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SAM > Cardio - Cavanaugh > Flashcards

Cardio - Cavanaugh Flashcards

1
Q

Clinical signs of CHF in dogs and cats stem from what 3 major events?

A
  1. Fluid accumulation
  2. Low BP
  3. Tissue perfusion from low tissue out put
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2
Q

Dyspnea, tachypnea, lethargy, and syncope are main stay clinical signs of CHF in which species?

A

Cat

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3
Q

Dyspnea, tachypnea, cough, exercise intolerance, and syncope are mainstay clinical signs of CHF in which species?

A

Dogs

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4
Q

What are signs leading us to suspect L-CHF in cats?

A
  1. Cough (rare)
  2. Pulmonary effusion
  3. Pulmonary edema

2 & 3 —> due to draining into left and right atrium

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5
Q

What are some signs leading us to suspect R-CHF in cats?

A

Diarrhea (if large volume of ascites)

—>abdominal dissension

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6
Q

What are some signs that would lead us to suspect R-CHF in dogs?

A
  1. Pleural effusion ONLY (pleura empties into the Ratrium)

2. Diarrhea if large volume of ascites (abdominal distension)

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7
Q

_______ _________ (two words) is a compensatory mechanism in HF to improve cardiac output.

A

Sinus tachycardia

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8
Q

Why is spironolactone a useful drug?

A
  1. It’s a weak diuretic but K+-sparing
  2. It’s CARDIOPROTECTIVE (anti-fibrotic)
  3. Use in cases of Addison’s dz
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9
Q

Why would we use an ACE inhibitor?

A
  1. To decrease afterload (indirect vasodilator)
  2. CARDIOPROTECTIVE against myocardial fibrosis
  3. Combats the effects of CHRONIC RAAS activation
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10
Q

What are adverse effects of ACE inhibitors? When are they contraindicated?

A

Systemic hypotension;

Contraindicated if Pt is dehydrated or has Renal Dz (or NSAID use)

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11
Q

Name the drug:

Vasodilator (specifically pulmonary arteriodilator) that inhibits phosphodiesterase 5 and is used for pulmonary hypertension

A

Slidenafil

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12
Q

How would we treat ventricular tachycardia (emergency)?

A

Lidocaine (2mg/kg for dogs); (0.2 mg/kg for CATS)

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13
Q

How would we manage chronic ventricular tachycardia?

A

Mexiletine (PO - class 1 Na+ channel blocker)

Sotalol (PO - class 3 K+ channel blocker)

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14
Q

What drug can we us to treat atrial fib, supraventricular tachycardia, and myocardial relax in HCM?

A 
DILTIAZEM: class IV Ca2+ channel blocker
(0.1mg/kg IV SLOW over 5 min - in cats and dogs)
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15
Q

Beta blockers are great cardioprotective drugs for decreasing heart rate AND contractility. However, there’s a caveat… what is it?

A

ONLY give to stable patients!!

Do NOT give if they’re sick and you don’t know the underlying dz, ESPECIALLY if they have ventricular systolic dysfunction!

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16
Q

T or F:
Pertaining to dietary adjustments in Heart Failure, omega-3 FAs, sodium restriction, and protein restriction may be implemented to help improve the condition.

A

FALSE; everything is correct up until the protein restriction - they need to maintain muscle mass!

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17
Q

Congenital Disease characterized by volume overload (dilated eccentric hypertrophy) to LEFT side of heart.
Left (o2) —> Right (no O2) shunt!

And continuous heart murmur at Lbase - high grade!
—>check left Axillary region
—>left chamber enlargement on thor radiographs
—>turbulent flow into pulmonary artery on echo

A

PDA! (Dogs)

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18
Q

What would we see with REVERSE PDA? How do we cure it?

A

Severe pulmonary hypertension; not curable :(

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19
Q

What dog breeds are predisposed/associated with Subaortic stenosis (SAS)?

A 
Large breeds:
Goldens
Newfies
Rotties,
Shepherds,
Boxers
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20
Q

Concentric pressure overload in dogs with SAS is toward which side of the heart?

A

Left!

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21
Q

Upon examination of a young, large breed dog, you hear a systolic murmur at the LEFT base of the heart, near the 3-4th intercostal arch. What fits this murmur description?

A

SAS

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22
Q

In a dog with SAS, what radiographical findings would we expect?

A

Prominent ascending aorta + LEFT sided cardiomegaly

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23
Q

How do we cure SAS?

