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Small Animal Medicine > Cardio Basics > Flashcards

Cardio Basics Flashcards

ECG and Echo

1
Q

DfDx for pale mucous membranes

A

Anemia

Peripheral vasoconstriction

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2
Q

DfDx for bright red mucous membranes

A

Excitement
Peripheral vasodilation
Sepsis
Polycythemia

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3
Q

DfDx for blue/gray mucous membranes

A 
Airway disease 
Pulmonary parenchymal disease
Right to left cardiac shunt
Hypoventilation 
Shock 
Methemoglobinemia
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4
Q

DfDx for icteric mucous membranes

A

Hemolysis

Hepatobiliary disease

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5
Q

DfDx for Jugular Pulsations

A

Jugular pulse DOES NOT indicate congestive heart failure

Indicate elevated right heart filling pressures or obstruction to filling of the right heart

Tricuspid insufficiency
Hypertrophied right ventricle (ex. pulmonic stenosis, pulmonary hypertension)
Certain arrhythmias (heart block)

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6
Q

DfDx of Jugular distension (+/- pulsations)

A

Occlusion of the cranial vena cava/RA by external compression (mass or thrombosis)

Very high right heart filling pressures (pericardial effusion)

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7
Q

Precordial thrill

A

Palpable Murmur

Loud murmur that has a palpable buzzing sensation on the chest wall over the heart

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8
Q

Shifted precordial impulse

A

Cardiac enlargement (right heart hypertrophy)
Mass lesions displacing the heart
Collapsed lung lobes allowing cardiac displacement
Focal accumulations of air or fluid

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9
Q

Decreased intensity of precordial impulse

A 
Obesity 
Pleural effusion
Pericardial effusion
Weak cardiac contractions 
Thoracic masses
Pneumothorax
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10
Q

What do you feel when feeling for a pulse?

Diastolic? Systolic?

A

Systolic!

Blood loss: will feel decreased pulse

Excitement; increase pulse

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11
Q

Causes of hyperkinetic pulses

A

High adrenergic tone
PDA (decreases diastolic)
Aortic regurgitation

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12
Q

Causes of hypokinetic pulses

A

Reduced stroke volume
Heart failure
Hypovolemia
Some arrhythmias

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13
Q

Causes of turbulent blood flow (general)

A

Murmur = turbulent blood flow (hear sound when there should be silence)

Increased velocity (narrowed vessels, abnormal valves, shunts)

Decreased viscosity (anemia, valves could be fine)

Large diameter vessels (horse, cows) - physiologic murmur

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14
Q

How do you describe murmurs

A

Timing (systolic or diastolic)
PMI
Pitch and quality

Intensity
Radiation

Murmur sounds are not correlated with disease severity

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15
Q

Most common dog murmur?

And what timing?

A

Mitral valve

Systolic (90%)

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16
Q

S1
What is it
Pathologic

A

Closing of the AV valves and vibrations of cardiac walls (deceleration of blood)

Pathologic:
Split S1 can be heard with ventricular premature contractions (VPCs)

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17
Q

S2
What is it
Pathologic

A

Closure of the pulmonic and aortic valves

Pathologic:
Split S2; delayed closure of the pulmonic valve (VPCs, RV hypertrophy) or aortic valve (VPCs, LV hypertrophy)

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18
Q

S3
What is it
Pathologic

A

Vibrations in the heart wall associated with rapid ventricular filling (normal in horses)
Diastolic sound

Pathologic:
Dogs and cats; dilated ventricles (DCM) and is referred to as a gallop rhythm

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19
Q

S4
What is it
Pathologic

A

Atrial contraction (normal in large animals)

Pathologic:
Dogs and cats; contraction of very dilated atria, secondary to ventricular hypertrophy (HCM) also called a gallop

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20
Q

When does Systolic occur (S phases)

A

Between S1 and S2

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21
Q

When does Diastolic occur (S phases)

A

After S2 and before S1

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22
Q

Timing of murmurs includes:

A

Systolic vs Diastolic

Continuous?

Early? Middle? Late?

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23
Q

PMI of murmurs includes

A

Localizing the lesion (PAM); basilar (top) or apical (bottom)

Identifying intercostal space

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24
Q

What side is a PDA heard on? A VSD?

A 
PDA = left 
VSD = right
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25
Q

Common place for regurgitant murmur

A

Mitral (LAV)

Tricuspid (RAV)

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26
Q

Common place for an ejection murmur

A

Pulmonary stenosis
Subaortic stenosis
Physiologic

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27
Q

Continuous

A

PDA (left heart base)

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28
Q

Intensity/Grade (6)

A

1: very soft, localized to one region
2: soft, radiates to 2 heart regions
3: moderate, radiates to 3 heart regions (any mix)
4: loud, radiates all 4 heart regions
5: loud, radiates all regions, precordial thrill
6: hear when stethoscope is removed from chest wall

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29
Q

What does left sided congestive heart failure due to the lungs?

