cardio Flashcards
1
Q
located in the right atrium & contains clusters of pacemaker (P) cells
A
SA node
2
Q
what is the setup for lead ii
A
right front leg (-) compared to left hind leg (+)
3
Q
paper speed Multiply by 10 to determine bpm
A
25
4
Q
Multiply by 20 to determine bpm
A
50
5
Q
atrial depolarization
A
P wave
6
Q
ventricular repolarization
A
T wave
7
Q
ventricular depolarization
A
R wave
8
Q
time between the end of
ventricular depolarization & the beginning of repolarization, normally isoelectric
A
ST interval
9
Q
normal ms for QRS complex for dogs and for cats
A
dog <60ms, cat <40ms
10
Q
what species is sinus arrhythmia normal for
A
brachycephalics
11
Q
what is sinus arrhythmia
A
shorter on inspiration
longer on expiration
12
Q
ECG with variable p wave amplitudes
A
wandering pacemaker
13
Q
what are the 3 mechanisms of arrhythmia formation
A
- disturbances of impulse formation
- disturbances of impulse transmission
- both
14
Q
breeds that get SSS
A
miniature schnauzer, West Highland white terrier, dachshund, cocker spaniel
15
Q
T/F
small breeds get A. FIB more commonly
A
FALSE - large breeds
16
Q
cause of atrial standstill
A
hyperkalemia
17
Q
what class drug is lidocaine
A
type 1 - sodium blocker
18
Q
what class drug is atenolol
A
2 - beta blockers
19
Q
sotalol is what type of drug
A
class 3 - potassium blocker
20
Q
class 4 drug that is most common
A
diltiazem - ca channel blocker
21
Q
first choice drug for supraventricular tachycardia
A
diltiazem
22
Q
first choice drug for atrial fibrillation
A
diltiazem
23
Q
first choice drug for VT
A
lidocaine - IV unstable patients
sotalol per os if stable
24
Q
T/F
rhythm control is most common for tx of A fib
A
FALSE - rate control is
25
what is rate control
Slow conduction in the AVN to reduce the # of impulses reaching the ventricles
26
drug used for rate control
diltiazem
27
T/F
| rate control Restores AV synchrony
FALSE - rhythm control does
28
what is the purpose of the atropine response test
To differentiate bradyarrhythmias caused by high vagal tone from bradyarrhythmias caused by structural heart disease
29
what does a positive atropine response test indicate
-- you will see sinus tachycardia, no pauses and no AV block
• Bradyarrhythmia was likely due to high vagal tone
30
what does a negative atropine response indicate
STRUCTURAL HEART DZ
31
what arrhythmias can be treated with a pacemakers
AVB: Atrioventricular Blocks (AVBs)
▪ High grade 2nd degree AV Block ▪ 3rd Deg AV Block
Sick Sinus Syndrome (the bradycardia requires Pacemaker)
PRIMARY Atrial standstill
32
a syndrome in which the heart is unable to meet the metabolic needs of tissues despite adequate venous return (VR)
heart failure
33
refers specifically to cardiac malfunction resulting in markedly increased
pulmonary venous and/or systemic venous pressures
CHF
34
backward HF patients are ___
wet -- due to effusion/edema
35
forward HF patients are ___
cold -- hypoperfusion
36
specifically to severe ventricular dysfunction resulting in poor tissue perfusion & arterial hypotension
low output heart failure
37
T/F
| increased ventricular filling pressures will lead to pulmonary congestion and edema
TRUE
38
T/F
| low output HF is always before CHF
FALSE -- other way
39
The amount of stretching of ventricular myocytes prior to contraction
preload
40
Determined by the quantity of blood that fills the ventricle (ie, end-diastolic volume)
preload
41
when preload increases contractility _____
increases
42
The tension acting on ventricular myocytes after the onset of myocyte shortening
afterload
43
what happens to stroke volume if the afterload increases
SV will decrease
44
The inherent ability of cardiomyocytes to contract
inotropy - contractility
45
when contractility increases -- stroke volume ??
