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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
What is the Reynolds number and how does it relate to turbulence?
- Ratio of inertia:viscosity - Velocity over viscosity - When it's >2000, turbulence occurs - Increased velocity or decreased viscosity (e.g. anemia) predisposes to murmurs
26
What is the level of PCV at which murmurs of anemia are typically noted?
- PCV <25
27
How to characterize murmurs?
- Part of the cardiac cycle - Intensity - Shape/frequency - PMI - Radiation
28
Types of radiation
- Systolic, diastolic, and continuous
29
Systolic murmur
- Between 1st and 2nd sound
30
Diastolic murmur
- Between 2nd and 1st sounds
31
Murmur Grade 1
Soft, difficult to hear
32
Murmur grade 2
Soft, readily heard
33
Murmur Grade 3
Moderate
34
Murmur Grade 4
Loud with palpable thrill
35
Murmur Grade 5
Louder but still need stethoscope
36
Murmur Grade 6
- Audible with stethoscope not contacting skin surface (really loud)
37
Where is PMI for Pulmonic valve?
- Left sided heart base (3rd-4th ICS)
38
Where is PMI for aortic | valve?
- Left sided heart based, radiates | - 4th to 5th ICS
39
Where is PMI for mitral valve?
- Left, near elbow (apical) | - 5th or 6th ICS
40
Where is PMI for tricuspid valve?
- Right sided - Between shoulder and elbow - 3rd or 4th ICS
41
Ejection murmur
- Crescendo-decrescendo
42
Regurgitant murmur
- Same
43
Diastolic decrescendo murmur
- Decreases only
44
Dfdx for ejection murmurs?
- Innocent - Anemia, fever - Aortic or pulmonic stenosis - ASD, VSD, Tetralogy
45
Regurgitant murmur dfdx
- Mitral regurgitation - Tricuspid regurgitation - VSD, Tetralogy
46
Which valve most commonly has regurgitation?
- Tricuspid valve
47
What are four categories of reasons for muffled heart sounds?
1. Displacement 2. Soft tissue mass 3. Air 4. Fat
48
Displacement causes
- Pericardial effusion | - Diaphragmatic hernia (rare)
49
Soft tissue mass causes
Abscess, tumor, GIT
50
Air muffling causes
- Pneumothorax, pneumomediastinum, emphysema
51
Fat muffling causes
- Just fat
52
What can cause exercise intolerance/weakness?
Many systems, including cardiovascular
53
Manifestations of exercise intolerance that might be measurable
- Failure to perform or produce - Cough on exertion - Respiratory distress - Recumbency, reluctance to rise or move
54
Where is the normal jugular pulse?
- <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
55
What contributes to the jugular pulse positivit?
- Atrial contraction - Isovolumetric ventricular contraction - Atrial filling
56
Root cause of venous distention and pulsations
- Increased resistance to right ventricular filling
57
Dfdx for distention and pulsations
- Right heart failure - Constrictive pericarditis - Cardiomyopathy
58
Dfdx for prominent pulsations
- Tricuspid regurgitation | - Arrhythmias associated with atrial contraction against a closed AV valve
59
Causes of congenital CV diseases
- Most not established - Hereditary in some - May happen with other congenital problems
60
When do you suspect congenital CV disease?
- Young animals - Holodiastolic or continuous murmur (+/- thrill) - Wide radiation - Lethargic, weakness, failure to thrive - Cyanosis
61
What is the most commonly reported congenital disease?
- Ventricular septal defect | - Can be alone or associated with something else
62
Cause of VSD
- Unknown | - Maybe heritable in some breeds
63
Where is the VSD in bovines compared to in camelids?
- Bovine: Usually in the membranous septum, ventral to the tricuspid - In camelids, often towards the apex
64
CLinical signs of VSD
Variable! Depends on: 1. Size 2. Shunt direction 3. Concurrent problems (valve or myocardium)
65
Normal clinical signs of VSD
- Poor growth, dyspnea, etc.
