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Small animal (fourth year) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what is the most common heart disease of dogs?

A

myxomatous degenerative valve disease

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2
Q

what age animals are effected by myxomatous degenerative valve disease?

A

older animals (it is a degenerative disease)

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3
Q

what valves are effected by myxomatous degenerative valve disease?

A

mitral and tricuspid

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4
Q

what breeds are effected by myxomatous degenerative valve disease?

A

small breed dogs (cavalier King Charles spaniel…)

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5
Q

what are some possible diseases causing valves to leak?

A

myxomatous degenerative valve disease
mitral dysplasia
mitral regurgitation (DCM)
endocarditis

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6
Q

what age dogs are effected by mitral dysplasia?

A

young dogs - congenital condition

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7
Q

what breed dogs are effected by mitral dysplasia?

A

large breed dogs

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8
Q

what does the myxoma part of myxomatous degenerative valve disease relate to?

A

nodular thickening of valve leaflets

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9
Q

what causes the thinking of the valve leaflets in myxomatous degenerative valve disease?

A

accumulation of collagen based material (glycosaminoglycan and proteoglycan)

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10
Q

over tike what does the nodular thickening of valve leaflets caused by myxomatous degenerative valve disease lead to?

A

lengthening and rupture of the chordae

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11
Q

what are the gross pathological findings of hearts with myxomatous degenerative valve disease?

A

left atrial dilation
left ventricle dilation
elongated chordae tendinae
thickened leaflets
jet lesions

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12
Q

what pathological histology is found in cases of myxomatous degenerative valve disease?

A

accumulation of glycosaminoglycan (dark purple)

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13
Q

what happens to blood if the mitral valve leaks?

A

blood leaks back into the left atria

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14
Q

what does leakage of blood back into the left atria due to a mitral valve leak cause?

A

reduction in stroke volume (blood leaving the heart)

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15
Q

since blood has leaked back into the left atrium due to a mitral valve leak, what happens in the next diastole?

A

the volume of blood entering the left ventricle increases (volume overload)

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16
Q

why does regurgitant blood flow into the left atrium if the mitral valve is leaky?

A

because the left atrium is under lower pressure so the afterload is reduced and it is easier for blood to flow back into the atrium than out the aorta

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17
Q

why does preload increase of the left ventricle increase in cases of myxomatous degenerative valve disease?

A

there is a higher volume of blood in the ventricle at the end of diastole (filling phase) because its got its normal input from the atrium plus the regurgitant blood

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18
Q

why is stroke volume of the left ventricle reduced in myxomatous degenerative valve disease?

A

regurgitant blood flows back into the atrium instead of our of the aorta

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19
Q

what does the reduced stroke volume in animals with myxomatous degenerative valve disease activate?

A

RAAS

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20
Q

what does volume overload of the left ventricle lead to?

A

eccentric hypertrophy

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21
Q

what does RAAS aim to do once activated due to reduced stroke volume?

A

increase circulating volume and cause vasoconstriction

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22
Q

what happens in neurohumoral activation due to myxomatous degenerative valve disease?

A

sympathetic nervous system activated - tachycardia, positive inotrope, vasoconstriction
RAAS - sodium/water retention, increased circulatory volume, vasoconstriction
remodelling - eccentric hypertrophy

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23
Q

what is the negative sequelae of chronic sympathetic nervous system activation from myxomatous degenerative valve disease?

A

cardiomyocytes require more oxygen, can’t get this so die
intracellular calcium overload leads to toxic death for cardiomyocytes
(these both then decrease the systolic function of the heart)

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24
Q

what is the negative sequelae of chronic RAAS activation from myxomatous degenerative valve disease?

A

increases circulatory volume to increase the workload of the heart

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25
Q

what is the negative sequelae of chronic remodelling (eccentric hypertrophy) from myxomatous degenerative valve disease?

A

fibrosis (poor contractility)
increased wall stress

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26
Q

what are categories for staging myxomatous degenerative valve disease?

A

A - at risk
B1 - murmur and no enlargement
B2 - murmur and enlargement
C1 - CHF (hospitalised)
C2 - CHF (home)
D1 - refractory (hospitalised)
D2 - refractory (home)

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27
Q

how is the murmur associated with myxomatous degenerative valve disease described?

A

loud harsh left apical systolic murmur (in an old animal)

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28
Q

what biochemical marker is used for myxomatous degenerative valve disease?

A

NTProBNP

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29
Q

what is NTProBNP a measure of?

A

wall stress

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30
Q

why is hypertension in myxomatous degenerative valve disease cases bad?

A

increased afterload meaning the regurgitant fraction of blood will be worse meaning the disease will progress faster

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31
Q

what is NTProBNP an indirect measure of?

A

heart size

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32
Q

other than NTProBNP, what other biomarker can be used for myxomatous degenerative valve disease?

A

troponin I

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33
Q

what does troponin I measure?

A

heart damage

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34
Q

if the patient is on diuretics, what should be monitored carefully?