increases
46
what are the acute responses to lower co and bp
decreases PSNS and increases SNS
| - increased vasoconstriction, contractility, HR
47
concentric hypertrophy
pressure overload
48
eccentric hypertrophy
volume overload
49
cleaves angiotensinogen into angiotensin 1
renin
50
converts ang 1 into ang 2
ACE - from the lungs
51
what does angiotensin II do
increase the blood pressure by increases vasocontriction and SNS tone
52
what is a chronic effect of low CO and BP
RAAS activated because renal blood flow is low and the kidney is like hey make more volume
53
increases water and sodium resorption
aldosterone
54
triggers aldosterone
ang II
55
T/F
| aldosterone desreases blood volume
FALSE - increases
56
T/F
| the first sign of L-CHF in cats is a cough
false - they rarely cough
57
3 goals of HF therapy
1. relieve congestion
2. improve cardiac out put
3. prevent progression
58
how can congestion be relieved in HF
decrease ventricular filling pressure
diuretics - furosemide
venodilators to lower preload
increase forward flow - thoracocentesis
59
emergency dose furosemide in dog
2-4 mg/kg IV
60
emergency dose furosemide in cat
1-3mg/kgIV
61
Inhibit the Na/K/2Cl
| cotransporter in the thick loop of Henle and helps excrete water
furosemide -- loop diuretic
62
K sparing and Cardioprotective weak diuretic
spironolactone
63
moa of ace inhibitors
dont let ang 1 go to ang ii
64
what are enalapril and benazepril
ACE i
65
drug of choice for hypertension in dog
ACEi - benazepril
66
nitroprusside is ____
vasodilator
67
Hydralazine is drug of choice for ______
hypertensive cats
68
drug of choice for hypertensive cats
Hydralazine
69
Hydralazine, amlodipine and Sildenafil are all what type of drug
vasodilator
70
positive inotrope and vasodilator used in HF
pimobendan
71
Suppress VPCs & vent tachy with this anti-arrhythmic positive inortope
digoxin
72
used in severe HF and cardiogenic shock - strong beta 1 receptor agonist
dobutamine
73
diltiazam ER dosage
Acute ER- 0.1mg/kg IV SLOW over 5 min
74
lidocaine emergency dose in dogs and cats
DOGS: 2 mg/kg IV SLOW over 2-3 min
CATS: 0.2 mg/kg IV SLOW
75
Chronic management vent tachy & other complex vent tachy
sotalol
76
T/F
| vasodilators increase the afterload on the ventricles
false -- decrease
77
T/F
| in HF patients should should restrict protein in the diet
FALSE -- PATIENTS will get CACHEXIA: loss of lean body mass (muscle not fat)
78
```
T/F
drug class of choice for a stressed patient is beta blockers
```
FALSE -- only use on stalble patients at home, not emergency cases
79
if split S2 is pathological what is it due to
it is due to pulmonary hypertension
80
what side of the heart is the tricuspid valve
RIGHT
81
what valve is at the apex beat
mitral
82
what are the valves doing at S1
AV closing while semilunar opening
83
What are the Valves doing at S2
Semilunar closing while AV opening
84
which is a higher pitch: S1 or S2
S2
85
this arrhythmia is usually due to hyperkalemia
atrial standstill -- no p waves
86
first step with cranial trauma
treat shock first
87
what type of shunt is seen in PDA
L-R
88
what type of shunt is seen in reversed PDA
R - L
89
what type of hypertophy is seen in PDA
vol overload -- eccentric
90
bichon or other toy breed dog with a continuous heart murmur
PDA
91
how do you treat PDA
surgical ligation
92
poodle with split S2 or no murmur, and cyanotic to paralysis hind legs
reversed PDA - not correctable
93
what is PDA
Ductus arteriosus remains patent after birth
94
what is SAS
Subaortic Stenosis -- when fibrous tissue builds in the subvalvular region
95
T/F
| subaortic stenosis is not always present at birth
TRUE
96
Where is the obstruction with SAS
it obstructs blood flow from the LV to the aorta
97
type of overload and hypertrophy in SASA
pressure -- stenosis!!!!
