Cardiology (1-9) Flashcards
in canine cardiac cases, what is a cough commonly due to?
left atrial enlargement
is it common for cats to cough with cardiac disease?
no
what clinical sign is commonly seen with congestive heart failure (CHF) in cats and dogs
dyspnoea
dyspnoea is commonly seen in left congestive heart failure (CHF) due to what?
pulmonary oedema
dyspnoea is commonly seen in right congestive heart failure (CHF) due to what?
pleural effusion
what is pleural effusion in cats commonly caused by?
left congestive heart failure (CHF)
what type of activity can prolonged hypoxia cause?
seizure-like activity
what blood test assesses myocardial damage?
troponin-1
what blood test assesses myocardial stretch?
Pro-BNP
name 6 factors that affect the quality of thoracic radiographs
- phase of respiration
- view
- rotation
- exposure factors
- developing
- obesity
what vertebrae do you measure the vertebral heart score (VHS) from?
T4
what should the vertebral heart score be?
less than or equal to 10.5
name 3 types of blood pressure measurements
- direct
- oscillometric
- doppler
name the heart disease
chronic activation of the compensatory systems (RAAS, sympathetic system, vasopressin, endothelin, etc) leads to fluid retention and cardiac remodelling
congestive heart failure (CHF)
name the stage of heart failure - MMVD (myxomatous mitral valve disease)
genetic predisposition but no structural changes
stage A
name the stage of heart failure - MMVD (myxomatous mitral valve disease)
no clinical signs, murmur, no clinically significant cardiomegaly
Stage B1
name the stage of heart failure - MMVD (myxomatous mitral valve disease)
no clinical signs, murmur, cardiomegaly (EPIC)
Stage B2
name the stage of heart failure - MMVD (myxomatous mitral valve disease)
past or current clinical signs of congestive heart failure (CHF)
Stage C
name the stage of heart failure - MMVD (myxomatous mitral valve disease)
severe refractory CHF
Stage D
what drugs can be used to treat heart failure by decreasing preload?
diuretics
(furosemide, torasemide, spironolactone)
name 3 diuretics that can be used to decrease preload
- Furosemide
- Torasemide
- Spironolactone
what drugs can be used to treat heart failure by decreasing afterload?
vasodilators
(ACEi, pimobendan)
name 4 types of vasodilators that can be used to decrease afterload
- ACEi
- inodilators
- nitric oxide donors
- Ca2+ channel blockers
name the 5 step approach to an acute case of left-sided CHF (congestive heart failure)
- oxygen and cage rest
- IV furosemide
- IV pimobendan (licensed for dogs only)
- sedation if distressed
- thoracocentesis (cats)
name the 3 step approach to an acute case of right-sided CHF (congestive heart failure)
- thoracocentesis (dog) if dyspnoeic
- abdominocentesis
- treat underlying cause
what is the standard treatment for a chronic case of congestive heart failure (CHF) in dogs
(4 drugs)
- furosemide
- pimobendan
- ACEi
- Spirinolactone
what is the standard treatment for a chronic case of congestive heart failure (CHF) in cats
(3 parts)
- furosemide
- clopidogrel
- +/- thoracocentesis
name the 3 categories of diuretics
- loop diuretics
- K+ sparing
- hydrochlorthiazies
name the diuretic
potent diuretic;
fast onset of action;
inhibits K+/Na+/2Cl- pump in thick ascending loop of Henle;
highly protein-bound, NOT filtered! needs to be secreted into tubule for its action
furosemide
what drug should be used with furosemide due to side effect of activating RAAS further
ACEi
name 6 side effects of furosemide
- hypokalaemia, hyponatraemia
- activates RAAS further
- hypocalcaemia, hypomagnesaemia
- metabolic alkalosis
- excessive dehydration
- can aggravate azotaemia
name the diuretic
weak diuretic, end DCT;
competitive antagonist of aldosterone R;
slow onset of action (days);
improved absorption with food;
effects on myocardial fibrosis
spironolactone
name the diuretic
weak diuretic, end DCT;
inhibits Na+ channel in DCT;
combined with hydrochlorthiazide
