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Ag Animal II > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Selenium toxicity - how does it happen in Sm Rum?

A
  • Often if give the wrong form (different concentration)
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2
Q

Manifestations of CV Disease

A
  • Edema, pleural effusion, ascites
  • Arrhythmias
  • Murmurs
  • Muffled Heart Sounds
  • Exercise Intolerance, Weakness, SYncope
  • venous distension/pulsations
  • Painful peripheral swelling
  • Lymphadenopathy
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3
Q

Main causes of edema?

A
  1. Increased vascular permeability
  2. Increased capillary hydrostatic pressure
  3. Decreased vascular oncotic pressure
  4. Increased tissue oncotic pressure
  5. Lymphedema
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4
Q

What can cause increased vascular permeability?

A
  • Endotoxin
  • Trauma
  • Infection
  • vasculitis
  • Mechanisms are cytotoxins and oxygen radicals, leukotrienes, H2O2, etc.
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5
Q

Clinical signs of increased vascular permeability

A
  • petechiation and ecchymoses
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6
Q

Where to look for signs of sepsis like petechiation and ecchymoses?

A
  • Nares, pinna, vulva
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7
Q

What causes increased capillary hydrostatic pressure?

A
  • CHF (e.g. Se deficiency with cardiomyopathy)
  • Tricuspid valve insufficiency
  • venous thrombosis
  • Liver disease (portal vs obstruction)
  • Etc.
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8
Q

Total protein value and albumin value for edema attributable to decreased vascular oncotic pressure?

A
  • <5 g/dL for TP

- <1.5 g/dL for albumin

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9
Q

Causes of decreased vascular oncotic pressure?

A
  1. Don’t make it! (starvation, liver disease)
  2. Lose it (renal, GIT, 3rd space)
  3. You screwed up (hemodilution)
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10
Q

Causes of edema from increased tissue oncotic pressure?

A
  • Infection
  • Topical counterirritants
  • Not generally a big deal
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11
Q

What causes lymphedema due to blocked lymphatics?

A
  • Tumors
  • Trauma
  • increased CVP
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12
Q

How do you diagnose edema?

A
  • Press into it to see if it pits
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13
Q

Other causes of swelling to consider

A
  • Hydrops
  • Prepubic tendon rupture
  • Fat
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14
Q

Benign arrhythmias

A
  • SInus arrhythmia

- Sinus bradycardia

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15
Q

What usually causes sinus bradycardia in ruminants?

A
  • Lack of feed intake
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16
Q

Pathologic arrhythmias

A
  • Atrial fibrillation, premature depolarization
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17
Q

What usually causes atrial fibrillation?

A
  • GIT disease

- Electrolyte or Acid/Base Disturbances

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18
Q

Atrial standstill

A
  • No P waves
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19
Q

What causes Atrial standstill most commonly in Ruminants?

A
  • Mostly metabolic acidosis, which influences potassium
  • Hydrogen crosses across the cell membrane into the cell cytoplasm
  • To maintain electroneutrality, if a cation goes in, either a cation hsa to go out or an anion has to come in
  • Potassium leaves the cell in exchange for hydrogen ions going into the cell
  • Results in increased extracellular potassium
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20
Q

What happens to action potentials with hyperkalemia?

A
  • Membrane is closer to threshold
  • Stimulus that would normally be subthreshold can trigger an action potential
  • Ultimately the sodium channels become refractory and go into standstill
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21
Q

What happens to action potentials with hypokalemia?

A
  • Less likely to fire an action potential
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22
Q

Hyperkalemia and the heart

A
  • Increased potassium = membrane depolarization
  • Depolarization opens sodium channels, increases inactivation (slow depolarization = increased accommodation, no action potential)
  • more depolarization –> decreased sodium channels, increased potassium channels
  • Cells become refractory as they can’t hyperpolarize
  • Results in atrial standstill, ventricular fibrillation, and asystole
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23
Q

Other causes of arrhythmias (less common)

A
  • Electrolyte abnormalities
  • Pericarditis
  • Valvular disease
  • Myocardial disease
  • Toxemia
  • Cor pulmonale
  • Lymphosarcoma
  • Fever
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24
Q

What causes murmurs?