66
Murmur in VSD***
- 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
What is Eisenmenger's complex?
- Right heart resistance results in VSD Left to right shunt (pulmonary hypertension) and eventually becomes right to left shunt
68
What's the main issue with a right to left shunt?
- Putting unoxygenated blood directly into the left ventricle
69
Normal physiology of ductus arteriosus after birth?
- Ductus arteriosus normally closes due to decreased pulmonary vascular resistance and increased systemic vascular resistance
70
How long after birth is a PDA normal in calves? foals?
- Abnormal after birth in calves at any time | - UP to 96 hours in foals
71
What can cause variability in clinical signs of a PDA?
- SIze - Direction of shunt - Concurrent defects
72
Murmur in PDA
- Continuous, high pitched, MACHINERY murmur - Loudest on left but audible on the right 3rd-4th ICS - Can exist without a murmur (large ones)
73
Tetralogy of Fallot - what are the four parts?
- Overriding aorta - VSD - RV hypertrophy - Obstruction of pulmonic arterial flow (stenosis)
74
What causes Tetralogy of Fallot?
- Abnormal development of conal septum in an embryo
75
Murmur in Tetralogy of allot
- pansystolic murmur with a thrill, left 3-4th ICS
76
What is the most common cause of cyanosis in extremely young animals with a murmur?
- Tetralogy of Fallot
77
How to rule out respiratory distress from Tetralogy of Fallot?
- TF has a murmur
78
How to rule out CNS disease from TF?
- TF has not other neuro manifestations
79
ASD - how common?
- Relatively common in calves
80
What is ASD often associated with?
- PDA
81
Signs of ASD
- Frequently asymptomatic
82
Shunt for ASD
- Left to right
83
Murmur in ASD
- Holosystolic ejection murmur at left heart base | - Shunt is usually left to right
84
What is the name when the heart is outside of the chest in the throat?
- Ectopia chorids cervicalis
85
Other congenital defects that are possible
- Pulmonic stenosis - Tricuspid atresia - Mitral chordae rupture - Ventricular hypoplasia - Truncus or pseudotruncus arteriosus - Aortic anomalies - Ectopia chordis cervicallis
86
Etiology of valvular diseases
- Degeneration, infection/inflammatory, trauma, or unknown (DIT in DAMNIT)
87
How do valvular diseases manifest in terms of murmur?
- Systolic, regurgitant murmur | - PMI over affected valve
88
How can infections result in valvular disease?
- Chronic active infections like footrot, abscesses, rumenitis, other septic processes) resulting in sustained bacteremia
89
Is preliminary valve damage necessary for valvular endocarditis?
- No
90
Most common bacteria in valvular endocarditis?
- T. pyogenes - Strep species - Most common
91
Which neoplasia can cause valvular disease?
- Primarily lymphosarcoma
92
Prognosis of valvular disease
- Depends on etiology, onset, duration, severity | - Generally guarded to poor
93
Treatment for bacterial endocarditis
- Long term cidal antimicrobials based on culture and sensitivity - Aspirin - Low dose heparin - Furosemide - Digoxin
94
How to diagnose bacterial endocarditis?
- Most often with blood culture | - Repeated blood culture is helpful
95
What is Cor pulmonale also known as?
- Brisket disease - Pulmonary hypertension - High mountain disease
96
Pathophysiology of cor pulmonale?
- Effect of lung dysfunction on the heart (SECONDARY form of heart disease) - Pulmonary hypertension --> right ventricular hypertrophy --> right ventricular dilation --> right ventricular failure
97
How does high mountain or altitude disease lead to Cor pulmonale?
- Hypoxic vasoconstriction of pulmonary arterioles | - Worsened by locoweed Oxytropis, Astralagus)
98
Chronic pulmmonary disease and Cor pulmonale Pathophys
- Hypoxic vasoconstriction of pulmonary arterioles - Bronchopneumonia - Lungworm infestation
99
Clinical signs of right heart failure in cor pulmonale
- Edema of brisket, mandible, ventrum, limbs - Jugular distension, pulsations - Dyspnea, tachypnea - Tachycardia - Split S2 (aortic and pulmonic valve closure) - Tricuspid or pulmonic insufficiency
100
Rule outs for cor pulmonale
- Endocarditis, tricuspid insufficiency, cardiomyopathy, cardiac neoplasia, pericarditis, pleuritis, pleural effusion, etc.
