilunar closing while AV opening

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84
Q

which is a higher pitch: S1 or S2

A

S2

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85
Q

this arrhythmia is usually due to hyperkalemia

A

atrial standstill – no p waves

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86
Q

first step with cranial trauma

A

treat shock first

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87
Q

what type of shunt is seen in PDA

A

L-R

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88
Q

what type of shunt is seen in reversed PDA

A

R - L

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89
Q

what type of hypertophy is seen in PDA

A

vol overload – eccentric

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90
Q

bichon or other toy breed dog with a continuous heart murmur

A

PDA

91
Q

how do you treat PDA

A

surgical ligation

92
Q

poodle with split S2 or no murmur, and cyanotic to paralysis hind legs

A

reversed PDA - not correctable

93
Q

what is PDA

A

Ductus arteriosus remains patent after birth

94
Q

what is SAS

A

Subaortic Stenosis – when fibrous tissue builds in the subvalvular region

95
Q

T/F

subaortic stenosis is not always present at birth

A

TRUE

96
Q

Where is the obstruction with SAS

A

it obstructs blood flow from the LV to the aorta

97
Q

type of overload and hypertrophy in SASA

A

pressure – stenosis!!!!

concentric hypertrophy

98
Q

what type of dogs typically get SAS

A

large and giant breed dogs

99
Q

murmur with sas

A

Left basilar systolic murmur

100
Q

you have a small breed puppy with a bounding femoral pulse and normal HR

A

PDA

101
Q

SAS dogs are also at risk for what

A

sudden death due to vtach

endocarditis

102
Q

Treatment for subaortic stenosis

A

not curable – give cardioprotective drugs

give atenolol beta blocker to lower myocardial o2 demand

103
Q

stenosis that obstructs blood flow from the right ventricle to the pulmonary artery

A

pulmonic stenosis

104
Q

T/F

pulmonic stenosis is most common in cats

A

false - dogs

105
Q

pulmonic stenosis overload and hypertophy

A

stenosis is always pressure

and RIGHT concentric!

106
Q

murmur heard with pulmonic stenosis

A

L basialr systolic

107
Q

ventricular septal defects are common in what animals

A

cats and spaniels

108
Q

T/F

with VSD the larger the defect the louder the murmur

A

false - smaller defect = louder murmur

109
Q

VSD blood flow

A

from LV to RV

110
Q

VSD hypertophy

A

vol overload - left sided eccentrci

111
Q

how can we tell the severity of the VSD

A

doppler

112
Q

VSD tx

A

either banding sx or cardioprotective drugs

113
Q

tricuspid valve dysplasia hypertrophy

A

vol overload and right sided eccentric hypertrophy

114
Q

what murmur is heard in TVD

A

RIGHT apical systolic Murmur

115
Q

TVD is common in what animals

A

cats and labs

116
Q

most common issue with mitral valve dysplasia

A

mitral regurg

117
Q

what side is the mitral vavle

A

left

118
Q

what side chf can be seen with mitral valve dysplasia

A

left

119
Q

T/F

in mitral valve dysplasia there is RV outflow tract obstruction

A

FALSE - left ventricle bc the mitral vavle is on the left

120
Q

when stenosis is present during MVD what is seen

A

the LA is dilated & the LV is small – you could use a thoracic radiograph to see this but an echo is still best ddx

121
Q

Atrioventricular septal defects are common mostly in what animal

A

cats

122
Q

T/F

Atrioventricular septal defects have a really good prognosis if you give drugs

A

FALSE - they will die sorry… CHF and sudden death likely

123
Q

what are the four parts of Tertalogy of fallot

A
  1. Pulmonic stenosis
  2. Secondary concentric
    hypertrophy of the right
    ventricle
  3. Overriding aorta
  4. Ventricular septal def
124
Q

MOST common cause of

cyanotic heart disease in cats & dogs

A

tetralogy of falloy

125
Q

what type of shunt is seen in ToF

A

Right to left – reason for the cyanosis (remember reversed PDA is the same )

126
Q

Vascular ring anomaly (VRA) characterized by persistence of the right fourth aortic arch during fetal development

A

persistent right aortic arch - megaesophagus

127
Q

low grade systolic murmur that will go away by 6 months old

A

innocent

128
Q

in degenerative valve disease this valve gets the most effected

A

mitral

129
Q

what breed is genetically predisposed to DVD

A

king charles spaniels

130
Q

what murmur would you hear if there is degenerative valve disease ?