A

kidney function

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35
Q

where are veins found on thoracic radiographs?

A

ventral and central

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36
Q

what arrhythmia means a dog isn’t in heart failure?

A

sinus arrhythmia

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37
Q

what signs seen on echocardiography are indicative of myxomatous degenerative valve disease?

A

enlarged left atrium (LA>LV)
significant mitral regurgitation
dilated left ventricle
rounded left ventricle
hyperdynamic systolic function
tricuspid regurgitation

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38
Q

how big should the left atrium be compared to the aorta?

A

no more than 1.5x

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39
Q

how can the staging of myxomatous degenerative valve disease be remembered?

A

A - at risk
B - broken but ok
C - congested
D - dying

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40
Q

what does at risk me on myxomatous degenerative valve disease staging?

A

any animal predisposed to myxomatous degenerative valve disease (small breed dogs)

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41
Q

what is the difference in treatment for B1 and B2 myxomatous degenerative valve disease?

A

pimobendan is given to B2 (not B1)

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42
Q

if a B1 myxomatous degenerative valve disease animal is found, what should be done in term of treatment?

A

nothing but run a NTProBNP every month, as soon as this increases start treatment

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43
Q

what treatment is started when a dog is in myxomatous degenerative valve disease stage C?

A

furosemide
pimobendan
ACE inhibitors
spironolactone

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44
Q

what are the four drugs available for heart failure?

A

furosemide
pimobendan
ACE inhibitors
spironolactone

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45
Q

what is a good nutraceutical that can be used for heart failure?

A

omega 3 fish oils
taurine

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46
Q

what are some good predictors of a negative outcome of myxomatous degenerative valve disease?

A

left ventricular dimensions
left atrial enlargement
rupture of major chorda
NTProBNP

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47
Q

what is endocarditis?

A

infection of one or more endocardial surfaces (valves) - typically the mitral and aortic in smallies

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48
Q

what are the requirements for an animal to develop endocarditis?

A

bacteraemia
damaged endothelium
ability for bacteria to adhere
hypercoagulable state

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49
Q

what is the prognosis of endocarditis?

A

very guarded (rare to see as animals often just die)

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50
Q

what is a cardiomyopathy?

A

myocardial disorder in which the heart muscle is structurally or functionally abnormal

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51
Q

what is the most common primary cardiomyopathy in dogs?

A

dilated cardiomyopathy (DCM)

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52
Q

what dogs are predisposed to DCM?

A

older large breed dogs (dobermans and Great Danes)

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53
Q

what is the prognosis for dogs with DCM?

A

guarded (CHF and sudden death)

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54
Q

what is the overall effect that DCM has on the heart?

A

decreases contractility (impaired systolic function and dilated chambers)

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55
Q

what is the aetiology of DCM?

A

idiopathic
secondary causes (DCM like phenotype)
genetically predisposed

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56
Q

how does a DCM heart appear grossly?

A

dilated 4 chambers (left ventricle more than atrium) - left side more than right
mitral/tricuspid annulus stretch (leakage)
ball shaped heart

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57
Q

how does the pathology of the heart appear histologically in DCM hearts?

A

attenuated fibres (atrophied) - thin and fibrosis
myocyte lysis

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58
Q

what effect does the impaired systolic function with DCM effect the heart?

A

reduces the cardiac output

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59
Q

what does the reduced cardiac output associated with DCM trigger?

A

RAAS
sympathetic nervous system

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60
Q

what negative impact does RAAS and sympathetic nervous system activation have on the heart?

A

increased HR and contractility - myocardial hypertrophy leading to increased oxygen demand and myocardial death

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61
Q

how does vasoconstriction caused by sympathetic activation and DCM due to DCM effect the heart?

A

increased blood pressure meaning afterload increases which means the heart has to contract/work harder

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62
Q

why do the mitral/tricuspid valves become leaky in DCM cases?

A

the valves become stretched open due to heart dilation

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63
Q

what are the similarities between DCM and myxomatous degenerative valve disease?

A

enlarged left ventricle and atrium
mitral regurgitation

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64
Q

what are the differences between mitral regurgitation in myxomatous degenerative valve disease and DCM?

A

DCM has mild mitral regurgitation and myxomatous degenerative valve disease has severe

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65
Q

what are the differences between systolic function in myxomatous degenerative valve disease and DCM?

A

DCM has reduced systolic function but it is normal/greater in myxomatous degenerative valve disease

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66
Q

what are the differences between ventricular/atrial size in myxomatous degenerative valve disease and DCM?

A

DCM the left ventricle is bigger than the atrium but its the opposite in myxomatous degenerative valve disease

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67
Q

what is DCM in cocker spaniels associated with?

A

taurine deficiency

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68
Q

what is the main breed that is predisposed to arrhythmogenic right ventricular cardiomyopathy?

A

boxers (bull type breeds)

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69
Q

what are the gross pathological changes associated with arrhythmogenic right ventricular cardiomyopathy?

