Cardiology

Question 1

What is the prognosis for chemodectoma?

Answer 1

Fair to good, tend to be slow growing. Sometimes these tumors do not cause clinical signs.
Prolonged survival is possible with successful surgical resection
MST 42-129 days with medical management (i.e., diuretics ± chemotherapy)
MST 661-730 days following pericardiectomy
Mean survival time for dogs treated with pericardiectomy is significantly longer than medical management (661 days v 129 days)
MST for dogs treated with pericardiectomy is significantly longer than medical management (730 days v 42 days)

Question 2

Pericardial fluid analysis is most likely to diagnose which types of neoplasia?

Answer 2

Lymphoma and malignant histiocytosis

Question 3

What is the age of most dogs with cardiac tumors

Answer 3

85% are 7-15 years old

Question 4

What is the most common cardiac tumor in a cat?

Answer 4

Lymphoma

Question 5

Second most common heart based tumor in a dog?

Answer 5

Chemodectoma. Masses involving heart base and ascending aortic region. More common in brachycephalic dogs.

Question 6

What is the most common cardiac tumor in a dog?

Answer 6

Hemangiosarcoma in right auricle, occ at left ventricle, heart base. Associated with hemorrhagic pericardial effusion and cardiac tamponade. Primary cardiac rarely mets to other locations. Splenic hemangiosarcoma occ mets to heart. Breeds: Goldens, GSD, Afgan hound, cocker

Question 7

Which cardiac tumor is difficult to identify echocardiographically?

Answer 7

Mesothelioma

Question 8

Constrictive pericardial disease

Answer 8

Thickening/scarring of viseral/parietal pericardial layers. Coccidomycosis, actinomycosis, mycobacteria, bastomycosis, bacteria, metallic foreign body in pericardium, prior surgery. Middle to large/medium size breed dogs. GSD. Diagnosis is hard to obtain, can obtain with echocardiography. Treatment: Pericardectomy. Pulomonary thrombosis is a complication

Question 9

Describe how to perform a pericardiocentesis.

Answer 9

Right side, 4th to 6th rib over percordial impulse near costocondral joint (to miss coronary vessels on L side) There are vessels caudal to each rib. VPCs often occur if needle touches heart, monitor with ECG

Question 10

Left atrial rupture is diagnosed on echocarography. Do you perform a pericardiocentesis? What is the prognosis?

Answer 10

Only to control the signs of cardiac tamponade if they exist. If you puncture the pericardium and do not need to continued drainage can lead to bleeding. Remaining blood is reabsorbed. LA rupture recurrence is high, prognosis is poor.

Question 10

What are treatment options for right auricular HSA?

Answer 10

Thorascopic pericardectomy, pericardectomy, tumors are generally not resectible. High risk of surgery. The average survivial time without surgery is 2-3 weeks. Multiagent chemotherapy reports a survival of 4-8 months

Question 11

Idiopathic pericardial effusion was diagnosed. Treatment?

Answer 11

Pericardiocenteisis is the treatment, recommend fluid analysis, culture. Apparent recovery in 1-3 taps in 1/2 of affected dogs. If 2-3 taps is not sucessful, pericardectomy is recommended. Always recommend an echo to rule out masses, mesothelioma. Can consider steroids, NSAIDS as treatment. Often antibiotics are not indicated.

Question 12

What is electrial alternans on a lead II ecg?

Answer 12

In dogs, electrical alternans on an ECG, characterized by alternating QRS complex amplitudes, is often associated with pericardial effusion, where the heart’s motion within the fluid-filled pericardium causes this electrical variation

Question 13

Cardiac tamponade of shows signs of left or right heart failure?

Answer 13

Right. Often variable collapse of right auricle, sometimes right ventricle. Diastolic right ventricular collapse with LV compression is an emergency. Requires an immediate pericardiocentesis

Question 14

Most common heart based tumor in a dog?

Answer 14

Chemodectoma

Question 15

Pulsus paradoxus

Answer 15

Term used to describe exagerated variation in artial blood pressure that occurs during respiratory cycle becasue of cardiac tamponade

Question 16

Treatment of arrhythmogenic right ventricular cardiomypathy

Answer 16

Sotalol and mexiletine are first line treatments. Omega 3-fatty acid recommended. Goal: Decrease number of VPCs and syncope episodes. There is a risk of sudden death

Question 17

What is the most common acquired heart disease of boxers? What are the common exam findings?