A

Pulmonary edema (effusion in cats)

End-inspiratory/initial expiratory fine crackles

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30
Q

Respiratory sounds:

Stertor and Stridor

A

Discontinuous sounds and wheezes heard without stethoscope

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31
Q

Respiratory sounds:

Crackles

A

Nonmusical, discontinuous sounds (crumpled paper)

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32
Q

Wheezes

A

Musical, continuous sounds

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33
Q

What does fluid in the lungs or pericardium indicate?

A

Congestive heart failure

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34
Q

Fluid accumulation in right vs. left sided heart failure

A

Right: ascites

Left: Pulmonary edema (fluid in parenchyma)

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35
Q

Lateral radiograph: normal heart

A

Should be less than 2/3 of chest cavity height.

Should be less than 3.5 IC spaces wide

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36
Q

DV radiograph: normal heart

A

Width: less than 2/3 of chest cavity in dog, less than 1/2 chest cavity in cat

Length: less than 5 IC spaces

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37
Q

Pulmonary vessels

Enlargement examples

A

Ventricular septal defect

PDA

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38
Q

Pulmonary venous hypertension

A

Occurs prior to left heart failure and man manifest as engorged pulmonary veins relative to arteries

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39
Q

Caudal vena cava enlargement

A

Systemic venous congestion
Elevations in right heart filling pressure
Compare size to aorta (should be 1:1 in size)

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40
Q

Pulmonary Patterns:

Bronchial

A

Increased opacity of airways
Doughnuts!

Examples:
Feline asthma
Canine Chronic Bronchitis

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41
Q

Pulmonary Patterns:

Interstitial

A

Cloudy/fuzzy parenchyma

Obscures edges of heart and vessels

Example:
CHF
Feline pulmonary edema
Neoplasia 
Inflammatory fluid
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42
Q

Pulmonary Patterns:

Alveolar

A

Very progressed interstitial (flooded alveoli)

Bronchi are visible (air-bronchogram)
Parenchyma very dense to consolidated (soft tissue opacity)

Examples:
Pneuomonia

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43
Q

Pulmonary Patterns:

Vascular

A

Generalized enlarged pulmonary vessels (arteries and veins)

Examples:
PDA
VSD

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44
Q

Three classic radiographic findings of left heart failure

A

Left heart enlargement (especially left atrium)

Pulmonary venous enlargement

Interstitial opacity (especially around vessels); pulmonary edema

45
Q

What are the 3 hallmarks of a reverse D? What does this indicate?

A

Right pressure overload

Right ventricle enlargement
Right atrial enlargement
Main pulmonary trunk bulge (enlarged right PA)

Also see:
Bronchointerstitial lung pattern (difficult to see vessels)
Small volume of pleural effusion

46
Q

Radiographic findings in patient with Chronic Mitral Valve Regurgitation

A

LV enlargement
Left atrial bulge
Venous enlargement
Left auricular bulge

47
Q

What occurs during the P wave?

A

Atrial muscle depolarization

48
Q

What occurs during the PR wave?

A

Conduction from SA through AV node

49
Q

What occurs during the QRS wave?

A

Ventricular muscle depolarization

50
Q

What occurs during the T wave?

A

Ventricular muscle repolarization

51
Q

Normal Lead II reading vs. abnormal (what is occuring?)

A

For dog and cat!

Normally: more heart mass on left so get a positive reading (QRS)

Abnormal: right ventricular enlargement indicating more muscle mass on right; get negative reading (QRS)

52
Q

What information can you get from an ECG?

A

Heart rate
Heart rhythm and conduction
Chamber enlargement (not very sensitive) - duration can tell us this

Can NOT tell you about CHR or quality of cardiac muscle contraction

53
Q

What does an ECG look like with pericardial effusion?

A

Low-voltage complexes

54
Q

What does an ECG look like with hypothyroidism?

A

Low-voltage complexes

55
Q

What does an ECG look like with hypoadrenocorticism?

A

Bradycardia
Spiked T wave
Flat P wave

56
Q

Normal ECG heart rate:

Dogs? Cats?

A

Dogs: 70-160 bpm
Cats: 150-220 bpm

57
Q

How do you determine HR from an ECG?

A

Count the QRS complexes in 3 seconds and multiply by 20

50 mm/sec paper: 30 boxes is 3 seconds

25 mm/sec paper: 15 boxes is 3 seconds

58
Q

What is a sinus rhythm?

A

There is a normal P wave for every QRS

Normal heart rate
Normal similar shaped QRS
Regular, very little variation in P-P interval

Normal in dogs and cats

59
Q

What is a sinus arrhythmia?