A

Wellll, we dont. There is no cure, but most are asymptomatic and live a normal life span.

Also, atenolol may help.

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24
Q

Concentric pressure overload in dogs with Pulmonic Stenosis goes toward which side of the heart?

A

RIGHT!

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25
Q

What breeds of dogs are predisposed/associated with pulmonic stenosis?

A

Terrier, bulldog, chihuahua, labs

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26
Q

Upon examination of a young dog, you hear a systolic murmur at the left base of the heart. Additional, radiographs reveal a PA bulge at 1-2 o’clock. What are these findings consistent with?

A

Pulmonic stenosis

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27
Q

Cats with ventricular septal defect (VSD) have a defect in the IV septum leading to eccentric volume overload to what 2 locations?

A

Lungs + LEFT side of heart

Perimembranous region “high”

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28
Q

In cats, what is VSD commonly seen in combination with?

A

Pulmonary stenosis/pulmonary hypertension

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29
Q

In cats with VSD, what is characteristic of the murmur?

A

Systolic; the smaller the defect, the LOUDER the murmur…

*no Tx if murmur is loud

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30
Q

Who is predisposed/associated with Tricuspid valve dysplasia?

A

Cats + labs

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31
Q

What would we see on rads if Tricuspid valve dysplasia is present?

A

R ventricle and atrium enlarged

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32
Q

In patients with tricuspid valve dysplasia, eccentric volume overload would be to which side of the heart?

A

RIGHT

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33
Q

In tricuspid valve dysplasia, what would the murmur sound like?

A

Right-sided APICAL systolic - low grade even with severe dz

34
Q

What might we see on EKG of a patient with tricuspid valve dysplasia?

A

Splintered QRS complex (+atrial fib) = 2 Rwaves

35
Q

What would we expect on rads of a patient with mitral valve dysplasia?

A

L ventricle and atrium enlarged

36
Q

What type of murmur would a patient with MVD have?

A

Left apical systolic

37
Q

Patients with mitral valve dysplasia would have dilated eccentric volume overload to which side of the heart?

38
Q

If the left ventricle outflow is obstructed in MVD, how do we treat?

A

Beta blockers

39
Q

Tetralogy of Fallot; go!

A
  1. Pulmonic stenosis
  2. Secondary concentric hypertrophy of the R ventricle
  3. Overriding aorta
  4. Ventricular septal defects
40
Q

What is the most common cause of cyanotic heart dz in cats and dogs?

A

Tetralogy of Fallot

41
Q

What is the most common acquired valvular dz in dogs? What breeds are predisposed?

A

Degenerative mitral valve dz (DMVD);
Cavalier King Charles spaniels-young!
*otherwise, older/small dogs

42
Q

What contributes to the valve remodeling in DMVD?

A

Increased serotonin signaling via accumulation of GAGs, collagen loss, and fibrosis

43
Q

In DMVD, eccentric dilation volume overload would be toward what side of the heart?

A

LEFT (atria) and ventricular enlargement

44
Q

What type of murmur would we hear with DMVD?

A

Left apical systolic murmur

45
Q

What stage of DMVD is aka “congestive heart failure stage” = L-CHF?
What else would we see on radiographs?

A

stage C - we would also see pulmonary edema (left side)

46
Q

How do we treat stage C DMVD?

A

Furosemide, pimobendan, ACE inhibitor +/- spironolactone

47
Q

What type of murmur IS ALWAYS present in DMVD stage C?

A

LEFT apical SYSTOLIC

48
Q

What are the clinical signs associated with stage C DMVD?

A

Increase RR/HR;
Cough;
Syncope;
Exercise intolerance

49
Q

How do we diagnose DMVD?

A 
Thoracic radiographs (gold standard for L-CHF):
RL, LL, DV
  • must have:
    1. Left sided cardiomegaly (LA enlarged)
    2. Interstitial (+alveolar) pulmonary infiltrates—>edema in perihilar area

And MAYBE
3. Enlarged pulmonary veins

50
Q

Upon diagnosis of DMVD, what BP would we expect?

A

Systemic hypertension

51
Q

What is the gold standard for DMVD diagnosis?

52
Q

Risk factors for Endocarditis….

A

Subaortic Stenosis

Old, male, large dogs

53
Q

What are some clinical signs that accompany endocarditis?

A

Kidney: glomerulonephritis + thromboembolic dz
Joints: polyarthritis + lameness

54
Q

Most common causative agents of endocarditis?