amiloride
name the diuretic
inhibit the Na+/Cl- cotransporter in DCT;
better diuretic than K+ sparing;
oral formulation (8-12h duration);
slow onset of action (12h);
side effects: hypokalaemia, hyponatraemia, hypochloraemia
hydrochlorothiazide
name the vasodilator
blocks conversion to Angiotensin II
(RAAS activated in CHF)
ACEi
name 2 ACEi drugs that can be used to decrease afterload in CHF
- Benazepril
- Enalapril
name the vasodilator
inodilator - positive inotrope (calcium sensitiser);
phosphodiesterase III inhibitor (peripheral vasodilation);
phosphodiesterase V inhibitor (pulmonary hypertension)
pimobendan
name the vasodilator
acute management of LCHF in dogs;
glyceryl trinitrate (Percutol cream) & Sodium Nitroprusside;
mediates vasodilation through cGMP
nitric oxide donors
name the drug
used for inotropic support in patients with acute HF, septic shock;
used to support myocardial function during GA;
synthetic beta1 adrenergic agonist;
can induce arrhythmias caused by intracellular calcium overload
Dobutamine
name the drug
weak positive inotropy (use in DCM in dogs);
negative chronotropy (antiarrhythmic in dogs);
from Digitalis purpurea (foxglove);
blocks Na+/K+ ATPase leading to incr. intracellular Na+
Digoxin
name the 3 most common congenital cardiac diseases in dogs
- subaortic stenosis
- pulmonic stenosis
- patent ductus arteriosus
name the 2 more common congenital cadiac diseases in cats
- ventricular septal defects
- atrioventricular valve dysplasia
name 5 dog breeds that are predisposed to subaortic stenosis
- boxers
- newfoundland
- GSD
- golden retrievers
- rottweiler
name 3 clinical findings on physical exam that indicate subaortic stenosis
- sytolic murmur
- PMI left heart base
- poor pulse quality
what should be used to diagnose subaortic stenosis
echocardiography
what breed is most commonly predisposed to pulmonic stenosis
bull dogs
(but also several breeds)
name 1 clinical finding on physical exam that may indicate pulmonic stenosis
- systolic murmur (left heart base)
what should be used to diagnose pulmonic stenosis in a dog
echocardiography
what 2 signs of pulmonic stenosis may be seen on radiographs
- right-sided enlargement
- post-stenotic dilatation
what direction of shunting is the most common in patent ductus arteriosus (PDA)
left to right shunting
name 3 clinical findings on physical examination that may indicate a PDA
- continuous “machinery” murmur
- “water-hammer”/bounding pulse
- PMI left base
what 2 signs of PDA are usually seen on radiographs
- left-sided enlargement
- pulmonary overcirculation
what is the treatment for a PDA
closure of the PDA
what dog breed is most predisposed to mitral valve dysplasia
english bull terriers
what sign of mitral valve dysplasia may be seen on radiographs
left-sided enlargement
name 2 signs of mitral valve dysplasia that may be seen on electrocardiography
- left atrial enlargement
- left ventricular enlargement
what does mitral valve dysplasia lead to
left-sided congestive heart failure
what does tricuspid valve dysplasia lead to
right-sided congestive heart failure
what breed is the mose predisposed to tricuspid valve dysplasia
labradors
what sign of tricuspid valve dysplasia may be seen on radiographs
right-sided enlargement
name 2 signs of tricuspid valve dysplasia that may be shown on electrocardiography
- right-sided enlargement
- splintered QRS
what direction of shunting is most common in a ventricular septal defect
left to right shunting
what breed is the most predisposed to ventricular septal defect
english springer spaniel
(and cats!)
name 2 signs of ventricular septal defect that may be seen on radiographs
- left (+/- right) enlargement
- pulmonary overcirculation
is the systolic murmur louder with a smaller or bigger ventricular septal defect
louder with smaller hole
what 3 things does stenisus cause
- pressure overload
- concentric hypertrophy
- forward and backward failure
what 3 things do leaks and holes in the heart cause?
