Cardiology Flashcards by Edward Shelton

What ACE-inhibitor is NOT a prodrug

Captopril (enalapril, benazepril, ramipril etc all are)

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What are risk factors for mortality in dogs with infective endocarditis?

Development of congestive heart failure, thrombotic events and AKI

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What treatment is associated with improved survival in dogs with infective endocarditis?

Antithrombotic therapy

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What are differential diagnosis for a pathological split s2 sound?

Heartworm disease , primary pulmonary hypertension, r to l pda

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What is the name of the reflex implicated in vasovagal syncope?

Bezold-Jarisch reflex

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An audible S3 sound is associated with what?

Rapid ventricular filling , typically diastolic volume overloading eg dcm , pda , mitral insufficiency (cats dcm, anaemia, hypert4)

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An audible S4 sound is associated with what ?

Generated by blood flow into ventricles during atrial contraction - heard in ventricular hypertrophy and stiffness (May be audible with 3rd degree AVB)

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A murmur with PMI at left heart base but radiating to the ventral neck area and audible also at the right cranial thorax is suggestive of what ?

Subvalvular aortic stenosis

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Entry point for pericardiocentesis?

5th intercostal space, R , below costocondral junction

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Which electrolyte derangement can cause resistance to class I antiarrhythmics like lidocaine?

Hypokalaemia

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Pseudohyperkalaemia can be seen in cats with what blood sample submission?

More likely to have increased potassium with serum than plasma sample - consider pseudohyperK in cat if blood is stored for 20-28 hrs or in non additive tube (ie not heparin) or both (javma 2021 paper )

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which heart rate should be aimed for in controlling atrial fibrillation

Mean <125

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which echocardiographic feature has been shown to be helpful to predict development of atrial fibrillation in dogs with MMVD?

Peak left atrial longitudinal strain <28%

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Which factors may be predictors of sudden cardiac death in dogs wth atrial fibrillation?

History of syncope, younger age at diagnosis, large left atrial size

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What echocardiographic finding is associated with higher NT-proBNP and cardiac troponin-I concentrations in cats with HCM?

presence of SAM

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What is the sensitivity and specificity for point of care NT proBNP ELISA in detecting heart disease in apparently healthy cats? How do these values change when applied to cats with a heart murmur?

Sensitivity specificity 43% and 96% , improved to sensitivity of 71% if cat has heart murmur

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which POCUS features may differentiate cardiogenic from noncardiogenic nonhemorrhagic asictes?

hepatic and CVC distension

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which genetic defects are associated with DCM in Dobermans?

TTN and PDK4

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which valve most commonly affected in UK dogs with infective endocarditis?

mitral

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What is expressed on the surface of some bacteria commonly causing infectious endocarditis that is implicated in formation of vegetative lesions?

MSCRAMMS - microbial surface components recognising adhesive matrix molecules

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What are the modified Duke’s criteria for diagnosis of infective endocarditis

Must meet 2 major criteria or 1 major and 2 minor criteria - MAJOR criteria= consistent echo findings (vegetative lesions etc), positive blood cultures with >/= 2 bottles with typical organism or >/= 3 bottles with common skin contaminant, persistent positive cultures over >/= 12 hours. MINOR CRITERIA: T >39DC , new or worsening HM, predisposing heart dz (e.g. sub aortic stenosis), evidence of thromboembolic dz , evidence secondary IM dz, positive bartonella serology, blood cultures not meeting major criteria

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Which dogs are overrepresented in HCM in dogs?

small breeds (Shih tzu and terrier breeds)

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The use of which drug has not been shown to have an impact on 180day outcomes in cats with recent CHF and HCM?

Pimobendan

Which factor does not appear to affect tolerance of Pimobendan in cats?

Presence or absence of outflow tract obstruction

what proportion of dogs with intracardiac heart worms have caval syndrome

25%

After lethargy, what is the second most common clinical sign in dogs with intracardiac heart worms?

Pigmenturia

what changes may occur in dogs with MMVD prior to onset of CHF?

increased HR, RR, RRR; decrease BW and rectal temp. vertebral heart score increased earliest, increases in RR and resting RR most extreme and happened immediately before CHF

What vertebral heart size can be used to identify and exclude dogs with echocardiographic left heart enlargemetn?

VHS >11.7 identified dogs with LHE, VHS

which loop diuretic has been associated with decreased likelihood of death, euthanasia or study withdrawal compared to furosemide?

torasamide

What are risk factros for development of atrial fibrillation in MMVD?

More advanced stage of disease, increased LA size, increased body weight, decreased FS

What impact does the addition of ramipril to furosemide and Pimobendan have in dogs with CHF secondary to MMVD?

No improvement in survival time

what measurement is superior to vertebral heart score for radiographically identifying LA enlargement in dogs with MMVD?

Modified-vertebral left atrial size (M-VLAS)

The risk of dying or worsening from cardiac causes, was significantly reduced in dogs receiving furosemide and benazepril when which drug was added?