A
  • Turbulence! (vs laminar flow)
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25
Q

What is the Reynolds number and how does it relate to turbulence?

A
  • Ratio of inertia:viscosity
  • Velocity over viscosity
  • When it’s >2000, turbulence occurs
  • Increased velocity or decreased viscosity (e.g. anemia) predisposes to murmurs
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26
Q

What is the level of PCV at which murmurs of anemia are typically noted?

A
  • PCV <25
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27
Q

How to characterize murmurs?

A
  • Part of the cardiac cycle
  • Intensity
  • Shape/frequency
  • PMI
  • Radiation
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28
Q

Types of radiation

A
  • Systolic, diastolic, and continuous
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29
Q

Systolic murmur

A
  • Between 1st and 2nd sound
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30
Q

Diastolic murmur

A
  • Between 2nd and 1st sounds
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31
Q

Murmur Grade 1

A

Soft, difficult to hear

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32
Q

Murmur grade 2

A

Soft, readily heard

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33
Q

Murmur Grade 3

A

Moderate

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34
Q

Murmur Grade 4

A

Loud with palpable thrill

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35
Q

Murmur Grade 5

A

Louder but still need stethoscope

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36
Q

Murmur Grade 6

A
  • Audible with stethoscope not contacting skin surface (really loud)
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37
Q

Where is PMI for Pulmonic valve?

A
  • Left sided heart base (3rd-4th ICS)
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38
Q

Where is PMI for aortic

valve?

A
  • Left sided heart based, radiates

- 4th to 5th ICS

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39
Q

Where is PMI for mitral valve?

A
  • Left, near elbow (apical)

- 5th or 6th ICS

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40
Q

Where is PMI for tricuspid valve?

A
  • Right sided
  • Between shoulder and elbow
  • 3rd or 4th ICS
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41
Q

Ejection murmur

A
  • Crescendo-decrescendo
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42
Q

Regurgitant murmur

A
  • Same
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43
Q

Diastolic decrescendo murmur

A
  • Decreases only
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44
Q

Dfdx for ejection murmurs?

A
  • Innocent
  • Anemia, fever
  • Aortic or pulmonic stenosis
  • ASD, VSD, Tetralogy
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45
Q

Regurgitant murmur dfdx

A
  • Mitral regurgitation
  • Tricuspid regurgitation
  • VSD, Tetralogy
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46
Q

Which valve most commonly has regurgitation?

A
  • Tricuspid valve
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47
Q

What are four categories of reasons for muffled heart sounds?

A
  1. Displacement
  2. Soft tissue mass
  3. Air
  4. Fat
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48
Q

Displacement causes

A
  • Pericardial effusion

- Diaphragmatic hernia (rare)

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49
Q

Soft tissue mass causes

A

Abscess, tumor, GIT

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50
Q

Air muffling causes

A
  • Pneumothorax, pneumomediastinum, emphysema
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51
Q

Fat muffling causes

A
  • Just fat
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52
Q

What can cause exercise intolerance/weakness?

A

Many systems, including cardiovascular

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53
Q

Manifestations of exercise intolerance that might be measurable

A
  • Failure to perform or produce
  • Cough on exertion
  • Respiratory distress
  • Recumbency, reluctance to rise or move
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54
Q

Where is the normal jugular pulse?

A
  • <1/3 of the neck with the head up
  • Shouldn’t go above about 8cm above the base of the heart
  • Remember if the head is below the neck, it can go further up
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55
Q

What contributes to the jugular pulse positivit?