- volume overload
- eccentric hypertrophy
- backward failure
what is the most common cardiac disease in dogs?
myxomatous mitral valve disease (MMVD)
name the cardiac disease
the basic, thin, mitral valve structure is disrupted and distorted by expansion of the matrix of the spongiosa;
the valve leaks leading to a systolic murmur
myxomatous mitral valve disease (MMVD)
how does age affect myxomatous mitral valve disease (MMVD)
severity and leak increases with age
as preload increases, which part of the heart enlarges?
left atrium
which part of the heart enlarges with eccentric hypertrophy?
left ventricle
a leakly mitral valve causes volume overload which eventually leads to what kind of heart failure?
left-sided congestive heart failure
backward or forward heart failure signs?
- cough
- dyspnoea
- abdominal distension
backward failure signs
backward or forward heart failure signs?
- exercise intolerance
- lethargy
- syncope
forward failure signs
which comes first in myxomatous mitral valve disease (MMVD), backward or forward failure signs?
backward failure signs
name 2 biomarkers from blood samples that can aid management and diagnosis of congestive heart failure
- Troponin-I
- NT-proBNP
name the biomarker
released according to atrial stretch and ventricular wall stress
pro-BNP
what diagnostic is required in order to diagnose left-sided congestive heart failure?
chest radiograph
acute presentations of congestive heart failure in a dog with MMVD is often due to the rupture of what structure?
chordae tendinae rupture
(less likely: left atrial rupture)
name the 4 drugs/therapies used to treat acute congestive heart failure
- Furosemide IV
- Oxygen
- Nitroglycerine ointment
- Pimobendan
(reach for phone, then have a pee)
if you have to choose, what are the 2 most important drugs for treating congestive heart failure
furosemide + pimobendan
name two predictors of congestive heart failure;
increase in the 4 months before stage C of failure
- incr. HR
- incr. RR
(BW decreases by 3%)
the valves on which side of the heart are affected by bacterial endocarditis?
left side
name the 2 commonest sites of bacterial endocarditis in dogs & cats
- mitral valve
- aortic valve
(left side of heart)
name 4 non-specific signs of malaise that dogs with bacterial endocarditis typically present with
- pyrexia
- joint stiffness
- new murmur
- diastolic murmure over left heart base
what is the treatment for bacterial endocarditis?
supportive care and antibiotics
what 3 signs should be seen in a chest radiograph to diagnose CHF (congestive heart failure) in dogs with MMVD (myxomatous mitral valve disease)?
- left atrial/auricular enlargement
- pulmonary venous congestion
- peri-hilar pulmonary oedema
what chemotherapy drug can cause secondary DCM (dilated cardiomyopathy)
Doxorubicin
name 3 nutritional causes of secondary DCM (dilated cardiomyopathy)
- taurine deficiency
- carnitine deficiency
- “BEG” diets
what is the main histopathological feature of DCM (dilated cardiomyopathy)
wavy myocardial fibres
what value should always be measured to aid in diagnosis, prognosis and management of DCM (dilated cardiomyopathy)
T4/TSH
what makes the definitive diagnosis of DCM (dilated cardiomyopathy)
echocardiography
is echocardiography necessary to diagnose myxomatous mitral valve disease (MMVD)?
no, can diagnose with just stethoscope
what drug can be used to incr. contractility and prolong pre-clinical period of DCM (dilated cardiomyopathy)
(does not cure it)
Pimobendan
(PROTECT study)
what drug can be used to treat atrial fibrillation?
digoxin
name 2 postitive inotropes that can be used in acute management of DCM (dilated cardiomyopathy)
- pimobendan
- dobutamine
name the 4 drugs that should be used for chronic management of DCM (dilated cardiomyopathy) with congestion
- furosemide
- pimobendan
- ACE inhibitor
- Spironolactone
name 3 dog breeds that must be warned of sudden death with DCM (dilated cardiomyopathy)
- Dobermans
- Boxers
- Great Danes
what is the most common cardiac disease in cats?
hypertrophic cardiomyopathy (HCM)
name the subtye of HCM
when dynamic left ventricular outflow tract obstruction occurs with HCM (hypertrophic cardiomyopathy)
HOCM (hypertrophic obstructive cardiomyopathy)
what type of heart failure does HCM (hypertrophic cardiomyopathy) in cats lead to?
left-sided congestive heart failure
what heart sound in a cat usually suggests cardiac disease?
gallop sound
(murmur does not always mean cardiac disease in cats)
what diagnostic exam is superior to radiography in dyspnoeic cats?