Answer 17

Arrhythmogenic right ventricular cardiomyopathy. You will have moderate to sever RV dilation. Fatty and fibrous tissue. signs of right heart failure are noted. Fatty of fibrofatty infiltration of the right ventricle. Genentic, autosomal dominant. Left basilar murmur puls or minus ad arrhythmia and puse deficits. Syncope noted. Can have signs of right heart fialure, ascites, hepatosplenomegaly, pleural and pericardial effusion. Can also have a DCM component!

Question 18

Restrictive cardiomyopathy

Answer 18

Extensive endocardiac, subendocardial fibrosis, diastolic dysfunction in absence of mycocardial hypertrophy. Can ne a result of endomyocarditis or infiltrative neoplastic disease such as lymphoma. Can be difficult tp differentiate from end stage remodeled HCM

Question 19

Is skeletal muscle effected by calcium channel blockers?

Answer 19

No. Skeletal muscle doesn’t need extracellular calcium for muscle contraction. It just uses it’s sarcoplasmic reticulum.

Question 20

Mechanism of action of calcium channel blockers:

Answer 20

Calcium Ion Role: Calcium ions (Ca²⁺) play a critical role in muscle contraction and various cellular functions. In cardiac and smooth muscle cells, an influx of calcium ions is essential for initiating contraction.

Voltage-Gated Calcium Channels: These channels are located in the plasma membrane of muscle cells and are activated by changes in membrane potential (voltage). When these channels open, calcium ions flow into the cells, triggering contraction.
They block cell phase ZERO
Blocking Calcium Influx: CCBs bind to these voltage-gated calcium channels and prevent calcium ions from entering the cells. By inhibiting this influx:

Cardiac Muscle: The reduction of calcium availability decreases the force of contraction (negative inotropic effect) and slows down the conduction of electrical impulses through the heart (negative dromotropic effect). This can help control arrhythmias and reduce overall workload on the heart.
Smooth Muscle: In vascular smooth muscle, the inhibition of calcium entry leads to relaxation (vasodilation). This helps lower blood pressure by reducing peripheral resistance.
Effects on Heart Rate: Some CCBs, especially those that target the heart (like diltiazem), also slow the heart rate (negative chronotropic effect) by affecting the sinoatrial (SA) node, which is responsible for regulating heartbeats.

Question 21

Calcium channel blockers, what are their drug names?

Answer 21

The original “big three” calcium channel blockers in vet med are: nifedipine, verapamil, & diltiazem. They have been joined by amlodipine which is most closely related to nifedipine.
Diltiazem and amlodipine are the most common

Question 22

Calcium channel blockers are (choose negative or positive)
Positive or Negative: ionotropes, Positive or Negative: dromotropic
Positive or negative: lusitropes

Answer 22

Calcium channel blockers are: negative inotropes- they decrease the force of contraction
negative dromotropes (meaning that they slow conduction through the AV node).
positive lusitropes (meaning they relax heart muscle/make it more compliance)

Question 23

List some potential indications and adverse effects for calcium channel blockers

Answer 23

Indications for calcium channel blockers are hypertension, supraventricular arrhythmias, atrial fib, & HCM. Potential adverse effects are hypotension & AV block.

Question 24

How do you treat restrictive cardiomyopathy?

Answer 24

Typically these do not have an outflow trat obstruction so pimbobendan is acceptable. CHF treatment is the same as it normally would be. Atenolol or diltiazem for A-fib

Question 25

Dilated cardiomyopathy in cats

Answer 25

In the 1980s the most common cause was taurine deficiency. Doxorubricin can cause DCM. Like dogs, the main feature is poor cardiac contractility. Pleural effusion is common, with hepatomegaly and acities. Diagnosis via echocardiogram.

Question 26

DCM what is the prognosis?

Answer 26

For taurine deficient DCM cats that survive 1 month have a 50% chance for a one year survival DCM without taurine deficiency has a poor prognosis. 49 days is the mean survival time.

Question 27

Corticosteroid associated heart failure

Answer 27

CHF noted 3-7 days after long lasting steroid injection such as depomedrol (methylprednisolone acetate). The proposed mechanism of action is the diabetogenic effect of glucocorticoids causing a transient hyperglycemia and fluid shift.

Question 28

Peritonealpericardial diaphragmatic hernia. Breeds and clinical features?

Answer 28

It is a communication between pericardium and abdominal cavity, thought to be from the inappropriate embryonic development of septus traversum. It is the most common pericardial malformation. Top breeds Weimaraners, persians, himalayns, DLH cats. Clinical features include vomting, diarrhea, anorexia, weight loss, shock and collapse. Muffled heart soudns on one or both sides, "empty" feeling abdomen. Cardiac tamponade is possible as well as an atypical precordial impulse

Question 29

Peritonealpericardial diaphragmatic hernia- how is it diagnosed?