A

right ventricular dilation
wall thinning

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70
Q

what are the histological pathological changes associated with arrhythmogenic right ventricular cardiomyopathy?

A

loss of myocytes, they’re replaced by fatty deposits

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71
Q

what are the three possible presentations of arrhythmogenic right ventricular cardiomyopathy?

A

asymptomatic with ventricular arrhythmias
sympathetic with ventricular arrhythmias
ventricular dilation, myocardial dysfunction with/without arrhythmias

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72
Q

what breeds are predisposed to atrial cardiomyopathy?

A

English springer spaniel
labrador

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73
Q

what are the gross pathological signs of atrial cardiomyopathy?

A

thin atrial walls

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74
Q

what heart rhythm is associated with atrial cardiomyopathy?

A

atrial standstill (escape rhythm with no P wave)

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75
Q

what breeds are predisposed to canine hypertrophic cardiomyopathy?

A

terriers, pointers, golden retrievers

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76
Q

what are some possible causes of secondary cardiomyopathy?

A

myocarditis
tachycardia induced cardiomyopathy
taurine deficiency

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77
Q

what type of diet should a breed at risk of taurine deficiency not be on?

A

grain free diet is not advised

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78
Q

what type of murmur is heart in DCM patients?

A

quiet soft left apical systolic heart murmur

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79
Q

what are the features that would make you suspicious that a dog has DCM?

A

large breed
arrhythmia
quiet left apical systolic murmur
dyspnoea and tachypnoea
collapsed adult dog
(may have no clinical signs)

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80
Q

what is the best biomarker for DCM?

A

troponin I (disease is in the myocardium - shows damage)
NTProBNP (wall stretch)

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81
Q

what organ should be checked in cases of suspected DCM?

A

thyroid (hyperthyroid contributes to systolic dysfunction)

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82
Q

what are the signs of DCM on echocardiography?

A

enlarged left ventricle/atrium
dilated left ventricle
rounded left ventricle
thin walls
reduced systolic function

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83
Q

what is used to screen for DCM?

A

holter (ambulatory ECG)

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84
Q

what therapy is used for preclinical DCM?

A

pimobendan (9 months additional time clinical sign free)

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85
Q

if DCM progresses to congestive heart failure, what is done to treat it?

A

furosemide
pimobendan
ACE inhibitors
spironolactone

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86
Q

if an animal on pimobendan goes into heart failure, what treatment should be given?

A

furosemide first then other drugs for heart failure if they can afford it

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87
Q

what are negative prognostic indicators for DCM dogs?

A

young age
ascites
dyspnoea
atrial fibrillation

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88
Q

what are some examples of primary feline myocardial disease?

A

hypertrophic cardiomyopathy
restrictive cardiomyopathy
non-specific cardiomyopathy
dilated cardiomyopathy
arrhythmogenic right ventricular cardiomyopathy

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89
Q

what are some secondary myocardial diseases?

A

hypertensive cardiomyopathy
hyperthyroid cardiomyopathy
cardiomyopathy associated with acromegaly, azotaemia, diabetes…

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90
Q

what is acromegaly?

A

excess of growth hormone

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91
Q

what are the classic histological findings of a heart of a cat with feline hypertrophic cardiomyopathy?

A

cardiomyocyte fibre disarray and replacement fibrosis

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92
Q

what cats is hypertrophic cardiomyopathy most common in?

A

large males
over weight cats

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93
Q

what causes feline hypertrophic cardiomyopathy?

A

environmental (overweight, males…)
genetic (Maine coons, ragdolls…)

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94
Q

how are most cats with hypertrophic cardiomyopathy detected?

A

asymptomatic heart murmur (sometimes arrhythmias, diastolic gallops…)

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95
Q

what biomarkers are used to detect feline hypertrophic cardiomyopathy?

A

increased NTpro-BNP
troponin I

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96
Q

how do clinical cases of feline hypertrophic cardiomyopathy present?

A

dyspnoea, tachypnoea, congestive heart failure, pleural effusion
feline arterial thrombo-embolism
syncope
open mouth panting
sudden death

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97
Q

what is the most common place to find feline arterial thromboembolism-embolism (FATE)?

A

external iliac artery bifurcation (saddle thrombus)

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98
Q

what are the clinical signs of feline arterial thromboembolism-embolism?

A

pain, purple footpads
off its back legs

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99
Q

how can feline hypertrophic cardiomyopathy be classified?

A

A - predisposed
B1 - normal/mild atrial enlargement
B2 - moderate/severe atrial enlargement
C - CHF
D - refractory CHF

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100
Q

how do hearts of cats with feline hypertrophic cardiomyopathy appear of DV radiographs?

A

“shoulder pads” - big atrial appendages

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101
Q

how can an ECG of a cat with feline hypertrophic cardiomyopathy appear?

A

can be unremarkable
tall R wave - LV enlargement
intraventricular conduction disturbances

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102
Q

what causes the murmur associated with feline hypertrophic cardiomyopathy?