101
Who most commonly gets cor pulmonale?
- Cattle - Mostly calves - May be a genetic predisposition
102
What elevation is most common for Cor pulmonale?
- >6000 ft above sea level, but can manifest at a lower elevation if locoweed
103
Morbidity of cor pulmonale
0.5-2%
104
How does locoweed predispose to cor pulmonale?
- Toxic myocardial damage
105
Treatment for cor pulmonale
- Lower altitude*** (most important) - Treat primary lung disease - Diuretics - DIgoxin
106
Prognosis for cor pulmonale
- Guarded once signs of RHF
107
Prevention of Cor pulmonale (IMPORTANT)
- 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
What is PAP?
- 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
Causes of myocarditis
- Bacterial - Viral - Parasitic
110
Bacterial causes of myocarditis
- S. aureus, C. chauvoei, Mycobacterium spp.
111
Viral causes of myocarditis
- FMD
112
Parasitic causes of myocarditis
- Strongyles, Toxoplasma, Sarcocysts, Borrelia
113
Cardiomyopathy definition
- Subacute to chronic disease of ventricular myocardium without disease of valves, vessels or lungs
114
Causes of cardiomyopathy (4 main causes)
- Inherited - Toxic - Deficiencies - Neoplasia
115
Cardiomyopathy - who is predisposed to inherit?
- Red Holsteins and Polled Herefords maybe
116
Toxins that can lead to cardiomyopathy
- Monensin - Lasalocid - Gossypol - Phalaris
117
Vitamin/Mineral deficiencies or overdoses that can lead to cardiomyopathy
- Copper and selenium deficiency | - High molybdenum or sulfates
118
Which neoplasia can lead to a cardiomyopathy?
- Lymphoma
119
Clinical signs of cardiomyopathy and myocarditis
- 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
Treatment of Myocarditis and cardiomyopathy
- Treat underlying cause or agent | - Control arrhythmias, CHF, shock
121
What is the name for Vitamin E and Selenium Deficiency?
- White muscle disease
122
Lesions in white muscle disease
- Fibrosis | - Mineralized foci in the heart
123
Selenium toxicity lesions
- More an acute inflammatory process without the mineralization
124
Pericarditis definition
- Inflammation or pericardium resulting in accumulation of fluid/exudate between visceral and parietal pericardium
125
Typical etiology pericarditis
- Trauma - "hardware disease" - Hematogenous - Extension from lungs or pleura - Neoplasia
126
Clinical signs of pericarditis
- 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
Treatment for pericarditis
- Usually salvage procedure - Poor prognosis - Drainage - 5th rib resection, pericardectomy
128
Prevention of pericarditis
- Magnets | - management to help with indiscriminate prehension
129
Necropsy findings of pericarditis
- Often fibrin covering the heart
130
How common are cardiac tumors?
- rare
131
Most common cardiac tumor?
- Lymphosarcoma - Manifestation of BLV - LEntivirus in cattle
132
Other cardiac tumors
- Mesothelioma - Fibrosarcoma - Adenosarcoma - Carcinomas
133
Definition of atrial fibrillation
- Incoordinated atrial electrical activity
134
What is most common cause of atrial fibrillation in cattle?
- Acid/base and electrolyte disturbances secondary to GIT disease - Hypocalcemia, hypokalemia, hypochloremia - Metabolic alkalosis
135
Auscultation of atrial fibrillation
- irregularly irregular rhythm
136
ECG of atrial fibrillation
- Irregular R-R interval, No P waves (f waves), irregular QT intervals
137
Treatment for Atrial fibrillation in cattle?
- 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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