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Small animal Medicine- Cardiology > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pressure overload definition

A

disease that requires the heart to generate greater than normal ventricular pressures to eject blood

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2
Q

Systolic dysfunction definition

A

disease that results in reduced pumping function of the heart (low stroke volume and cardiac output)

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3
Q

Volume overload definition

A

Disease that results in a higher than normal end diastolic volume in the ventricle

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4
Q

diastolic dysfunction definition

A

diseases that result in reduced relaxation function of the heart

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5
Q

what are the 6 rules of the heart

A
  • Two circulations are arranged in series. Systemic and pulmonary circulation
  • the heart is a muscle
  • The heart’s response to disease is predictable -
  • The heart has 3 functions: conduction, diastole, systole
  • blood is lazy - flows in the direction of least resistance
  • Blood pressure = cardiac output x vascular resistance
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6
Q

concentric hypertrophy definition

A

appears as an increased wall thickness and small chamber Pressure overload is the common cause

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7
Q

Eccentric hypertrophy definition

A

Appears as a normal wall thickness with a dilated chamber. Wall thickness remains normal. Volume overload is the common cause

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8
Q

What items in an animals history are helpful?

A
  • onset, duration, progression of presenting complaint - changes in weight, appetite, thirst, urination/defecation, vomiting - coughing/sneezing/respiratory effort/ gagging (frequency, character) - activity level and any recent changes in activity or endurance, fainting spells, weakness, or collapse - Travel and vaccination history and any concurrent medical conditions -diet and medications and supplements
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9
Q

Define cachexia

A

A disproprotionate loss in muscle mass that is commonly seen in inflammatory conditions

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10
Q

What are differentials for cachexia

A
  • end stage cardiovascular disease
  • neoplasia
  • renal disease
  • chronic inflammatory conditions
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11
Q

What are differentials for abdominal distension

A

abdominal fluid (a sign of R-CHF) organomegaly weakened abdominal muscles

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12
Q

Define fluid wave and what are differentials for a fluid wave

A

vibration of fluid palpated on ballottment of moderate to severe abdominal fluid - Right sided CHF - Liver disease, protein losing entero/nephropathies - Neoplasia - Trauma, bleeding mass, coagulopathies

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13
Q

When evaluating Mucous membranes, what do you consider as a differential when you have pale mucous membranes?

A
  • poor perfusion* peripheral vasoconstriction anemia
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14
Q

When evaluating mucous membranes, what do you consider as a differential when you see blue/gray colored mucous membranes

A

R to L shunting, pulmonary parenchymal disease (such as pulmonary edema from left sided congestive heart failure) airway disease, hypoventilation, shock

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15
Q

What are differentials for cyanosis

A

pink MM cranially and blue MM caudally. This is a finding in dogs with a R to L shunting in a patent ductus arteriosus (Reverse PDA)

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16
Q

What is the status of your patient when you see brick red or “injected” Mucous membranes

A

Early phases of Shock

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17
Q

What are differentials for yellow mucous membranes

A

hemolysis, hepatobiliary disease

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18
Q

What is peripheral pitting edema, and list differentials

A
  • Edema (fluid in tissues) in the ventral extremities or ventral thorax/abdomen Differentials: An uncommon seen sign in patients with right sided congestive heart failure. More common in horses and cattle. Non-cardiac differentials include hypoalbuminemia and rarely renal disease.
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19
Q

Precordium definition

A

to palpate the precordium is to palpate the heart beat on the chest wall. It is normally felt strongest on the L hemithorax

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20
Q

What side is the precordium stronger on?

A

Left side is generally strongest

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21
Q

What does it mean if there is a stronger Right sided precordium than the left side?

A

Right sided heart enlargement

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22
Q

What is a precordial thrill?

A

ability to palpate the fine vibrations of a murmur ont he chest wall. Precordial thrills may be palpated in patients with very loud murmurs. (grade V or VI)

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23
Q

What sounds are systolic sounds?

A

S1- closure of the mitral and tricuspid valves causes an abrupt deceleration of blood flow resulting in vibrations of the cardiac walls and blood S2- produced by the closure of the aortic and pulmonic valves and is best heard over the aortic area.