A

left ventricular hypertrophy causes a septal bulge meaning in changes the direction of blood flowing out of the ventricle
can suck the mitral valve into the ventricle (systolic anterior motion) - further narrowing the outflow tract and causing regurgitation into the atrium

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103
Q

other than murmurs, what other heart sounds can be heard in cases of feline hypertrophic cardiomyopathy?

A

S3 - rapid deceleration of blood in LV
S4 - LV filling associated with atrial contraction
(diastolic gallops)

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104
Q

what is used to treat cats with hypertrophic cardiomyopathy and CHF?

A

diuretics (furosemide)
venodilator (if life threatening pulmonary oedema)
ACE inhibitors
prevent thromboembolism (clopidogrel)

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105
Q

when would a venodilator be used in cases of feline hypertrophic cardiomyopathy and CHF?

A

if there is a life-threatening oedema

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106
Q

what treatment can be used in asymptomatic feline hypertrophic cardiomyopathy, but never with CHF?

A

beta blockers

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107
Q

what is used to treat asymptomatic feline hypertrophic cardiomyopathy?

A

beta blockers (atenolol)
ACE inhibitors
diltiazem (positive lusitrope)

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108
Q

what must be excluded on diagnosis of feline dilated cardiomyopathy?

A

taurine deficiency (assess response to taurine supplementation)

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109
Q

what treatments are commonly used in feline dilated cardiomyopathy cases?

A

warmth and humidified oxygen
drain effusions
furosemide
ACE inhibitors
pimobendan (positive inotrope)

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110
Q

what are the two forms of restrictive cardiomyopathy?

A

myocardial
endocardial

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111
Q

what are the characteristic features of feline restrictive cardiomyopathy?

A

normal LV wall measurement
normal LV chamber dimensions
normal LV systolic function
marked LA enlargement

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112
Q

when is a cardiomyopathy described as non-specific?

A

if there are features of more than one form of cardiomyopathy

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113
Q

how does the heart of cats with arrhythmogenic RV cardiomyopathy appear?

A

bigger right side of the heart than left
fatty replacement of myocardium (impaired contraction)

114
Q

why is the contraction of hearts with arrhythmogenic RV cardiomyopathy impaired?

A

myocardium is replaced by fatty deposits

115
Q

whatever the form of feline cardiomyopathy, what is used to treat CHF?

A

furosemide
pimobendan
ACE inhibitor
spironolactone

116
Q

what is the easiest way to screen for feline cardiomyopathies?

A

NTpro-BNP

117
Q

what are the two layers of pericardium?

A

outer (fibrous)
inner (serous)

118
Q

what are the two parts of the inner layer of the pericardium?

A

parietal and visceral

119
Q

what is the function of the pericardium?

A

protection (fluid and lubricant)
prevents over dilation
coordinate left and right ventricular interaction
maintains position in mediastinum

120
Q

what are the general causes of pericardial effusion in cats?

A

congestive heart failure
FIP
infectious, lymphoma…

121
Q

what are the general causes of pericardial effusion in dogs?

A

idiopathic
neoplasia

122
Q

what dog breeds are predisposed to idiopathic pericardial effusion?

A

large breeds - st Bernard, Labrador…

123
Q

what is the most common neoplastic cause of pericardial effusion in dogs with a poor prognosis?

A

haemangiosarcoma

124
Q

how long does it take for idiopathic pericardial effusions to build up in dogs?

A

chronic long term

125
Q

how long does it take for neoplastic pericardial effusions to build up in dogs?

A

acute presentation

126
Q

what dogs are predisposed to haemangiosarcoma pericardial effusions?

A

German Shepherds

127
Q

what is the most common location of haemangiosarcomas on the heart?

A

right atrium

128
Q

why should the abdomen be looked at if a haemangiosarcoma is found on the heart?

A

they are extremely metastatic (poor prognosis)

129
Q

what is the fluid in a pericardial effusion caused by a haemangiosarcoma?

A

blood from haemangiosarcoma bleeding (difficult to perform pericardiocentesis as it can keep bleeding)

130
Q

what is a neoplastic cause of pericardial effusion in dogs that has a good prognosis?

A

chemodectoma

131
Q

what are other names for a chemodectoma?

A

aortic body tumour
heart base tumour

132
Q

what dog breeds are predisposed to chemodectoma?

A

brachycephalic

133
Q

why is the prognosis of dogs with a chemodectoma generally good?

A

slow growing benign tumours with low metazoic rate

134
Q

is the prognosis for a mesothelioma causing pericardial effusion good or bad?

A

poor prognosis

135
Q

why is mesothelioma difficult to diagnose?

A

everywhere has mesothelial cells that will become inflamed and angry when sampled

136
Q

which chamber of the heart gets compressed most by pericardial effusions?

A

right atrium (lowest pressure) - followed by right ventricle

137
Q

why does volume overload occur with pericardial effusions?

A

decreased right ventricular filling leads to less blood entering left atrium and ventricle which means less cardiac output and hence RAA activation

138
Q

why does oedema occur elsewhere in the body when pericardial effusion is present?