A
  • Atrial contraction
  • Isovolumetric ventricular contraction
  • Atrial filling
56
Q

Root cause of venous distention and pulsations

A
  • Increased resistance to right ventricular filling
57
Q

Dfdx for distention and pulsations

A
  • Right heart failure
  • Constrictive pericarditis
  • Cardiomyopathy
58
Q

Dfdx for prominent pulsations

A
  • Tricuspid regurgitation

- Arrhythmias associated with atrial contraction against a closed AV valve

59
Q

Causes of congenital CV diseases

A
  • Most not established
  • Hereditary in some
  • May happen with other congenital problems
60
Q

When do you suspect congenital CV disease?

A
  • Young animals
  • Holodiastolic or continuous murmur (+/- thrill)
  • Wide radiation
  • Lethargic, weakness, failure to thrive
  • Cyanosis
61
Q

What is the most commonly reported congenital disease?

A
  • Ventricular septal defect

- Can be alone or associated with something else

62
Q

Cause of VSD

A
  • Unknown

- Maybe heritable in some breeds

63
Q

Where is the VSD in bovines compared to in camelids?

A
  • Bovine: Usually in the membranous septum, ventral to the tricuspid
  • In camelids, often towards the apex
64
Q

CLinical signs of VSD

A

Variable!

Depends on:

  1. Size
  2. Shunt direction
  3. Concurrent problems (valve or myocardium)
65
Q

Normal clinical signs of VSD

A
  • Poor growth, dyspnea, etc.
66
Q

Murmur in VSD***

A
  • Bilateral, harsh, plateau, continuous (holostystolic)***
  • Usually louder on the side it’s going to
  • PMI at right tricuspid area USUALLY but can be left pulmonic area
  • Palpable thrill usually
67
Q

What is Eisenmenger’s complex?

A
  • Right heart resistance results in VSD Left to right shunt (pulmonary hypertension) and eventually becomes right to left shunt
68
Q

What’s the main issue with a right to left shunt?

A
  • Putting unoxygenated blood directly into the left ventricle
69
Q

Normal physiology of ductus arteriosus after birth?

A
  • Ductus arteriosus normally closes due to decreased pulmonary vascular resistance and increased systemic vascular resistance
70
Q

How long after birth is a PDA normal in calves? foals?

A
  • Abnormal after birth in calves at any time

- UP to 96 hours in foals

71
Q

What can cause variability in clinical signs of a PDA?

A
  • SIze
  • Direction of shunt
  • Concurrent defects
72
Q

Murmur in PDA

A
  • Continuous, high pitched, MACHINERY murmur
  • Loudest on left but audible on the right 3rd-4th ICS
  • Can exist without a murmur (large ones)
73
Q

Tetralogy of Fallot - what are the four parts?

A
  • Overriding aorta
  • VSD
  • RV hypertrophy
  • Obstruction of pulmonic arterial flow (stenosis)
74
Q

What causes Tetralogy of Fallot?

A
  • Abnormal development of conal septum in an embryo
75
Q

Murmur in Tetralogy of allot

A
  • pansystolic murmur with a thrill, left 3-4th ICS
76
Q

What is the most common cause of cyanosis in extremely young animals with a murmur?

A
  • Tetralogy of Fallot
77
Q

How to rule out respiratory distress from Tetralogy of Fallot?

A
  • TF has a murmur
78
Q

How to rule out CNS disease from TF?

A
  • TF has not other neuro manifestations
79
Q

ASD - how common?

A
  • Relatively common in calves
80
Q

What is ASD often associated with?

A
  • PDA
81
Q

Signs of ASD

A
  • Frequently asymptomatic
82
Q

Shunt for ASD

A
  • Left to right
83
Q

Murmur in ASD

A
  • Holosystolic ejection murmur at left heart base

- Shunt is usually left to right

84
Q

What is the name when the heart is outside of the chest in the throat?

A
  • Ectopia chorids cervicalis
85
Q

Other congenital defects that are possible

A
  • Pulmonic stenosis
  • Tricuspid atresia
  • Mitral chordae rupture
  • Ventricular hypoplasia
  • Truncus or pseudotruncus arteriosus
  • Aortic anomalies
  • Ectopia chordis cervicallis
86
Q

Etiology of valvular diseases

A
  • Degeneration, infection/inflammatory, trauma, or unknown (DIT in DAMNIT)
87
Q

How do valvular diseases manifest in terms of murmur?