Answer 29

On radiographs you may see enlargement of the cardiac silhouette, dorsal tracheal displacement, gas in the cardiac silhouette. Contrast can be used if needed. In addition, echocardiogram CT and MRI are useful imaging modalities

Question 30

What is the most common pericardial effusion in a dog?

Answer 30

Most commonly it is hemorrhagic, has a PCV >7 and SC >1.016. Neoplastic is more likely in dogs greater than 7 Dogs under 7 that are predisposed to idiopathic are goldens, labs and st bernards

Question 31

Most common pericardial effusion in a cat?

Answer 31

Most common reason is from CHF, cardiomyopathy. It rarely causes cardiac tamponade. Less likely causes include neoplasia, FIP, PDDH, pericarditis

Question 32

Transudates in pericardial effusion

Answer 32

Clear, low cell count. <1000 cells m/L SG <1.012. Modified transudate. TP 2.5 to 5. Common causes are CHF, hypoalbuminemia, PPDH, pericardial cysts These conditions are commonly associated with low volume cardiac effusion- tamponade is rare

Question 33

Malignant histiocytosis with pericardial effusion can have other unusual clinical finding?

Answer 33

Tricavitary effusion

Question 34

If you sample pericardial effusion and find exudate, what does that mean?

Answer 34

High nucleated cell count, greater than 3,000. Rare except for cats with FIP. Infectious pericarditis, plant awn or quill. Also rule out fungal actinomycosis and tuberculosis

Question 35

Cardiac tamponade

Answer 35

Pericardial fluid accumulation. Rises intrapericardial pressure to or above normal cardiac diastolic pressure. Increased pressure limits right heart before left heart because it is more compliant than left heart. More common to see clinical signs associated with right heart failure, low cardiac output can lead to shock

Question 36

Cardiac troponin I, point of care ProBNP

Answer 36

Cardiac troponin I- the half life in dogs is 6 hours, moderate increase means ongoing myocardial damage. Excercise, renal dysfunction and older animals can have a slight increase in cardiac trononin I Point of care probnp- has a high negative predicitive value. A negative test is likely negative, makes CHF much less likely. A positive is less useful - should be paired with echocardiography, ECG, etc

Question 37

To and fro murmur (usually secondary to what disease)

Answer 37

Combination of subacortic stenosis and aortic valve insufficiency- Usually secondary to aortic valve endocarditis

Question 38

Most common cause of a continuous murmur is what, and describe what you hear

Answer 38

Patent ductus arteriosis- PDA is loudest at left base, dorsal to pulmonic valve. It radiates cranially, ventrally and to the right. Systolic is loudest over the chest, diastolic is loudest at left heart base

Question 39

What causes congestive signs in CHF? What are they?

Answer 39

Right sided heart failure- venous hypertensio resulting from systemic capillary hydrostatic pressure. High left heart pressure, pulmonary venous engorgement, edema This can lead to biventricular failure and you can have signs of low cardiac output (same in right and left heart failure)

Question 40

VD or DV, which view is better for assessing hilar region and caudal pulmonary arteries?

Answer 40

DV

Question 41

How do you calculate VHS and what is normal?

Answer 41

Start and T4 and count vertebrae- VHS normal to 11, Boxers 12.6 For cats, normal is 6.7 to 8.1 - over 9 is suggestive of heart disease

Question 42

What heart diseases cause generalized cardiac enlargement?

Answer 42

dilated cardiomyopathy, chronic mitral and tricuspid valve insufficiency, pericardial effusion, peritoneaopericardial diaphgragmatic hernia, tricuspid dysplasia, ventricular or atrial septial defect, patent ductus arteriosis

Question 43

Left atrial enlargement alone is caused by:

Answer 43

early mitral valve insufficiency, hypertrophic cardiomyopathy, early dilated cardiomyopathy, sub aortic stenosis

Question 44

Left atrial and ventricular enlargement is caused by what diseases

Answer 44

Dilated cardiomyopathy, hypertrophic cardiomyopathy, mitral insufficiency, aortic insufficiency, ventricular septal defect, PDA, subaortic stenosis, systemic hypertension, hyperthyroid disease

Question 45

Right atrial and ventricular enlargement is caused by

Answer 45

Advanced HW disease, chronic severe pulmonary disease, tricuspid insufficiency, pulmonic stenosis, tetralogy of fallot, atrial septal defect, pulmonary hypertesion, mass of right heart

Question 46

How furosemide works:

Answer 46

Diuretic: loop diurectic that interferes with ion transportin the loop of Henle and promotes salt and water loss Ascending limb to inhibit Cl, K, Na cotransport and promoting excretion of H+, Ca++, and Mg++ IV work in 5 minutes, peaks i 30 - lasts for 2 hours

Question 47

Spirolactone

Answer 47

More useful for its antialdosterone effects in cardaic and other tissues vs its diuretic effect but is useful in refractory CHF Competative antagonist of aldosterone Na loss, K retention in distal renal tubule- can reduce potassium wasting of furosemide

Question 48

Angiotensin -converting enzyme inhibitors

Answer 48

Modest diuretic and vasodilatory effects Main benefits from opposing effects of NH activation and abnormal CV remodeling changest Block angiotensin II Arteriolar and vasodilation

Question 49

Pimobendan

Answer 49

Calcium-sensitizing effect on contractile proteins by increasing affinity of the regulartory protein troponin C for calcium May modulate NH peak palsma concentration within an hour

Question 50

Innocent murmurs usually disappear in how many months? Describe a mitral valve HM secondary to degenerative valve disease. Subaortic stenosis murmur Pulmonary stenosis murmur

Answer 50

6 months Holosystolic, can be musical with DMVD, murmur intensity correlates with disease severity Low left base and right base with aortic arch L cranial heart base

Question 51

___% of the general cat population has a heart murmur The prevalence of cardiomyopathy in older cats is __% PMI of most heart murmurs in cats:

Answer 51

40% 30% have cardiomyopathy PMI sternal boarder

Question 52

Diastolic heart murmurs in dog indicate what possible conditions? Are they common?

Answer 52

They are always pathologic, not common Aortic valve insufficiency from infective endocarditis Or congenital malformation

Question 53

Differential cyanosis, what is it, when does it occur?

Answer 53

Reversed patent ductus arteriosis Head and forelimbs receive normally oxygenated blood, caudal part of body receives desaturated blood via ductus which arises from descending aorta

Question 54

True or false Cats cough secondary to pulmonary edema?

Answer 54

False. Cats do not cough, dogs do.

Question 55

Signs of low cardiac output

Answer 55

Tiring, excertional weakness, syncope, pre-renal azotemia, cyanosis, cardiac arrhythmias

Question 56

Congestive signs from increased right heart filling pressure

Answer 56

Systemic venous congestion, increased central venous pressure, jugular vein distension, hepatic and splenic congestion, pleural effusion, ascites, small pericadial effusion, subcutaneous edema, cardiac arrhythmia

Question 57

Congestive signs from increased left heart filling

Answer 57

pulmonary venous congestion, pulmonary edema, tachypnea, increased respiratory effort, cough, pulmonary crackles, tiring, cyanosis, post capillary pulmonary hypertension, cardiac arrhythmia

Question 58

Describe what syncope is.

Answer 58

Transient unconsiousness from insufficient oxygen/glucose to brain Often associated with excertion/excitement Lateral recumbancy with stiffening of forelimbs, opisthotonos, micturition Vocalization common **Tonic clonic motion, facial fits and defecation not common

Question 59

Classic exam finding of DCM

Answer 59

S3 gallop

Question 60

Diagnosis arrhythmogenic right ventricular cardiomyopathy

Answer 60

ECG ventricular ectopy, VPCS noted singly, in pairs, short or long runs >300 VPCs in a 24 hour period is consistent with ARVC Ventricular tachycardia results in increased risk of death

Question 61

What are the treatment options for a dog with DCM with atrial fibrilation?

Answer 61

Diltiazem is more effective at lowering the heart rate, can have negative ionotropic effects. (place on pimobendan if not on it) Digoxin is less potent, slow rate reduction but it is a positive ionotropic Long term, for many patients combination therapy with both is ideal

Question 62

Stage C DCM treatment at home

Answer 62

Stage C DCM has mild to moderate CHF so these patients need furosemide, often spirolactone, an ace inhibitor, antiarrythmic therpay if indicated Salt restriction Complete exercise restriction

Question 63

Describe use of Dobutamine in CHF

Answer 63

Dogs with poor myocardial contractility may benefit. Use for 1-3 days Lon term use of + inotropic drugs is contraindicated and thought to have detrimental effects on heart Patient MUST be observed for VPCS - if noted decrease the dose by half or discontinue

Question 64

Treatment of DCM stage B (what drugs treat atrial fibrillation vs ventricular tachycardia)

Answer 64

Client education, no high salt foods Pimobendan, ACE inhibitor, B blocker (atenolol, metprolol) Anti-arrythmic therapy if indicated -sotalol or mexiletine for ventricular tachycardia Diltaizem and digoxin combo for a fib