A

RAAS activated to increase volume and there is less venous return to heart due to pressure in right side, this causes an increase in venous and capillary pressure causing leakage

139
Q

what is pulses paradoxus caused by pericardial effusion?

A

when animal breathes in they appear dead (no/weak femoral pulse) - less output from the left side of heart

140
Q

what is cardiac tamponade?

A

increased intrapericardial pressure leads to right atrium and ventricle collapsing in diastole which impairs cardiac filling and output (results in CHF)

141
Q

why does the right atrium collapse during diastole in cardiac tamponade cases?

A

this is when the pressure is at the very lowest (heart relaxed)

142
Q

what are the specific signs of a dog with pericardial effusion?

A

abdominal enlargment
decreased exercise tolerance
mild cough
syncope/collapse

143
Q

what are the non-specific signs of pericardial effusion ion dogs?

A

decreased appetite (all organs become congested and full - makes animal feel full)
lethargy
GI upset

144
Q

what are the clinical signs of chronic pericardial effusion in dogs?

A

right sided CHF (organomegally, abdominal effusion, positive hepatojugular reflux, tachycardia…)
weak femoral pulse
muffled heart sound

145
Q

what are the clinical signs of acute pericardial effusions in dogs?

A

weak
collapsed
tachycardia (possible arrhythmias)
pale MM
haemorrhagic shock
weak pulse

146
Q

what is the quickest way to diagnose a pericardial effusion?

A

T-FAST

147
Q

before performing pericardiocentesis what should be done?

A

check PCV
haematology, biochemistry
troponin I (cell death marker)
coagulation (if concerned)
blood pressure
ECG

148
Q

why should troponin I be done before pericardiocentesis?

A

so you can see if the damage is caused by the tumour or if you cause the damage by jabbing the heart

149
Q

what should be done to the fluid obtained from the pericardiocentesis?

A

send for analysis

150
Q

how does an ECG change after a pericardiocentesis?

A

heart rate falls
QRS complex becomes bigger

151
Q

how does a pericardial effusion appear on radiography?

A

perfectly circular cardiac silhouette and large caudal vena cava

152
Q

what drug should not be used in dogs with a pericardial effusion?

A

furosemide (will kill them)

153
Q

why shouldn’t furosemide be used in dogs with pericardial effusion?

A

already struggling to get blood into the heart - reducing the blood volume will mean even less goes in the heart

154
Q

how should you position a dog to do a pericardiocentesis?

A

left lateral recumbency (main coronary vessel is on the left)

155
Q

where is the needle placed for pericardiocentesis?

A

5th - 6th intercostal space

156
Q

what sized catheter is used for pericardiocentesis?

A

14G over needle catheter (with side holes)

157
Q

how will the fluid of pericardial effusions appear when drained?

A

look like blood (even benign idiopathic cases)

158
Q

what will you see in the patient if you have placed your needle in the correct place and you are draining the pericardial effusion?

A

reduced HR
improved pallor
improved pulse
taller QRS on ECG

159
Q

what should be done if you’re carrying out a pericardiocentesis and the patient isn’t improving?

A

check PCV - couldn’t be draining whole blood and exsanguinating patient

160
Q

what will happen immediately after pericardiocentesis?

A

dog will need to wee - natural diuresis as ascites resolve

161
Q

what is constrictive pericarditis?

A

pericardium becomes thickened and fibrotic (looks like pericardial effusion without the fluid)

162
Q

how is constructive pericarditis treated?

A

pericardectomy

163
Q

what does PPDH stand for?

A

peritoneal pericardial diaphragmatic hernia

164
Q

what is the cause of PPDH?

A

congenital - failure of ventral diaphragm and pericardium to close properly (abdominal organs in pericardial sac)

165
Q

what are some differential diagnoses for heart murmurs in puppies?

A

innocent flow murmur
anaemia
congenital heart disease

166
Q

what causes an innocent flow murmur in puppies?

A

foetal haemoglobin and lower PCV (alters blood viscosity)

167
Q

how would an innocent flow murmur of a puppy be described?

A

low grade, systolic, musical, localised to left heart base

168
Q

what is a patent ductus arteriosus?

A

ductus arteriosus doesn’t close and connects the descending aorta to the pulmonary artery

169
Q

where does blood flow in a patent ductus arteriosus?

A

from aorta to pulmonary artery (continuous shunt - diastole and systole)

170
Q

what happens to the pulmonary circulation in patent ductus arteriosus cases?

A

more blood forced through the pulmonary circulation leading to a left sided volume overload (see an increase in pulmonary vessel size on radiograph)

171
Q

how is the murmur associated with patent ductus arteriosus described?

A

continuous, localised dorsally (left axilla), high grade (can feel it with hands)

172
Q

what can happen to the mitral valve due to volume overload caused by patent ductus arteriosus?