T-POCUS
(stress can cause sudden death in cats with heart disease)
name the 2 drugs used to treat HCM (hypertrophic cardiomyopathy) in cats with chronic congestive heart failure
- furosemide/torasemide
- clopidogrel
name the form of restrictive cardiomyopathy
normal LV wall thickness;
fibrosis of myocardium
myocardial form
name the form of restrictive cardiomyopathy
thick endocardial scar that may bridge LV lumen
endomyocardial form
name the feline emergency
Presentation:
acute onset, severe pain;
paresis of hindlimbs, cyanotic pads, cold limbs, no pulse;
up to 66% CHF - dyspnoea
feline aortic thromboembolism
what type of pain relief should be given to a cat with feline aortic thromboembolism
IV opioids
in the FAT cat study, what drug was able to outperform aspirin as an anti-thrombotic agent?
clopidogrel
name the disease
inflammation of the heart muscle
myocarditis
name 4 causes of myocarditis
- infectious
- neoplasia
- toxins
- immune-mediated
what value will be highly elevated in a patient with myocarditis
troponin (cTnl)
is heart failure typically systolic or diastolic in dogs?
systolic
is heart failure typically systolic or diastolic in cats?
diastolic
name the 2 main causes of pericardial disease
- idiopathic
- neoplastic
what breeds commonly have idiopathic pericardial disease?
- golden retrievers
- giant breeds
name 5 neoplastic causes of pericardial disease
- right atrial haemangiosarcoma
- chemodectoma
- thyroid carcinoma
- mesothelioma
- lymphoma
what diagnostic gives the definitive diagnosis of pericardial disease?
echocardiography
name 5 key diagnostic findings of pericardial disease that can be seen with echocardiography
- black fluid stopping at heart base
- pleural effusion
- neoplasm
- ascites
- distended caudal vc & hepatic vv
why is congestive heart failure (CHF) therapy contra-indicated in pericardial disease treatment?
filling is already compromised
name 3 treatment options for pericardial disease
- pericardiocentesis
- sub-total pericardiectomy
- balloon pericardiotomy (palliative)
what side of heart failure does pericardial effusion cause
right-sided heart failure
what is the best therapy for canine pericardial disease
pericardiocentesis
where do adult Angiostrongylus vasorum live in dogs?
in pulmonary arteries
name 3 respiratory signs in a dog with Angiostrongylus vasorum
- coughing
- haemoptysis
- dyspnoea
name 3 post mortem findings that diagnose Angiostrongylus vasorum
- nematodes in airways and vessels
- R ventricular hypertrophy
- thromboembolic lesion
name 2 definitive diagnostic tests for Angiostrongylus vasorum
- ELISA antigen test (Angio Detect test)
- Baermann analysis (faecal test)
name 3 haematology signs of Angiostrongylus vasorum
- eosinophilia
- thrombocytopenia
- anaemia
name 4 treatment options for Angiostrongylus vasorum
- Fenbendazole
- Milbemycin
- Moxidectin spot-on
- Selamectin spot-on
which lungworm is more common in north UK
Crenosoma vulpis
name the parasite
the spaghetti worm;
large, white-ish worm;
females 30cm, males 23cm w/ spirally coiled tail;
mosquito is intermediate host
Dirofilaria immitis
what is the primary clinical sign of Dirofilaria immitis
coughing
name 5 haematology signs of Dirofilaria immitis
- eosinophilia
- neutrophilia
- basophilia
- anaemia
- lymphopenia
what is the definitive diagnostic test for Dirofilaria immitis
Heartworm antigen test
(female only antigen)
name 3 treatments for Dirofilaria immitis in dogs
- doxycycline
- larvaicidal
- melarsomine hydrochloride
in what case is direct removal of Dirofilaria immitis (heartworm) performed?