A

LEFT apical systolic murmur due to the mitral regurg

131
Q

T/F

thoracic rads are good for R-CHF

A

no …

left

132
Q

dog with genetic predisposition to DVD but is not showing signs is what stage

A

A – just monitor

133
Q

dog that is asymptomatic but may have signs of a structural heart disease like a murmur or history of a murmur and there is not sign on the echo or radiographs of cardiogenic remodeling

A

B1

134
Q

dog that is asymptomatic but may have signs of a structural heart disease like a murmur or history of a murmur and there is valve regurg seen on dx tests

A

B2

135
Q

patients with past or current clinical signs of heart failure associated with structural heart
disease are what stage DVD

A

C

136
Q

DVD stage: patients with end-stage disease with clinical signs of heart failure caused by degenerative
valve disease that are refractory to ‘‘standard therapy”

A

D - for death

137
Q

diastolic dysfunction heart disorder in cats where the ventricle wall stiffness increased a lot

A

HCM

138
Q

what cats get HCM

A

rag doll
maine coon
DSH

139
Q

kitty cat with a left sided murmur, gallop heart beat, high BNP on test results, and dyspnea

A

HCM

140
Q

what is a severe complication in HCM

A

ATE - saddle thrombus, cold back legs

141
Q

diastolic dysfunction in cats but the ventricle walls do not increase in thickness they are just not compliant

A

RCM

142
Q

RCM/HCM antithrombic drug?

A

clopidogrel

143
Q

dilated cardiomyopathy is common in what type of dogs

A

big dogs
dobermans
Cocker, Portuguese, Manchester, dane

144
Q

what is the dysfunction in DCM

A

Primary ventricular systolic dysfunction

145
Q

what type of hypertophy is in dilated cardiomyopayhy

A

eccentric due to volume overlaod

146
Q

in cats what should you check for to monitor for DCM

A

taurine and BNP ?

147
Q

what are the genetic mutations in doberman for DCM

A

PDK4 & NCSU DCM 2 mutation

148
Q

asymptomatic stage of DCM

A

occult

149
Q

symptomatic stage of DCM

A

overt

150
Q

what arrythmias are common in DCM

A

-A fib/ V-tach/VPCs common -Sudden death

151
Q

T/F

Dogs cannot die from DCM

A

FALSE - sudden death is common and may be the first sign in some dogs – from V tach

152
Q

what type of murmur would you hear in DCM

A

LEFT apical systolic murmur

153
Q

what type of heart failure is in DCM

A

low output HF

154
Q

what is the cure for DCM

A

nothing … but you can give
Benazepril & pimobenden to slow the progression

diltiazem and digoxin if dog is in a fib

155
Q

Arrhythmogenic Right ventricular cardiomyopathy is a mutation in what gene

A

striatin

156
Q

T/F

Arrhythmogenic Right ventricular cardiomyopathy is diastolic dysfunction

A

FALSE – systolic

157
Q

T/F

Arrhythmogenic Right ventricular cardiomyopathy is common in the right ventricle

A

true….. look at the name???

158
Q

Arrhythmogenic Right ventricular cardiomyopathy most commonly affects this breed of dog

A

BOXER

159
Q

owner comes in like hey my boxer is tired AF

A

Arrhythmogenic Right ventricular cardiomyopathy

160
Q

histologic findings of Arrhythmogenic Right ventricular cardiomyopathy

A

fatty infiltration, myocyte vacuolization, myocyte loss

161
Q

what is a good way to monitor a boxer for Arrhythmogenic Right ventricular cardiomyopathy

A

24 hour holter monitor looking for Electrocardiogram: VPCs originating from right ventricle are upright and lead II (>1000 VPCs)

162
Q

drug of choice for Arrhythmogenic Right ventricular cardiomyopathy

A

sotalol – mexiletine if that doesnt work

there can still be sudden death

if it has type 3 with all the problems:
ARVC + systolic dys (type 3):
-ace inhib
-pimobendan
- furosemide/ spirolactone
163
Q

MOST common pericardial disorder dog/cat

A

pericardial effusion

164
Q

when IPP > ICP

A

diastolic filling pressure will decrease

CARDIAC TAMPONADE — this is an emergency

165
Q

what is the first step when you detect cardiac tamponade

A

pericardiocentesis

166
Q

you have a doggo with a lot of pericardial effusion and you wanna get that fluid to go away, you also have detected cardiac tamponade so you grab furosemide to help get rid of the effusion

A

FALSEEEEE – diuretics are not ok with tamponade plz no

167
Q

what is seen on the ECG with pericardial efffusion

A

alternans- tall short tall short

168
Q

T/F

lactate decreases in pericardial effusion

A

false - increased

169
Q

test to confirm dx of PE

A

FAST

170
Q

what is the cause of degenerative mitral valve disease

A

unknown

171
Q

Dog w/ CHF due to ______ have arteriosclerosis of intramural coronary arteries & myocardial fibrosis

A

degenerative mitral valve disease

172
Q

what do you use to treat stage B2 and stage C of DMVD

A 
ACE inhibitor (enalapril)/ pimobendan
and maybe some spironolactone a few weeks later
173
Q

characterized by moderate or severe left atrial enlargement*

A

left sided cardiomegaly

174
Q

what should the sleeping RRR be at home

A

<30

if greater than 30 start being concenred

175
Q

know the rib method

A

sydney texted it

176
Q

heart murmur caused by tricuspid valve regurg

A

Right sided CHF (think about it- you move to the right of the chest to hear tricuspid!) o +/-leftapicalsystoilcmurmur

177
Q

occursbecausepapillarymusclehypertrophyleadstodisplacementof

chordae tendineae into the LV outflow tract (LVOT)