A

dilation of the valve annulus leading to secondary mitral regurgitation

173
Q

what species is patent ductus arteriosus most commonly seen in?

A

dogs (rare in cats) - bitches more common than males

174
Q

what breeds are predisposed to patent ductus arteriosus?

A

German shepherd
collies
bichon frise
poodle
cavalier king Charles
irish setter

175
Q

what can cause a secondary murmur in patent ductus arteriosus cases?

A

mitral regurgitation

176
Q

what radiographic findings are present in patent ductus arteriosus cases?

A

left atrial/ventricle enlargement
triple knuckle (aortic, pulmonic, left auricular appendage bulge)
increased arteries/veins in pulmonary circulation

177
Q

what evidence of a patent ductus arteriosus could be seen on an ECG?

A

P mitrale
very tall R wave (atrial enlargment)

178
Q

how is patent ductus arteriosus treated?

A

surgical closure as soon as possible
catheterisation based occlusion of PDA

179
Q

what type of hypertrophy is seen in cases of subaortic stenosis?

A

concentric hypertrophy of left ventricle (pressure overload)

180
Q

what is the most common congenital heart defect in dogs?

A

aortic stenosis

181
Q

what breeds are predisposed to aortic stenos?

A

boxers
newfoundlands
golden retrievers
rottweilers
bull terrier

182
Q

what effect can the concentric hypertrophy due to aortic stenosis have on the coronary perfusion?

A

decreased as the vessels are squashed
larger mass of muscle so coronary system struggles to supplyenough blood

183
Q

how would a murmur caused by aortic stenosis be described?

A

harsh mid to holosystolic
grade corresponds to severity
radiates up carotids (right side of chest)

184
Q

what can occasionally happen in aortic stenosis cases that causes a diastolic murmur?

A

aortic regurgitation due to a faulty aortic valve

185
Q

what pressure gradient would mild, moderate and severe aortic stenosis have?

A

mild - <50mmHg
moderate - 50-80mmHg
severe - >80mmHg

186
Q

what breeds have a scheme to prevent breeding from dogs with aortic stenosis?

A

boxers and newfoundlands

187
Q

how is aortic stenosis treated?

A

no surgical treatment available
poor prognosis - often sudden death and CHF

188
Q

are the lesions of pulmonic stenosis usually subvalvular, valvular or supravalvular?

A

valvular

189
Q

what type of hypertrophy is seen with pulmonic stenosis?

A

concentric right ventricular hypertrophy (pressure overload)

190
Q

what breeds are predisposed to pulmonic stenosis?

A

cocker spaniel
cavalier king Charles
terrier
beagle
bulldogs
boxer

191
Q

what are the clinical signs of pulmonic stenosis?

A

heart murmur, exercise intolerance, syncope

192
Q

how would the murmur associated with pulmonic stenosis be described?

A

mid to holosystolic cranially on the left heart base
radiates dorsally

193
Q

how does pulmonic stenosis appear on a radiograph?

A

large right side of heart (lots of sternal contact) - lateral view
large pulmonary artery

194
Q

how would an ECG appear in cases of pulmonic stenosis?

A

negative QRS complex in lead one - right axis deviation (larger right side of heart)

195
Q

what can be done to treat pulmonic stenosis?

A

cardiac catheterisation - balloon valvuloplasty (usually works well)
surgical

196
Q

what happens to blood flow in ventricular septal defect cases?

A

blood shunted from left to right ventricle

197
Q

is ventricular septal defect more common in dogs or cats?

A

cats

198
Q

how does the murmur grade correlate with the severity of the ventricular septal defect?

A

inversely proportional

199
Q

why is the grade of the murmur inversely proportional to the severity of the ventricular septal defect?

A

small defects will maintain the pressure gradient between right and left ventricle so the flow through it will be very fats causing more turbulent flow and a louder murmur

200
Q

how is the murmur associated with ventricular septal defects described?

A

systolic murmur
right hemithorax is point of maximum intensity

201
Q

why may ventricular septal defects cause a relative pulmonic stenosis?

A

there is more blood in the right ventricle so more needs to exit via the pulmonic valve, giving the appearance of a stenosis

202
Q

what type of hypertrophy occurs in the right ventricle in cases of ventricular septal defects?

A

eccentric hypertrophy (volume overload)

203
Q

what type of hypertrophy occurs in the left atrium and ventricle in ventricular septal defect cases?

A

eccentric hypertrophy (volume overload due to pulmonary over circulation)

204
Q

what are possible sequelae for ventricular septal defects?

A

can remain asymptomatic
left sided heart failure (large defects)
some can close
prolpase of aortic valve (aortic regurgitation)
right to left shunt due to pulmoinary hypertension

205
Q

what is a right to left shunt in patent ductus arteriosus cases known as?

A

eisenmengers syndrome

206
Q

is atrioventricular valve dysplasia more common in cats or dogs?

A

cats

207
Q

what dog breeds are predisposed to mitral dysplasia?

A

bull terrier
golden retriever
great dane
German shepherd

208
Q

what dog breeds are predisposed to tricuspid dysplasia?