caval syndrome
what treatment for Dirofilaria immitis can be used in dogs but is toxic to cats
melarsomine
name 4 preventative treatments for Dirofilaria immitis
- ivermectin
- selamectin
- milbemycin oxime
- moxidectin
what is the preventative protocol for Dirofilaria after a trip duration <1 month
single treatment when back in UK
what is the preventative protocol for Dirofilaria after a trip duration >1 month
first treatment w/in 30 days of arrival at destination, then monthly thereafter & for 30 days after return to UK
list the 3 types of cells of the heart in order of most to least automaticity
- SA node (60-160/min)
- AV node (40-60/min)
- Perkinje cells (20-40/min)
where is electrical activity of the heart generated?
sinoatrial node
name the 6 parts of the conduction system of the heart in order
- sino-atrial node (SA)
- special tracts (ST)
- Atrial ventricular node (AV)
- bundle of His (H)
- Purkinje fibres (PF)
- ventricular muscle (VM)
name the 6 key anatomical elements that contriibute to the ECG
- spontaneous SA node
- atrial myocardiu
- insulating annulus fibrosus
- slowly conducting atrioventricular (AV) node
- rapidly conducting purkinje fibres
- ventricular myocardium
what is a normal beat on an ECG called?
sinus beat
what does the P wave represent on an ECG?
atrial depolarisation
what does the PQ interval represent on an ECG?
delay at AV node
what does the QRS complex represent on an ECG?
ventricalar depolarisation
what does the T wave represent on an ECG?
ventricular repolarisation
what 3 things soes an ECG tell you about?
- rate
- rhythm
- conduction
how should the animal be positioned to record an ECG?
R lateral recumbency
what 4 things should be labelled on ECG tracings
- name/number
- date
- paper speeds
- callibration mark
where does the red lead of an ECG go?
(UK)
Right fore (above point of elbow)
where does the yellow lead of an ECG go?
(UK)
Left fore (above point of elbow)
where does the green lead of an ECG go?
(UK)
Left hind (above the stifle)
where does the black lead of an ECG go?
(UK)
Right hind (above the stife)
this causes regular baseline oscillations at 50Hz on an ECG
AC interference
what type of oscillations do muscle tremors cause on an ECG?
coarse, disorganised oscillations
what does limb movement cause on an ECG?
single, well-defined deflections
how to determine the heart rate from an ECG at 25 mm/s
- count number of QRS complexes in 15cm
- multiply by 6 (6 seconds at 25mm/s)
how to determine the heart rate from an ECG at 50 mm/s
- count the number of QRS complexes in 15cm
- multiply by 20 (3 seconds at 50 mm/s)
if the impulse generating the QRS starts off above the annulus, how will the QRS complex look on ECG
tall and narrow
if the impulse generating the QRS starts off below the annulus, how will the QRS complex look on ECG?
wide and bizarre
what does a wide P wave on ECG indicate?
LA enlargement
what does a tall P wave on ECG indicate?
RA enlargement
what does a wide QRS complex on ECG indicate?
LV enlargment or LVBBB
what does a tall QRS complex on ECG indicate?
LV dilation/hypertrophy
what does a small QRS complex on ECG indicate?
effusions, obesity, hypothyroidism
what does alternating R waves in QRS complex on ECG indicate?
pericardial effusion
what does a deep S wave on ECG indicate?
RV enlargement or left anterior fascicular block
what does a wide S wave on ECG indicate?
RBBB
what does a prolonged QT on ECG indicate?
electrolyte disturbances, hypothermia
what does an elevated/depressed ST on ECG indicate?
hypoxial, artifacts
where does supraventricular premature complex start off?
above annulus
(tall & narrow QRS)
name the type of arrhythmia
4 or more consecutive SVPCs;
the R-R interval is regular
supraventricular tachycardia
name the type of arrhythmia
results from multiple re-entrant circuits above the annulus;
narrow QRS tachycardia with no P waves and irregular R-R intervals
atrial fibrillation
where do ventricular premature complexes (VPCs) start off from?
they are wide, bizarre and appear earlier than expected
below annulus
what is R-on-T on an ECG a risk factor for?
