Cardiology Flashcards
Formulate a differential diagnosis for syncope in dogs.
tachyarrhythmia
bradyarrhythmia
neurogenic - reflex mediated
Describe the ECG features of ventricular tachycardia. How do you determine from which ventricle a PVC is likely originating?
premature beats that are wide and abnormal
right ventricle = + QRS
left ventricle = - QRS
Know the first line therapy for acute in-hospital treatment of ventricular tachycardia.
IV lidocaine
At home therapy options for ventricular tachycardia?
oral - sotalol, amiodarone, mexiletine
List the 5 categories/causes of ventricular arrhythmias in dogs.
HEADS
Heart
Endocrine/Metabolic
Autonomic
Drug/Toxin
Systemic issues
Characterize the auscultatory features of an innocent/functional heart murmur.
soft 1-2/6 systolic
NOT continuous
no clinical signs related to heart disease or structure changes
List 5 differentials for a loud systolic heart murmur in a puppy. Where would the heart murmur be the loudest for each differential?
- subaortic stenosis - left base, weak pulse
- pulmonic stenosis - left base, normal pulse
- VSD - right apex
- mitral dysplasia - left apex
- tricuspid dysplasia - right
What is the most common form of congenital heart disease in the dog? cat?
dog - PDA
cat - VSD
What are the 6 causes of pulmonary hypertension?
- pulmonary arterial hypertension
- left heart disease
- resp disease or hypoxia
- PTE
- heartworm
- multifactorial or masses
Describe treatment strategies for a patient with pulmonary hypertension.
sildenafil or tadalafil (PDE5 inhibitors)
oxygen
butorphanol for sedation
+/- pimobendan (PDE3 inhibitor)
List three common causes of left ventricular concentric hypertrophy in the cat.
systemic hypertension
hyperthyroidism
primary HCM
What is NT-proBNP and how do you interpret an elevated value?
cardiac biomarker through blood or pleural effusion
NORMAL < 100
ABNORMAL > 275 more indicative of CHF
ACVIM stage A in cats
& treatment
predisposed breeds
none
ACVIM stage B1 in cats
& treatment
subclinical
normal/mild atrial enlargement
none, monitor
ACVIM stage B2 in cats
& treatment
subclinical
moderate/severe atrial enlargement
clopidogrel
ACVIM stage C in cats
& treatment
current/previous CHF or ATE
acute or chronic treatment
ACVIM stage D in cats
& treatment
refractory CHF
switch to torsemide +/- spironolactone and pimobendan
acute CHF treatment in cats
sedation
oxygen
furosemide
chronic CHF treatment in cats
furosemide
clopidogrel
low sodium diet
+/- ACE inhibitor
Describe the pathophysiology of feline aortic thromboembolism.
commonly associated with cardiomyopathy
thrombus originates in left heart and dislodges to systemic arterial system
What are 5 physical examination findings for a patient with FATE?
pulselessness
pallor
pain
paresis
polar/poikilothermia
What diagnostics may be helpful in diagnosing FATE?
decreased glucose
increased lactate
lack of doppler BP
increased CK, AST/ALT
treatment of FATE
priority is analgesia = fentanyl
anti-thrombotics
- enoxaparin SQ
- oral factor Xa inhibitor (apixaban or rivaroxaban)
anti-platelet = oral clopidogrel
What are some possible complications of treating FATE?
hyperkalemia due to reperfusion injury (monitor electrolytes and rhythm)
limb necrosis
What is the prognosis for patients with FATE?
poor
why do left apical systolic murmurs secondary to DCM tend to be quieter
usually grade 1-2 because it’s a “functional/pump” problem
what are the echo hallmarks of DCM
LV and LA dilation secondary to overt systolic dysfunction
Appreciate the ECG features of atrial fibrillation.
no discernable P waves
narrow complex, SVT
irregular, irregular
Describe the 3 radiographic hallmarks of cardiogenic pulmonary edema (L CHF)
pulmonary venous congestion
pulmonary edema (perihilar/caudodorsal interstitial pattern)
LA and LV enlargement
Appreciate the acute (in hospital) management of CHF in dogs with DCM.
SPOF
sedation
pimobendan
oxygen
furosemide
ACVIM stage A in dogs & treatment
predisposed breeds
none
ACVIM stage B1 in dogs & treatment
MMVD w/o cardiac remodeling
none
ACVIM stage B2 in dogs & treatment
MMVD w/ cardiac remodeling
Pimobendan
ACVIM stage C in dogs & treatment
MMVD + CHF
acute or chronic treatment
ACVIM stage D in dogs & treatment
refractory CHF
uptitrate drugs
Explain why checking blood pressure in dogs with MMVD is important.
these dogs often old small breeds with comorbidities that can lead to systemic hypertension – worsening mitral regurg and LA enlargement
Appreciate the chronic (at home) management of CHF in dogs with MMVD.
DAFSP
diet (low Na)
ACE inhibitors
furosemide
spironolactone
pimobendan
what are the 4 strategies for cardiac surgery
- beating heart
- venous inflow occlusion
- cardiopulmonary bypass
- hybrid
what are the beating heart surgery options
PDA ligation
PA Band for VSD
Modified BTT shunt for tetralogy of fallot
epicardial pacemaker
what are the brief circulatory arrest surgery options for?
intracardiac mass
foreign body
cor triatriatum
what procedures can you do cardiopulmonary bypass surgery?
valve disease (repair or replacement)
septal defect repair
tetralogy of fallot
what procedure can you do that is a hybrid cardiac surgery?
transcatheter edge-edge mitral valve repair “V clamp”
ACDO for PDA
PDA ligation
palliative or curative?
curative
dilatable pulmonary artery banding
palliative or curative?
palliative for VSD
Modified blalock-taussig-thomas shunt
palliative or curative?
palliative for tetralogy of fallot
epicardial pacemaker
palliative or curative?
curative
brief circulatory arrest surgiers
palliative or curative?
curative/palliative
cardiopulmonary bypass surgeries
curative/palliative
hybrid cardiac surgeries
curative or palliative?
curative/palliative