A

labradors

209
Q

what type of hypertrophy is seen with mitral valve dysplasia?

A

volume overload of left side of heart causing eccentric hypertrophy

210
Q

what type of hypertrophy is seen with tricuspid valve dysplasia?

A

volume overload of right side of heart causing concentric hypertrophy

211
Q

how harsh is the murmur heart with atrial septal defects?

A

low grade as there isn’t much of a pressure gradient

212
Q

what are the defects of the tetralogy of fallot?

A

pulmonic stenosis
right ventricular hypertrophy
ventricular septal defect
dextraposed aorta

213
Q

what can cause constriction at the heart base leading to megaoesophagus?

A

persistant right fourth aortic arch (vascular ring abnormality)

214
Q

how can cardiac arrhythmias be divided?

A

Brady/tachy
supraventricular/ventricular
sustained/paroxysmal

215
Q

what can be used for a long term ECG monitor?

A

holter
reveal LINQ device (placed into chest) - device can stay in for 2 years and memorise the loop of ECG

216
Q

what can tachyarrhythmias be divided into?

A

supraventricular (narrow QRS complex)
ventricular (wide bizarre QRS complex)

217
Q

what is the general appearance of an ECG of a supraventricular tachycardia?

A

narrow normal QRS

218
Q

what is the general appearance of an ECG of a ventricular tachycardia?

A

wide bizarre QRS complex
oppositely directed T wave

219
Q

what do anti-arrhythmic drugs effect?

A

action potential

220
Q

what are the classes of anti-arrhythmic drugs?

A

1 - sodium channel blocker
2 - beta blockers
3 - potassium channel blockers
4 - calcium channel blockers

221
Q

what phase of action potential do class 1 anti-arrhythmic drugs effect?

A

sodium channel blockers effect phase 0 (steepness of phase 0 decreases)

222
Q

what tissue do class 2 anti-arrhythmics mainly effect?

A

nodal tissue

223
Q

what phase of the action potential do class 2 anti-arrhythmic effect?

A

beta blockers effect phase 4 making the resting potential and slower depolarisation

224
Q

what phase of the action potential do class 3 anti-arrhythmic drugs effect?

A

potassium channel blockers lengths the action potential duration by delaying repolarisation

225
Q

what tissue do class 4 anti-arrhythmic drugs mainly act on?

A

nodal - AV and SA

226
Q

what causes sinus tachycardia?

A

can be physiological - response to pain, stress…

227
Q

what is an example of a re-entry circuit causing a supraventricular tachycardia?

A

atrial fibrillation

228
Q

what are the majority of pathological supraventricular tachyarrhythmias due to?

A

ectopic focus
accessory pathway

229
Q

how can atrial fibrillation be differentiated from supraventricular tachyarrhythmias?

A

atrial fibrillation has an irregular R-R interval
supraventricular tachycardias are regular

230
Q

what is used from emergency treatment of supraventricular tachyarrhythmias?

A

vagal manoeuvre
IV esmolol (beta blocker)
IV/oral diltiazem

231
Q

what is a vagal manoeuvre?

A

physically increasing vagal tone to Av node by such things as using ocular pressure (squeezing closed eye)

232
Q

what class of anti-arrhythmic drug is esmolol?

A

beta blocker (very short acting)

233
Q

what class of anti-arrhythmic drug is diltiazem?

A

calcium channel blocker

234
Q

what is meant by an accessory pathway causing a supraventricular tachyarrhythmia?

A

abnoraml connection between atria and ventricles resulting in a short PR interval

235
Q

what age are accessory pathways seen in dpgs causing a supraventricular tachyarrhythmias?

A

young dogs (1-2 years old)

236
Q

what is done to treat atrial fibrillation?

A

treat underlying cardiac disease (CHF)
accept rhythm and slow conduction through AVN - digoxin, calcium channel blockers…

237
Q

what effects does digoxin have on the heart?

A

negative chronotrope
weak positive inotrope
vagomimetic (slow conduction across AVN)

238
Q

what can be added with digoxin to aid treatment of atrial fibrillation?

A

diltiazem (better heart rate control) - calcium channel blocker

239
Q

which of the anti-arrhythmic drugs should never be used for uncontrolled congestive heart failure?

A

beta blockers

240
Q

what is used to assess whether a patient with ventricular tachycardia needs treatment or not?

A

look at patient
if haemodynamically significant
if it is multifocal
if very fast or close coupling

241
Q

what are some possible underlying causes of ventricular ectopics?

A

cardiac disease
catecholamines (stress, pain…)
acidosis
hyperkalaemia
thoracic trauma
drug induced

242
Q

what can be used for emergency treatment of ventricular tachyarrhythmias?

A

lidocaine IV
esmolol IV
amiodarone

243
Q

what can be used to treat ventricular tachyarrhythmias at home?

A

oral - sotalol, mexilitine, beta blockers, amiodarone
(sotalol most commonly used)

244
Q

what class anti-arrhythmic drug is sotalol?