(when there is no flat baseline between 2 complexes)
ventricular fibrillation
name the type of arrhythmia
4 or more consecutive VPCs and is life-threatening
ventricular tachycardia
name the type of arrhythmia
quick, but not fast enough to be a ventricular tachycardia
accelerated idioventricular rhythm
name the type of arrhythmia
the PQ interval is long but the AV still conducts
1st degree AV block
name the type of arrhythmia
some P wavs are conducted, some are not
2nd degree AV block
what is Mobitz type 1 (2nd degree AV block) mediated by?
vagally mediated
what is Mobitz type 2 (2nd degree AV block) due to?
pathology
name the type of 2nd degree AV block
the PQ varies or lengthens before the block
Mobitz type 1
name the type of 2nd degree AV block
the PQ interval is constant when a P wave conducts
Mobitz type 2
name the type of arrhythmia
no P waves are conducted, and escape beats come from below the annulus;
P waves are superimposed on QRS complexes
3rd degree AV block
name the type of arrhythmia
there is a pause in the P waves greater than 2 R-R intervals, but there are still P waves
sinus arrest
name the type of arrhythmia
there are no P waves at any point on the ECG tracing
atrial standstill
name the type of arrhythmia
a sinus rhythm with beat-to-beat variation in the height of the R waves;
often due to pericardial effusion
electrical alternans
name the type of arrhythmia
sinus rhythm with a deep S wave on leads 1, 2, and 3
right ventricular enlargement pattern
name the type of arrhythmia
a sinus rhythm with a deep S wave on leads 2 and 3 but not lead 1 (usually in cats only)
left anterior fascicular block
name the type of arrhythmia
combines supraventricular tachyarrhythmias with bradydysrhythmias
sick sinus syndrome
name the type of arrhythmia
uncoordinated, incessant ventricular activity;
looks like a scrawl and requires DC cardioversion
ventricular fibrillation
name the 2 reasons for treating an arrhythmia
- haemodynamically significant
- life threatening
name 5 drugs to treat tachyarrhythmias
- lidocaine
- beta blockade
- sotalol
- Ca channel blockers
- Digoxin
name 3 ways to treat bradyarrhythmias
- pacemaker
- sympathomimetics
- anti-cholinergics
name the Vaughan William classification
blocks Na+ channel;
prolongs AP;
ex: Quinidine, Procainamide;
for ventricular arrhythmias
Class 1A
name the Vaughan William classification
blocks Na+ channel;
shortens AP;
ex: Lidocaine, Mexiletine;
for ventricular arrhythmias
Class 1B
name the Vaughan William classification
blocks Na+ channels;
no effect on AP;
ex: Flecainamide;
for ventricular arrhythmias
Class 1C
name the Vaughan William classification
beta-blockers;
no effect on AP;
ex: Atenolol, Propanolol, esmolol
Class II
name the Vaughan William classification
blocks K+ channels;
marked prolongation of AP;
ex: amiodorone solatol
Class III
name the Vaughan William classification
blocks Ca2+ channels;
no effect on AP;
ex: diltiazem, verapamil;
for supraventricular arrhythmias
Class IV
name the arrhythmic class
membrane stabilising drugs;
Na+ channel blockers;
inhibit Na+ influx;
needs normal K+ for activity
Class 1
name the antiarrhythmic
class 1B;
affects phase 0, primarily in diseased tissue;
used as local anaesthetic;
rapid action;
IV use;
first choice for ventricular tachycardia!