| concentric hypertrophy
98
what type of dogs typically get SAS
large and giant breed dogs
99
murmur with sas
Left basilar systolic murmur
100
you have a small breed puppy with a bounding femoral pulse and normal HR
PDA
101
SAS dogs are also at risk for what
sudden death due to vtach
| endocarditis
102
Treatment for subaortic stenosis
not curable -- give cardioprotective drugs
| give atenolol beta blocker to lower myocardial o2 demand
103
stenosis that obstructs blood flow from the right ventricle to the pulmonary artery
pulmonic stenosis
104
T/F
| pulmonic stenosis is most common in cats
false - dogs
105
pulmonic stenosis overload and hypertophy
stenosis is always pressure
| and RIGHT concentric!
106
murmur heard with pulmonic stenosis
L basialr systolic
107
ventricular septal defects are common in what animals
cats and spaniels
108
T/F
| with VSD the larger the defect the louder the murmur
false - smaller defect = louder murmur
109
VSD blood flow
from LV to RV
110
VSD hypertophy
vol overload - left sided eccentrci
111
how can we tell the severity of the VSD
doppler
112
VSD tx
either banding sx or cardioprotective drugs
113
tricuspid valve dysplasia hypertrophy
vol overload and right sided eccentric hypertrophy
114
what murmur is heard in TVD
RIGHT apical systolic Murmur
115
TVD is common in what animals
cats and labs
116
most common issue with mitral valve dysplasia
mitral regurg
117
what side is the mitral vavle
left
118
what side chf can be seen with mitral valve dysplasia
left
119
T/F
| in mitral valve dysplasia there is RV outflow tract obstruction
FALSE - left ventricle bc the mitral vavle is on the left
120
when stenosis is present during MVD what is seen
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
Atrioventricular septal defects are common mostly in what animal
cats
122
T/F
| Atrioventricular septal defects have a really good prognosis if you give drugs
FALSE - they will die sorry... CHF and sudden death likely
123
what are the four parts of Tertalogy of fallot
1. Pulmonic stenosis
2. Secondary concentric
hypertrophy of the right
ventricle
3. Overriding aorta
4. Ventricular septal def
124
MOST common cause of
| cyanotic heart disease in cats & dogs
tetralogy of falloy
125
what type of shunt is seen in ToF
Right to left -- reason for the cyanosis (remember reversed PDA is the same )
126
Vascular ring anomaly (VRA) characterized by persistence of the right fourth aortic arch during fetal development
persistent right aortic arch - megaesophagus
127
low grade systolic murmur that will go away by 6 months old
innocent
128
in degenerative valve disease this valve gets the most effected
mitral
129
what breed is genetically predisposed to DVD
king charles spaniels
130
what murmur would you hear if there is degenerative valve disease ?
LEFT apical systolic murmur due to the mitral regurg
131
T/F
| thoracic rads are good for R-CHF
no ...
| left
132
dog with genetic predisposition to DVD but is not showing signs is what stage
A -- just monitor
133
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
B1
134
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
B2
135
patients with past or current clinical signs of heart failure associated with structural heart
disease are what stage DVD
C
136
DVD stage: patients with end-stage disease with clinical signs of heart failure caused by degenerative
valve disease that are refractory to ‘‘standard therapy”
D - for death
137
diastolic dysfunction heart disorder in cats where the ventricle wall stiffness increased a lot
HCM
138
what cats get HCM
rag doll
maine coon
DSH
139
kitty cat with a left sided murmur, gallop heart beat, high BNP on test results, and dyspnea
HCM
140
what is a severe complication in HCM
ATE - saddle thrombus, cold back legs
141
diastolic dysfunction in cats but the ventricle walls do not increase in thickness they are just not compliant
RCM
142
RCM/HCM antithrombic drug?
clopidogrel
143
dilated cardiomyopathy is common in what type of dogs
big dogs
dobermans
Cocker, Portuguese, Manchester, dane
144
what is the dysfunction in DCM
Primary ventricular systolic dysfunction
145
what type of hypertophy is in dilated cardiomyopayhy
eccentric due to volume overlaod
146
in cats what should you check for to monitor for DCM
taurine and BNP ?