A
  • Systolic, regurgitant murmur

- PMI over affected valve

88
Q

How can infections result in valvular disease?

A
  • Chronic active infections like footrot, abscesses, rumenitis, other septic processes) resulting in sustained bacteremia
89
Q

Is preliminary valve damage necessary for valvular endocarditis?

A
  • No
90
Q

Most common bacteria in valvular endocarditis?

A
  • T. pyogenes
  • Strep species
  • Most common
91
Q

Which neoplasia can cause valvular disease?

A
  • Primarily lymphosarcoma
92
Q

Prognosis of valvular disease

A
  • Depends on etiology, onset, duration, severity

- Generally guarded to poor

93
Q

Treatment for bacterial endocarditis

A
  • Long term cidal antimicrobials based on culture and sensitivity
  • Aspirin
  • Low dose heparin
  • Furosemide
  • Digoxin
94
Q

How to diagnose bacterial endocarditis?

A
  • Most often with blood culture

- Repeated blood culture is helpful

95
Q

What is Cor pulmonale also known as?

A
  • Brisket disease
  • Pulmonary hypertension
  • High mountain disease
96
Q

Pathophysiology of cor pulmonale?

A
  • Effect of lung dysfunction on the heart (SECONDARY form of heart disease)
  • Pulmonary hypertension –> right ventricular hypertrophy –> right ventricular dilation –> right ventricular failure
97
Q

How does high mountain or altitude disease lead to Cor pulmonale?

A
  • Hypoxic vasoconstriction of pulmonary arterioles

- Worsened by locoweed Oxytropis, Astralagus)

98
Q

Chronic pulmmonary disease and Cor pulmonale Pathophys

A
  • Hypoxic vasoconstriction of pulmonary arterioles
  • Bronchopneumonia
  • Lungworm infestation
99
Q

Clinical signs of right heart failure in cor pulmonale

A
  • Edema of brisket, mandible, ventrum, limbs
  • Jugular distension, pulsations
  • Dyspnea, tachypnea
  • Tachycardia
  • Split S2 (aortic and pulmonic valve closure)
  • Tricuspid or pulmonic insufficiency
100
Q

Rule outs for cor pulmonale

A
  • Endocarditis, tricuspid insufficiency, cardiomyopathy, cardiac neoplasia, pericarditis, pleuritis, pleural effusion, etc.
101
Q

Who most commonly gets cor pulmonale?

A
  • Cattle
  • Mostly calves
  • May be a genetic predisposition
102
Q

What elevation is most common for Cor pulmonale?

A
  • > 6000 ft above sea level, but can manifest at a lower elevation if locoweed
103
Q

Morbidity of cor pulmonale

A

0.5-2%

104
Q

How does locoweed predispose to cor pulmonale?

A
  • Toxic myocardial damage
105
Q

Treatment for cor pulmonale

A
  • Lower altitude*** (most important)
  • Treat primary lung disease
  • Diuretics
  • DIgoxin
106
Q

Prognosis for cor pulmonale

A
  • Guarded once signs of RHF
107
Q

Prevention of Cor pulmonale (IMPORTANT)

A
  • Genetic selection (PAPs @ >5000 ft)
  • Remove susceptible cattle
  • Prevent locoweed ingestion
  • Reduce incidence of pulmonary diseases (vaccinate for respiratory pathogens and mitigate via management)
108
Q

What is PAP?