lidocaine
name the antiarrhythmic
similar properties and effects to lidocaine, but ORAL;
indicated for ventricular arrhythmias;
difficult to obtain;
good in combo with Solatol and Atenolol
Mexiletine
name the antiarrhythmic class
adrenergic beta-R blocker;
negative chronotrope;
negative ionotrope;
indications:
1. pheochromocytoma
2. hyperthyroidism
3. pressure overload
4. arrhythmias (V and SV)
Class 2
name 2 selective beta1-blockers;
for patients with asthma, diabetes
- Atenolol
- Esmolol
name 3 conditions where you must be careful using beta-blockers
- risk of CHF
- diabetes
- asthma
name the antiarrhythmic
class III;
half a beta-blocker + K+ blocker;
for V and SV arrhythmias;
prolongs action potential duration;
can lead to QT prolongation at high doses;
1st choice for ARVC (boxers)
sotalol
name the antiarrhythmic
class III;
K+ blocker but also effects class I, II, IV;
for V and SV arrhythmias;
very long half-life
amiodarone
name 4 possible side effects of amiodarone
- hepatotoxic
- hypothyroidism
- pulmonary fibrosis
- QT prolongation
name the antiarrhythmic class
Ca2+ channel blockers;
mainly for SV arrhythmias;
can induce vasodilation, bradycardia
Class IV
name the antiarrhythmic
class IV;
well absorbed but first pass metabolism;
oral form (admin TID, modified release BID);
for acute SVT and atrial fibrillation
Diltiazem
name the antiarrhythmic
narrow therapeutic index;
weak positive inotrope;
parasympathomimetic activity;
useful in atrial fibrillation;
careful if V arrhythmias;
long half life
Digoxin
name 5 reasons to reduce digoxin dose
- hypoalbuminaemic
- hypokalaemic
- azotemic
- cachexic
- Doberman
name 3 GI signs that can be caused by digoxin toxicity
- nausea
- vomiting
- anorexia
name 4 ECG signs of malignancy that indicate risk of ventricular fibrillation
- Ron T
- multifocal VPCs
- very premature
- couplets, triplets
name 3 criteria for a haemodynamically significant arrhythmia
- HR > 180-200 bpm
- hypotension
- clinical signs
name the 4 parts of treatment for sustained ventricular tachycardia in order
(emergency)
- lidocaine IV
- class III
- beta blockers
- cardiversion
name 3 types of effective drugs for management of narrow QRS tachycardia
- beta-blockers (class III)
- calcium blockers (class IV)
- class III
what 2 drugs should be used to treat atrial fibrillation
Diltiazem + Digoxin
name 3 options for medical treatment of bradyarrhythmias
- parasympatholytics
- sympathomimetics
- adenosine R
name 3 things that affect stroke volume
- preload
- afterload
- contractility
the lower the cardiac reserve, the (lower or greater?) the exercise intolerance
greater
what is the relationship between oxygen delivery (DO2) & oxygen uptake (VO2) when cardiac reserve is exhausted?
DO2 < VO2
name 4 reasons that animals with cardiovascular disease are at increased risk from anaethesia
- anaesthetics impair cardiopulmonary function
- CV disease causes multiple secondary organ effects
- CV disease alters drug pharmacokinetics
- treatment may interact with anaesthetics
what 2 organs are most commonly secondarily affected by CV disease?
- renal dysfunction
- liver dysfunction
name 3 signs of renal dysfunction secondary to CV disease
- hyperkalaemia
- azotaemia
- hypoalbuminaemia
name 3 signs of liver dysfunction secondary to CV disease
- coagulation abnormalities
- hypoglycaemia
- delayed drug metabolism
name 9 ways to reduce anaesthetic risk in a dog/cat with CV disease
- make an accurate diagnosis
- understand pathophysiology
- recognise secondary complication
- recruit cardiovascular reserve
- choose anesthetics that offset primary haemodynamic effects
- reduce adverse haemodynamic effects of surgery
- use adjunct drugs
- titrate against clinical effect
- adequate monitoring
name 3 ways to decr. cardiac work preoperatively for an animal with CV disease
- vasodilators
- rest
- anxiolytics
name 3 ways to remove fluids preoperatively for an animal with CV disease
- diuretics
- pericardiocentesis
- diets
which is safer for an animal with CV disease:
gen. anaesthesia OR sedation?
gen. anaesthesia
(monitoring!)
name 5 negative effects of hypothermia during anaethesia in a patient with CV disease
- depressed ventilation
- incr. blood viscosity
- ‘left shift’ OxyHb dissociation curve
- arrhythmogenic
- causes shivering
why should a patient with CV disease not be positioned in a severe ‘head-up’ position during anaesthesia?
reduces venous return
why should a patient with CV disease not be positioned in a severe ‘head-down’ position during anaesthesia?
- impairs breathing
- decr. cerebral perfusion