147
what are the genetic mutations in doberman for DCM
PDK4 & NCSU DCM 2 mutation
148
asymptomatic stage of DCM
occult
149
symptomatic stage of DCM
overt
150
what arrythmias are common in DCM
-A fib/ V-tach/VPCs common -Sudden death
151
T/F
| Dogs cannot die from DCM
FALSE - sudden death is common and may be the first sign in some dogs -- from V tach
152
what type of murmur would you hear in DCM
LEFT apical systolic murmur
153
what type of heart failure is in DCM
low output HF
154
what is the cure for DCM
nothing ... but you can give
Benazepril & pimobenden to slow the progression
diltiazem and digoxin if dog is in a fib
155
Arrhythmogenic Right ventricular cardiomyopathy is a mutation in what gene
striatin
156
T/F
| Arrhythmogenic Right ventricular cardiomyopathy is diastolic dysfunction
FALSE -- systolic
157
T/F
| Arrhythmogenic Right ventricular cardiomyopathy is common in the right ventricle
true..... look at the name???
158
Arrhythmogenic Right ventricular cardiomyopathy most commonly affects this breed of dog
BOXER
159
owner comes in like hey my boxer is tired AF
Arrhythmogenic Right ventricular cardiomyopathy
160
histologic findings of Arrhythmogenic Right ventricular cardiomyopathy
fatty infiltration, myocyte vacuolization, myocyte loss
161
what is a good way to monitor a boxer for Arrhythmogenic Right ventricular cardiomyopathy
24 hour holter monitor looking for Electrocardiogram: VPCs originating from right ventricle are upright and lead II (>1000 VPCs)
162
drug of choice for Arrhythmogenic Right ventricular cardiomyopathy
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
MOST common pericardial disorder dog/cat
pericardial effusion
164
when IPP > ICP
diastolic filling pressure will decrease
| CARDIAC TAMPONADE --- this is an emergency
165
what is the first step when you detect cardiac tamponade
pericardiocentesis
166
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
FALSEEEEE -- diuretics are not ok with tamponade plz no
167
what is seen on the ECG with pericardial efffusion
alternans- tall short tall short
168
T/F
| lactate decreases in pericardial effusion
false - increased
169
test to confirm dx of PE
FAST
170
what is the cause of degenerative mitral valve disease
unknown
171
Dog w/ CHF due to ______ have arteriosclerosis of intramural coronary arteries & myocardial fibrosis
degenerative mitral valve disease
172
what do you use to treat stage B2 and stage C of DMVD
```
ACE inhibitor (enalapril)/ pimobendan
and maybe some spironolactone a few weeks later
```
173
characterized by moderate or severe left atrial enlargement*
left sided cardiomegaly
174
what should the sleeping RRR be at home
<30
| if greater than 30 start being concenred
175
know the rib method
sydney texted it
176
heart murmur caused by tricuspid valve regurg
Right sided CHF (think about it- you move to the right of the chest to hear tricuspid!) o +/-leftapicalsystoilcmurmur
177
occursbecausepapillarymusclehypertrophyleadstodisplacementof
| chordae tendineae into the LV outflow tract (LVOT)
SAM -- systolic anterior motion of the mitral valve
178
why do some cats with HCM not have a murmur
the blood is flowing normally unless there is SAM or DLVOTO -- no turbulence = no murmur
179
what do cats with ATE need for treatment
ANALGESIA - this is painful
antithrombotic - heparin or clopagril
supprtive tx
180
4 causes of physiologic murmurs in cats
* Dynamic right ventricular outflow tract obstruction (DRVOTO)
* Anemia
* Hyperthyroidism
* Fever
181
Differential Diagnoses –LV Concentric Hypertrophy
```
Aorticstenosis
Systemic hypertension
Hyperthyroidism
Acromegaly
lymphoma
```
182
why are these important
| Differential Diagnoses –LV Concentric Hypertrophy
must rule all out before saying it is HCM
183
main drug in HF to increase contractility
pimobendan
184
the dilation in DCM occurs secondary to ??