A
  • Pulmonary arterial pressure testing
  • They want to choose >5000 for cows that will be at high elevation
  • Measure from right atrium to right ventricle to pulmonic artery
  • If they don’t pass, don’t breed them
109
Q

Causes of myocarditis

A
  • Bacterial
  • Viral
  • Parasitic
110
Q

Bacterial causes of myocarditis

A
  • S. aureus, C. chauvoei, Mycobacterium spp.
111
Q

Viral causes of myocarditis

A
  • FMD
112
Q

Parasitic causes of myocarditis

A
  • Strongyles, Toxoplasma, Sarcocysts, Borrelia
113
Q

Cardiomyopathy definition

A
  • Subacute to chronic disease of ventricular myocardium without disease of valves, vessels or lungs
114
Q

Causes of cardiomyopathy (4 main causes)

A
  • Inherited
  • Toxic
  • Deficiencies
  • Neoplasia
115
Q

Cardiomyopathy - who is predisposed to inherit?

A
  • Red Holsteins and Polled Herefords maybe
116
Q

Toxins that can lead to cardiomyopathy

A
  • Monensin
  • Lasalocid
  • Gossypol
  • Phalaris
117
Q

Vitamin/Mineral deficiencies or overdoses that can lead to cardiomyopathy

A
  • Copper and selenium deficiency

- High molybdenum or sulfates

118
Q

Which neoplasia can lead to a cardiomyopathy?

A
  • Lymphoma
119
Q

Clinical signs of cardiomyopathy and myocarditis

A
  • variable - depends on extent and cause
  • May be signs of a primary disease like mastitis or metritis
  • Tachycardia, arrhythmias
  • Signs of CHF
  • Often go undiagnosed or masked by primary disease
120
Q

Treatment of Myocarditis and cardiomyopathy

A
  • Treat underlying cause or agent

- Control arrhythmias, CHF, shock

121
Q

What is the name for Vitamin E and Selenium Deficiency?

A
  • White muscle disease
122
Q

Lesions in white muscle disease

A
  • Fibrosis

- Mineralized foci in the heart

123
Q

Selenium toxicity lesions

A
  • More an acute inflammatory process without the mineralization
124
Q

Pericarditis definition

A
  • Inflammation or pericardium resulting in accumulation of fluid/exudate between visceral and parietal pericardium
125
Q

Typical etiology pericarditis

A
  • Trauma - “hardware disease”
  • Hematogenous
  • Extension from lungs or pleura
  • Neoplasia
126
Q

Clinical signs of pericarditis

A
  • Nonspecific fever, anorexia, weight loss, lethargy
  • Peripheral edema, jugular distension/pulses, tachypnea, dyspnea
  • Ventral pain, abducted elbows, grunting, etc.
  • Muffled heart sounds - absent lung sounds ventrally
  • Pericardial friction rub- some thing washing machine murmur
127
Q

Treatment for pericarditis

A
  • Usually salvage procedure
  • Poor prognosis
  • Drainage
  • 5th rib resection, pericardectomy
128
Q

Prevention of pericarditis

A
  • Magnets

- management to help with indiscriminate prehension

129
Q

Necropsy findings of pericarditis

A
  • Often fibrin covering the heart
130
Q

How common are cardiac tumors?

A
  • rare
131
Q

Most common cardiac tumor?

A
  • Lymphosarcoma
  • Manifestation of BLV
  • LEntivirus in cattle
132
Q

Other cardiac tumors

A
  • Mesothelioma
  • Fibrosarcoma
  • Adenosarcoma
  • Carcinomas
133
Q

Definition of atrial fibrillation

A
  • Incoordinated atrial electrical activity
134
Q

What is most common cause of atrial fibrillation in cattle?

A
  • Acid/base and electrolyte disturbances secondary to GIT disease
  • Hypocalcemia, hypokalemia, hypochloremia
  • Metabolic alkalosis
135
Q

Auscultation of atrial fibrillation

A
  • irregularly irregular rhythm
136
Q

ECG of atrial fibrillation

A
  • Irregular R-R interval, No P waves (f waves), irregular QT intervals
137
Q

Treatment for Atrial fibrillation in cattle?

A
  • Treat underlying cause
  • GIT disease
  • Acid/base and electrolyte abnormalitiest
  • Quinidine sulfate is DOC in cattle
  • Electroconversion in small ruminants

Ag Animal II (13 decks)

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