Spironolactone

Which echocardiographic measurement is decreased significantly in dogs with pulmonary hypertension not secondary to LH dz compared to dogs with PH secondary to LH dz?

TAPSE (two-dimensional echocardiography-derived tricuspid annular plane systolic excursion)

What is significantly associated with survival to discharge in dogs diagnosed with aortic thromboembolism?

Ambulation status at time of presentation

What are the 2 most common underlying causes reported for aortic thromboembolism in dogs

1. PLN , 2. neoplasia (comorbidity to cause aortic thromboembolism not found in 23% cases- classed as cryptogenic)

What percentage of dogs with orthodromic atrioventricular reciprocating tachycardia (OAVRT) cardiovert after administration of lidocaine?

84.4% (conversion more likely with right free wall accessory pathways)

Which RAAS components have been shown to be increased in dogs with CHF?

ACE 2 , angiotensin peptides 1-7 and 1-9

Which breed of cat has been shown to have a lower blood pressure ?

Birman (when compared to healthy DSH and Norwegian Forest)

HCT is increased in what percentage of chronically hypoxaemic dogs?

8.5% (none >65%)

Which factors are associated with shorter survival times in dogs with CHF?

cachexia, azotaemia, clinically relevant tachyarrhythmia, being over/underweight

which ACE inhibitor is not beneficial for treatment of cats with cardiac disease?

benazepril

which cardiac condition results in higher all cause mortality than apparently healthy cats?

preclinical HCM

What is the prevalence of atrial fibrillation in North American Irish Wolfhounds?

8.5%

Which law explains the principles behind concentric hypertrophy?

Law of laplace - wall stress= pressure x radius / 2x wall thickness Any increase in chamber size should be accompanied by proportional increase in wall thickness if normal Wall Stress is to be maintained - this happens with pressure overload. In eccentric hypertrophy (volume overload) wall thickness increase is only modest to maintain a normal ratio of wall thickness to radius , thereby normalising wall stress

At what pressures are signs of left and right CHF normally seen?

L- mean pulmonary capillary wedge pressure exceeds 25( normal <10) Right- central venous pressure exceeds 15 (normal <5 mmHg)

A mutation in which gene is associated with DCM in Welsh Springer Spaniels ?

Phospholamban

Improved RAAS inhibition in dogs displaying aldosterone breakthrough on ACE-I therapy could be achieved by the use of which class of drugs?

Aldosterone receptor antagonists

What cardiac abnormality can be iatrogenically induced in cats by ultrasound probe pressure on the chest?

right ventricular outflow tract obstruction and associated murmur

How does vitamin D status relate to outcomes in cats with cardiomyopathy?

Vitamin D is generally lower in older cats... but in cats with cardiomyopathy, vit D status positively related to fractional shortening and survival but negatively to LA enlargement

What impact does pimobendan have on left atrial function in cats?

Positive but minor effects

Which biomarker is higher in dogs fed a grain free or peas/lentils/potatoes containing diet compared to dogs fed a GI diet?

c-troponin-I

which medication is associated with improved outcome in right-to-left or bidirectional PDA?

sildenafil

What dosing frequency of ACE-I may optimise the cardioprotective benefits of ACE-I?

twice daily administration

Bronchomalacia is more common in dogs diagnosed with which conditions? Dogs diagnosed with bronchomalacia should be screened for what?

more common in dogs dx with tracheal or mainstream bronchial collapse or bronchiectasis. Pulmonary hypertension more prevalent in dogs with bronchomalacia so consider echo to screen for this

What cardiac biomarker changes are commonly seen in dogs with acute pancreatitis?

elevated cTP-I and NT-pro-bnp, however clinical consequences of myocardial injury uncommon

Which echocardiographic indices are different in healthy dogs eating non-traditional diets when compared to dogs eating traditional diets?

lower indices of systolic function (ejection fraction) and larger left ventricular volumes (left ventricular end-systolic volumes)

Which echocardiographic finding is increased in dogs with atrial fibrillation but carries no prognostic significance?

presence of L waves

Concentrations of which marker of GFR are associated with MMVD-related death?

Serum cystatin-C

What is the sensitivity and specificity of cardiac bio markers for DCM in dobermans ?

CTroponinI - sens 81 and spec 70% for detecting DCM in DP NT-ProBNP has sens 70-80 and spec 90 for detecting preclinical dcm in DP

Which dog breeds have naturally higher NTProBNP?

Labradors and Newfoundlands

Which breed predisposed to taurine deficiency DCM can have higher circulating taurine levels in health?

Golden retriever

Which echocardiographic feature has a significant assocation with lower survival rate in dogs with MMVD?

Higher pulmonary vascular resistance estimated by echocardiography

what factors are associated with cachexia in cats with CHF

age, BUN, lower weihgt/bcs/hct

Short courses of oral steroids are associated with what echocardiographic changes in cats?

Increased median left atrium dimension and mean left ventricular internal diameter

What is the recurrence rate of ATE in cats on dual clopidogrel/ rivaroxaban therapy?

16.7%