A

Staph aureus, staph. Intermedius, strep, e.coli, pseudomonas, bartonella

55
Q

What type of endocarditis has a more grave prognosis?

A

Aortic (left basilar diastolic murmur) valve

56
Q

How should we go about treating endocarditis?

A

Long-term bactericidal antibiotics:

Beta lactams

57
Q

Describe the hypertrophy in cats with HCM as a response to sarcomeric dysfunction.

A

Primary concentric cardiomyocyte hypertrophy (wall thickness >6mm) of the LEFT ventricle!

58
Q

What creates mitral valve regurgitation or outflow obstruction in HCM?

A

Systolic anterior motion of mitral valve

59
Q

What would we see on radiographs for a cat with HCM?

A

Pulmonary edema,

Pleural effusion

60
Q

What must we rule out before being sure of HCM diagnosis?

A 
Aortic stenosis
Systemic hypertension
Hyperthyroidism
Acromegaly
Infiltration Dz (lymphoma)
61
Q

How can we describe RCM in cats?

A

Primary DIASTOLIC dysfunction w/structurally normal ventricular wall of the LEFT ventricle;
Atrial dilation is common

62
Q

What’s the deal with cats and advanced RCM?

A

They can have SYSTOLIC dysfunction w the diastolic

—> low output HF and CHF

63
Q

What breed is known for DCM due to 2 genetic mutations (pyruvate 4+NCSU)?

64
Q

What are the small breed exceptions to DCM? What should we do with them?

A

Cocker spaniels,
Portuguese Water Dog,
Toy Manchester terrier

  • do a taurine diet test on them!
65
Q

Categorize the myocardial dz:
Primary ventricular systolic dysfunction (dec contractility, inc blood volume), where ventricle dilation occurs secondarily (muscle can’t eject blood out after systole)

A

DCM (dogs)

66
Q

What arrhythmias can we see with DCM dogs?

A

A.fib
VPC
V.tach

67
Q

Breed disposition of Arrhythmogenic Right Ventricular cardiomyopathy (ARVC)?

A

Adult boxers

68
Q

How is type 3 ARVC different from types 1 and 2?

A

Type 3–>DYSFUNCTION: ventricular diastolic dilation;

Ventricular and supraventricular tachycardia; loss of AV synchrony :(

69
Q

What are clinical signs associated with ARVC?

A 
Syncope
Exercise intolerance (due to ventricular tachycardia)
*do 24 hr halter to find
70
Q

How would we diagnose ARVC by echo?

A

(Must have a ventricular arrhythmia)

VPC from RIGHT ventricle are UPRIGHT/POSITIVE in Lead II

71
Q

When are anti-arrhythmic drugs indicated in dogs with ARVC?

A

Dogs w/ >1000 VPCs a day!

Sotalol: class III anti-arrhythmic is 1st choice (1-3mg/kg PO BID)*caution in dogs w systolic dysfunction (or form 3 ARVC)

Mexilitine: class 1 antiarrhythmic

72
Q

Possible agents involved in myocarditis?

A 
Parvo
Paramyxo 
BacT
Bartonella
Borrellia
Leptospirosis
Toxo
Trypto
73
Q

T or F:

We will see arrhythmias (VPCs) in animals with myocarditis.

74
Q

How do we diagnose myocarditis?

A

Cardiac troponin 1-biomarker (leaked from DAMAGED/NECROTIC Cardiomyocytes!)

75
Q

Myocarditis in the dog caused by Trypanosoma cruzi is called ?

A

Chaga’s dz

76
Q

Categorize the general disorder:

Pericardial effusion - mostly right sided pressure overload with sanguineus hem fluid

A

Pericardial disorder

77
Q

If cardiac tamponade is present in a patient you suspect has pericardial disorder, what do we need to do immediately (EVEN IF IT LOOKS FINE)?

A

Emergency pericardiocentesis!

78
Q

Common cause of pericardial disorder in the dog?

A

Neoplasia;
HSA in R ATRIUM/AURICLE (Tx: doxorubicin chemo therapy)
Chemodectoma (aortic body tumor) in chemoreceptors cells in asc aorta/carotid body
Mesothelioma

79
Q

Common cause of pericardial disorderk in cats?

A

Cardiovascular: CHF

80
Q

How would we diagnose pericardial disorder on radiographs?

A

Bloboid cardiac silhouette d/t chronic severe pericardial effusion

81
Q

T or F:
In pericardial disorder, we may treat the R-CHF with furosemide, however diuretics are contraindicated in the presence of tamponade.

SAM (8 decks)

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