A

SAM – systolic anterior motion of the mitral valve

178
Q

why do some cats with HCM not have a murmur

A

the blood is flowing normally unless there is SAM or DLVOTO – no turbulence = no murmur

179
Q

what do cats with ATE need for treatment

A

ANALGESIA - this is painful
antithrombotic - heparin or clopagril
supprtive tx

180
Q

4 causes of physiologic murmurs in cats

A
  • Dynamic right ventricular outflow tract obstruction (DRVOTO)
  • Anemia
  • Hyperthyroidism
  • Fever
181
Q

Differential Diagnoses –LV Concentric Hypertrophy

A 
Aorticstenosis 
Systemic hypertension 
Hyperthyroidism
 Acromegaly
lymphoma
182
Q

why are these important

Differential Diagnoses –LV Concentric Hypertrophy

A

must rule all out before saying it is HCM

183
Q

main drug in HF to increase contractility

A

pimobendan

184
Q

the dilation in DCM occurs secondary to ??

A

systolic dysfunction

185
Q

drugs given to treat the occult stage of DCM

A

Benazepril & pimobendane (B-blocker theoretically beneficial)

186
Q

prognosis for occult DCM, and the prognosis once HF develops

A

for occult - this is asymptomatic and they could have 4-5 years until heart failure develops
once develops it is poor to guarded and they could die from sudden death

187
Q

boxers get this most

A

ARVC

188
Q

what does the heart look like grossly in ARVC

A

normal

189
Q

most common arrhythmia associated with ARVC

A

ventricular tachycardia

190
Q

normally the first choice anti-arryhthmic drug to treat ARVC

A 
sotalol - this is a class 3 potassium channel blocker
it also will not affect the GI so no upset tummy
191
Q

allows pericardial sac to stretch with slow fluid accumulation

A

fibroelastic properties

192
Q

s long as the_____ <

A

intrapericardial pressure (IPP) is < intracardiac pressure (ICP)

193
Q

most common location of heart affected by Hemangiosarcoma

A

right atrium/auricle most common

194
Q

number one cause in dogs of pericardial effusion

A

neoplasia – hemngiosarcome

195
Q

features of PPDH on thoracic radiograph

A

Enlarged cardia silhouette, different opacities, globoid

196
Q

order of conduction through the heart

A 
SA 
AV
Bundle HIs 
Bundle branches
purkinje fibers
197
Q

head tilt towards lesion, no CP deficits, HORIZ nystagmus slow toward, fast away. CN7,8

A

peripheral vestibular dz

198
Q

ipsilateral, CP deficits, cranial nerve def. VERT/HORIZ nystagmus, toxic, hypoTh, CN2,3

A

central vestibular dz

199
Q

when vesstibular dz is Lesion on Left, CP deficits on Right

A

paradoxical

200
Q

T/F

cat with cerebellar hypoplasia will have CP deficits and lower reflexes

A

FALSE – just ataxia

201
Q

Tx acute seizures

Tx seizures long

A

diazepam - acute stop

phenobarb always

202
Q

drug to help drain brain edema

A

mannitol

203
Q

– focal hemorrhage and edema, possible CP deficits

A

contusion

204
Q

4 differentials for wide QRS

A
  1. Hyperkalemia
  2. Bundle Branch Blocks
  3. Ventricular Tachycardia
  4. Ventricular Premature Complex
205
Q

hypercalcemia arrythmias

A

raises AP threshold, bradycardia, shorter QT, VPCs

206
Q

hypocalcemia arrhythmias

A

more in skeletal muscle, lowers AP threshold, longer QT

207
Q

hypokalemia arrythmias

A

prolongs repolarization, VPCs, APCs, lowers RMP

208
Q

hyperkalemia arrhythmias

A

tented T waves, wide QRS, long PR interval, absent P wave, V-fib, PEA/EMD

209
Q

High end diastolic pressure in the RV - what side HF

A

R- CHF

210
Q

lowered forward stroke volume = what side HF

A

L - CHF

211
Q

T/F

L-CHf results in hypertension

A

false - hypotension

212
Q

T/F

When an electrical impulse moves toward the positive pole, there will be an upward deflection on the ECG

A

TRUE

213
Q

AV association

A

Same impulse depolarizes; P for every QRS complex

214
Q

T/F

Both hyperkalemia and hypercalcemia can give you tachycardia

A

FALSE – both would give a bradycardia

215
Q

Tx for AIVR

A

none

216
Q

3 drugs that will increase contractility of heart

A

pimobendan
digoxin
dobutamine

these all have positive inotope effedcts

do not use in stenosis problems – contractility is already too high

217
Q

VSD murmur

A

systolic right murmur

this is a L-R shunt

218
Q

DCM is _____ dysfunction and _____ contractility

A

systolic

decreased

219
Q

ECG findings expected with DCM

A

a fib

VPCS

220
Q

type of hypertrophy in HCM

A

LV concentric

221
Q

most common cause of PE in cats

A

R-CHF

222
Q

what breed commonly gets Chemodectoma

A

bulldogs

223
Q

bartonella primarily affects this valve

A

aortic valve

small animal medicine (6 decks)

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