A

Irregular rhythm from SA node (normal in some species-dog-)

Pattern or increasing and decreasing heart rate because of a pronounced vagal tone (can be seen with respiration)
Gradual speeding and slowing of complexes

Varying P height; wandering pacemaker of vagal tone

60
Q

ECG: what do you see with ventricular depolarization abnormalities?

A

T-wave large; get repolarization abnormalities

Can indicate RV enlargement

61
Q

ECG: what does a large R wave indicate?

A

Left ventricular enlargement

62
Q

DfDx for:

Tall P wave

A

Dogs: right atrial enlargement, sinus tachycardia

Cats: left or right atrial enlargement

63
Q

DfDx for:

Wide P wave

A

Left atrial enlargement

64
Q

DfDx for:

Absent P wave

A

Hyperkalemia
Atrial standstill
Atrial fibrillation

65
Q

DfDx for:

PR/PQ shortening

A

High sympathetic tone

66
Q

DfDx for:

PR/PQ Prolongation

A

First degree AV block

67
Q

DfDx for:

Wide QRS

A

Ventricular enlargement

68
Q

DfDx for:

Small QRS

A

Pericardial or pleural effusion
Pneumothorax
Hypothyroidism
Obesity

69
Q

DfDx for:

QT prolongation

A

Hypo: kalemia, calcemia, thermia
Bradycardia
Conduction disturbance

70
Q

DfDx for:

QT shortening

A

Hyperkalemia
Hypercalcemia
Digoxin

71
Q

DfDx for:

Large T wave

A

Mycardial hypoxia
Bradycardia
Ventricular enlargement
Hyperkalemia

72
Q

DfDx for:

Small T wave

A

Normal for cats

Pericardial or pleural effusion
Pneumothorax
Hypothyroidism
Obesity

73
Q

Ectopic Complexes:

Supraventricular

A

Above the ventricles (within the atria)

P-wave can be absent

Premature beat; impinging on T wave

74
Q

Ectopic Complexes:

Ventricular

A

Below the AV node

Wide and bizzare beat (QRS does not look right)

75
Q

What is an escape beat?

A

Occurs after a long pause; helping keep the patient alive!

Severe bradycardia
Heart block

76
Q

Bradyarrhythmia

Common causes

A

Not always pathologic (especially in species with strong autonomic tone)

Sinus node issue:
Decreased rate of P waves or absent P waves

AV node issue:
Slow/absent conduction through the AV node
P waves without QRS

77
Q

Sinus bradycardia/bradyarrhythmia

A

Regular but a low rate

Normal P wave for every QRS BUT P and QRS are occuring at a slow rate

Normal PR and QRS

78
Q

Sinus bradycardia

Treatment

A

Address underlying cause!
High vagal tone
Anesthesia/sedation (may need to give atropine)
Medications
Identify and address the underlying cause

79
Q

Sick Sinus Syndrome

A

Sinus node NOT normal

Abnormal rhythm disturbance in older small breed dogs

Involves:
Sinus bradycardia
Sinus arrest (pause without P or QRS) -> may then see a ventricular escape rhythm
Atrioventricular (AV) block - due to SA pause
Supraventricular tachycardia

Animal may have collapsed (sinus arrest)

80
Q

AV node disease

A

Normal or elevated P wave rate

Decreased rate of conduction from P to QRS (long PR interval)

Can get complete block of AV node = AV Block

81
Q

AV Node Disease (3 types)

A

First degree
Second degree
Third degree

82
Q

First degree AV Block

A

Usually due to vagal tone
Physiologic process most often

Long space between P and QRS (prolonged PR)

Can have a normal HR

83
Q

Second degree AV Block

Differentiation?

A

Intermittant P without QRS

Normal to slow HR (usually irregular)

Can be normal in horses
Seen in dogs with high vagal tone or AV node disease

Differentiate with atropine; block will resolve if vagally mediated

84
Q

Third degree (complete) AV Block

A

P and QRS are regular but not related (doing their own thangs)

Slow regular HR

Ventricular QRS activity is from escape foci in AV node or ventricle (wide/bizarre)

AV node fails and then other pacemakers in ventricles kick in to keep patient alive (keeping CO)

85
Q

Third degree (complete) AV Block
Symptoms
Treatment

A

Symptoms:
Weakness
Exercise intolerance
Collapse

Requires pacemaker (ventricular beats are not using normal His purkinjie system) 
Not generally responsive to medical treatment
86
Q