A

3 (beta blocker)

245
Q

what are the possible types of bradyarrhythmias?

A

sinus bradycardia
sinus arrest
sinoventricular rhythm (hyperkalaemia)
1st degree AV block
2nd degree AV block
3rd degree AV block

246
Q

what are the features of a first degree AV block on ECG?

A

long P-R interval (often the effect of a drug or high vagal tone)

247
Q

what are the types of second degree AV block?

A

mobitz 1 (physiological)
mobitz 2 (pathological)

248
Q

what is a third degree AV block?

A

complete AV block (few ventricular waves - no association with P wave)

249
Q

why do cats cope better with third degree AV block?

A

tend to not be as active as dogs

250
Q

what are some possible treatment for bradyarrhythmias is the owner doesn’t want a pacemaker?

A

treat underlying disease
anticholinergics (if vagally mediated) - atropine
beta sympathomimetics

251
Q

what are the three main indications of measuring a patients blood pressure?

A

assessing severity of heart disease
identifying systemic hypertension
assessing response to drugs

252
Q

what are the two indirect methods of recording blood pressure?

A

doppler
oscillometric technique

253
Q

how is the doppler technique used to assess blood pressure?

A

cuff inflated until flow is occluded and then gradually deflated until flow is detected in the artery again this corresponds to the arterial blood pressure

254
Q

what is the advantage of using the oscillometric technique to measure blood pressure rather than the doppler?

A

can record both diastolic and systolic blood pressure

255
Q

what are the four main systems systemic hypertension can negatively effect?

A

ocular, renal, cardiac, CNS

256
Q

what are the possible ocular consequences of systemic hypertension?

A

hyphema, retinal detachment, retinal haemorrhage

257
Q

what is the drugs of choice used to reduce systemic blood pressure?

A

amlodipine

258
Q

what is the mode of action of amlodipine?

A

calcium channel agonist (limited to vascular smooth muscle)

259
Q

what is the main change in urine of animals with systemic hypertension?

A

proteinuria

260
Q

what drugs are indicated for proteinuria caused by systemic hypertension?

A

ACE inhibitors

261
Q

what is the mode of action of ACE inhibitors that means they are an effective treatment for proteinuria caused systemic hypertension?

A

effect the efferent arteriole more than the afferent (causes dilation of both)

262
Q

what is a commonly used ACE inhibitor?

A

benazepril

263
Q

what are the three features of Virchow’s triad that leads to a blood clot forming?

A

blood flow stasis
hyper-coagulable state
damaged endothelium

264
Q

what is the most common site of emboli formation in cats?

A

left atrium due to myocardial disease (associated with marked left atrial dilation)

265
Q

where do emboli formed in the left atrium usually embolise to?

A

distal aorta - feline arterial thromboembolism (FATE)

266
Q

how do cats with feline arterial thromboembolism (FATE) present clinically?

A

severe acute pain and loss of hindlimb function
cold limbs with non-pigmented pads turn cyanotic

267
Q

what is the prognosis of cats with FATE?

A

grave (needs adequate pain control)

268
Q

what is used to treat FATE?

A

opiates
clopidogrel - anti-platelet
aspirin - prevents further platelet activation

269
Q

what is the most common cause of thrombi in dogs?

A

endocrinopathy (hypothyroidism, hyperadrenocorticism)

270
Q

what are some possible causes of pulmonary hypertension?

A

pulmonary vascular changes
Dirofilaria or Angiostrongylus
left sided CHF
pulmonary thromboembolism

271
Q

what is the drug most commonly used to treat pulmonary hypertension?

A

pimobenden (sildenafil also useful)

272
Q

how can pulmonary hypertension be diagnosed?

A

clinical signs
radiographs (pulmonary arterial dilation)
doppler echocardiography (tricuspid or pulmonary regurgitation)

273
Q

how can pulmonary thromboembolism be diagnosed?

A

partial blood gas analysis - it creates a large ventilation:perfusion mismatch so there will be a large alveolar to arterial oxygen gradient

274
Q

what is the brief lifecycle of Dirofilaria immitis?

A

L3 transmitted to dog by mosquito
larvae matire to L5 in pulmonary arteries
microfilaria released into bloodstream to effect other mosquitoes

275
Q

what is the prepatent period of Dirofilaria immitis?

A

6 months

276
Q

how can Dirofilaria immitis be diagnosed?

A

thoracic radiographs
heart worm antigen test
antibody test
microfilaria test

277
Q

how is Dirofilaria immitis treated?

A

ivermectin or milbemycin

278
Q

what can be used to prevent heart worm?

A

ivermectin, milbemycin, modidectin (monthly, orally)
selamectin (monthly, topically)

279
Q

what is the prepatent period of Angiostrongylus vasorum?

A

7-9 weeks

280
Q

what can be used to treat angiostrongylus vasorum?

A

milbemycin or fenbendazole

Small animal (fourth year) (26 decks)

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