systolic dysfunction
185
drugs given to treat the occult stage of DCM
Benazepril & pimobendane (B-blocker theoretically beneficial)
186
prognosis for occult DCM, and the prognosis once HF develops
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
boxers get this most
ARVC
188
what does the heart look like grossly in ARVC
normal
189
most common arrhythmia associated with ARVC
ventricular tachycardia
190
normally the first choice anti-arryhthmic drug to treat ARVC
```
sotalol - this is a class 3 potassium channel blocker
it also will not affect the GI so no upset tummy
```
191
allows pericardial sac to stretch with slow fluid accumulation
fibroelastic properties
192
s long as the_____ <
intrapericardial pressure (IPP) is < intracardiac pressure (ICP)
193
most common location of heart affected by Hemangiosarcoma
right atrium/auricle most common
194
number one cause in dogs of pericardial effusion
neoplasia -- hemngiosarcome
195
features of PPDH on thoracic radiograph
Enlarged cardia silhouette, different opacities, globoid
196
order of conduction through the heart
```
SA
AV
Bundle HIs
Bundle branches
purkinje fibers
```
197
head tilt towards lesion, no CP deficits, HORIZ nystagmus slow toward, fast away. CN7,8
peripheral vestibular dz
198
ipsilateral, CP deficits, cranial nerve def. VERT/HORIZ nystagmus, toxic, hypoTh, CN2,3
central vestibular dz
199
when vesstibular dz is Lesion on Left, CP deficits on Right
paradoxical
200
T/F
| cat with cerebellar hypoplasia will have CP deficits and lower reflexes
FALSE -- just ataxia
201
Tx acute seizures
| Tx seizures long
diazepam - acute stop
| phenobarb always
202
drug to help drain brain edema
mannitol
203
– focal hemorrhage and edema, possible CP deficits
contusion
204
4 differentials for wide QRS
1. Hyperkalemia
2. Bundle Branch Blocks
3. Ventricular Tachycardia
4. Ventricular Premature Complex
205
hypercalcemia arrythmias
raises AP threshold, bradycardia, shorter QT, VPCs
206
hypocalcemia arrhythmias
more in skeletal muscle, lowers AP threshold, longer QT
207
hypokalemia arrythmias
prolongs repolarization, VPCs, APCs, lowers RMP
208
hyperkalemia arrhythmias
tented T waves, wide QRS, long PR interval, absent P wave, V-fib, PEA/EMD
209
High end diastolic pressure in the RV - what side HF
R- CHF
210
lowered forward stroke volume = what side HF
L - CHF
211
T/F
| L-CHf results in hypertension
false - hypotension
212
T/F
| When an electrical impulse moves toward the positive pole, there will be an upward deflection on the ECG
TRUE
213
AV association
Same impulse depolarizes; P for every QRS complex
214
T/F
| Both hyperkalemia and hypercalcemia can give you tachycardia
FALSE -- both would give a bradycardia
215
Tx for AIVR
none
216
3 drugs that will increase contractility of heart
pimobendan
digoxin
dobutamine
these all have positive inotope effedcts
do not use in stenosis problems -- contractility is already too high
217
VSD murmur
systolic right murmur
this is a L-R shunt
218
DCM is _____ dysfunction and _____ contractility
systolic
| decreased
219
ECG findings expected with DCM
a fib
| VPCS
220
type of hypertrophy in HCM
LV concentric
221
most common cause of PE in cats
R-CHF
222
what breed commonly gets Chemodectoma
bulldogs
223
bartonella primarily affects this valve
aortic valve