Three types of Tachycardia

A

Sinus
Supraventricular
Ventricular

87
Q

Sinus Tachycardia
Information
Causes
Treatment

A

QRS shape: Normal
Regularity: Regular
Onset: Gradual
P wave: Normal

Increased HR that originates in sinus node

Causes: pain, excitement, hypotension

Treatment:
Address primary cause

88
Q

Supraventricular Tachycardia

Information

A

3 or more supraventricular beats in a row

QRS: Normal
Irregular
Onset: Abrupt (ends abruptly too)
P wave: Abnormal

89
Q 
Ventricular Tachycardia
QRS
Regularity 
Onset
P wave
A

QRS: Wide/bizarre
Regular (occurs often)
Onset: Abrupt
P wave: Not associated

90
Q

Supraventricular tachycardia

Causes

A 
Atrial enlargement
Enlarged hilar lymphnodes 
Thoracic masses
Pulmonary inflammation
Electrolyte disturbances

“Painful” to atrium

91
Q

Atrial Fibrillation

What is it?

A 
Type of supraventricular tachycardia
Rapid heart rate 
Irregularly irregular R-R intervals (no pattern)
Continuous 
No obvious P waves
\+/- f waves
92
Q

Atrial Fibrillation

Causes

A

Small animal:
Severe atrial enlargement
Dilated cardiomyopathy
Chronic valvular disease

Uncommon in cats (but could be seen in HCM)

93
Q

Treatment of Atrial Fibrillation and Supraventricular tachycardia

A

Goal: decrease HR through decreasing conduction through AV node

Will not get a return to normal rhythm all the time

Rx:
Calcium Channel Blocker (Diltiazem)
Digoxin
Beta Blocker (Atenolol, sotalol)
Combinations (Digoxin and Diltiazem)
94
Q

Equine Atrial Fibrillation

A

No noticeable P waves
Irregularly irregular

Lone atrial fibrillations can be normal (have large atrial mass that it can happen sometimes)

95
Q

Equine (lone) Atrial Fibrillation

A

Lone; no evidence of structural heart disease and successful treatment -> converts rhythm to normal sinus rhythm

Horses should be treated; will decrease their performance

Rx: Quinidine (Digoxin possibly)
Want to treat ASAP in hopes to return to a normal rhythm
Relapse is common

96
Q

Ventricular Tachycardia

A

3 or more ventricular premature beats (VPC) in a row

97
Q

Ventricular Tachycardia
Treatment
Acute
Chronic

A

Sudden death can result from VTach

Antiarrhythmics decrease risk of VTach but sudden death avoidance is not gauranteed

Acute/Emergency:
Lidocaine (IV bolus); after response can switch to CRI

Chronic:
Mexilitine
Sotalol (beta-blocker)
Atenolol (beta blocker)

98
Q

Indications to treat VTach

A

Sustained VTach: > 140-160 bpm
>20 VPCs per minute
Multiform VPCs
Arrhythmias with myocardial failure present
Breeds at risk for sudden death (Dobermans, Boxers)
Hypotension
VPCs close to the T wave of the proceeding complex
Critically ill patients

99
Q

Ventricular Fibrillation

A

Disorganized electrical activity, end result of VTach

NO CO: no pulse generated

Sudden death (asystole)

100
Q

Ventricular Fibrillation

Treatment

A

Electrical defibrillation

Antiarrhythmics not effective

101
Q

Echocardiogram

Two dimensional use

A

Anatomic evaluation of the heart

Information on anomalies, chamber enlargements, pericardial effusion

102
Q

Echocardiogram

M-Mode

A

Evaluates cardiac motion over time in a single “ice pick” beam

Resolution of chamber surfaces is more readily defined for accurate measures (hypertrophy? thinning?)
Diastole: max volume
Systole: min volume

103
Q

M-Mode

MV View

A

Evaluates mitral valve motion

Evaluates left ventricular diastolic function

104
Q

M-Mode

LA:Ao View

A

Evaluates aortic valve motion
Evaluates left atrial size

LA: Ao should be a 1:1 (if increased usually due to atrial enlargement)

Aortic valve looks like boxes

105
Q

Fractional Shortening (FS%)

A

Difference between diastole and systole size (M-Mode)

Normal
Dog: 25-40%
Cats: 35-50%

106
Q

What does color doppler echocardiography evaluate?

A

Turbulence and direction of flow (qualitative)

Blue
Away
Red
Towards

Green/Yellow = turbulence and high velocity

Should have no color in atrial chambers during systole!

107
Q

What does spectral doppler echocardiography evaluate?

A

Flow speed/velocity (quantitative)

Can identify pressure gradient across stenotic valve or shunt (cardiac chamber pressures)

108
Q

What are the normal chamber pressures?

A 
RA: 2-8
RV: 15-30/2-8
PA: 15-30/4-12 
LA: 2-10
LV: 100-140/3-12 
Aorta: 100-140/60-90

If any are significantly higher there could be a potential stenosis

Small Animal Medicine (8 decks)

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