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24
Q

What sounds are considered Diastolic sounds

A

S3 - rapid ventricular filling S4- atrial contraction

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25
Q

Define murmur

A

A prolonged, audible vibration of blood in the heart or great vessels that can be associated with turbulent blood flow or abnormal blood flow

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26
Q

What is Grade 1/VI heart murmur

A

soft murmur heard in only 1 valve location, only in very quiet room; may only be intermittent

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27
Q

What is Grade II/VI heart murmur

A

soft murmur heard consistently, but only in 1 valve area Heard in 2 quadrants

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28
Q

What is a Grade III/VI heart murmur?

A

Moderate murmur heard in multiple valve locations on one side of the chest. Heard in 3 quadrants

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29
Q

What is a Grade IV/VI heart murmur?

A

Loud murmur heard on both sides of the chest. Heard in all 4 quadrants

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30
Q

What is a Grade V/VI heart murmur?

A

Loud murmur heard at all valve locations, associated with precordial thrill. Heard in 4 quadrants + thrill.

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31
Q

What is a Grade VI/VI heart murmur?

A

Loud murmur heard at all valve locations, even with stethoscope held 1cm from the chest wall. Heard in 4 quadrants + thrill + audible with stethoscope off chest

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32
Q

PMI

A

point of maximal intensity - describes the locatino on the heart where the murmur is most audible. This helps determine what valve the murmur is originating from.

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33
Q

what does “Radiation” mean when ausculting a heart?

A

This describes where else you can heart the murmur other than the PMI

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34
Q

When using the term “base” when describing the location of the PMI, what does it mean

A

this desecribes the upper half of the heart (above the costochondral junction). Murmurs that are the loudest at the base originate from the aortic or pulmonic valves

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35
Q

When using the term “apex” to describe the PMI, what does it mean?

A

this describes the lower half of the heart (below the costochondral junction). Murmurs loudest at the apex originate from the mitral or tricuspid valves.

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36
Q

How do you describe a ejection murmur?

A

this is a murmur that increases in intensity or who’s sound changes over time.

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37
Q

How do you describe a regurgitant murmur?

A

A consistent intensity and sound throughout the murmur

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38
Q

What are potential differentials for a jugular pulsation?

A

Eleveated R heart pressures (tricuspid regurgitation, other R sided volume or pressure overload disease, R sided CHF) - Pericardial disease - Inflow obstruction (mass or thrombus) - Arrhythmias (AV block, ventricular tachycardia)

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39
Q

Jugular distention definition

A

the jugular vein remain full of blood as if someone was holding off for blood

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40
Q

How do you describe normal arterial strength of arterial pulses?

A

This is Normokinetic, strong, or adequate

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41
Q

How do you describe a weaker strength arterial pulse? List some differentials

A

hypokinetic caused by a reduced stroke volume and narrowed pulse pressure. Subaortic stenosis, hypovolemia and some arrhythmias

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42
Q

How do you describe a stronger arterial pulse than normal?

A

Hyperkinetic caused by a widened pulse pressure. Bounding, or water-hammer pulses.

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43
Q

What are clinical signs associated with pulmonary edema?

A
  • Tachypnea at rest
  • Short, shallow respiratory pattern with inspiratory effort
  • signs of severe dyspnea
    • orthopneic (elbows pointed out and abducted)
    • Wide eyed
    • Neck outstretched
    • Open mouthed breathing in cats
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44
Q

Pleural effusion clinical signs

A
  • Tachypnea at rest
  • Inspiratory and expiratory effort
  • Abdominal component to breathing
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45
Q

What respiratory sounds do you hear with Pulmonary edema?

A

This is commonly associated with Left sided heart failure.

Respiratory exam: soft crackles at the end of inspiration and beginning of expiration are typical of patients with cardiogenic pulmonary edema from left sided CHF>

46
Q

What respiratory sounds do you hear with Pleural effusion

A

reduced or absent breath sounds ventrally due to fluid accumulation

47
Q

What does TPR stand for in thoracic radiograph film quality?

A

T = technique

P = Positioning

R = Respiratory phase

48
Q

What vertebral heart score is considered normal?

A

8.5-10.5

49
Q

What is the appropriate heart size for a cat when looking at a lateral and VD of a cat?

A

Lateral 2/3 the height of the chest cavity

VD 1/2 the width of the chest cavity

50
Q

If a dog has a wide heart, where is the enlargement?

A

Generally RV is too wide

51
Q

If a dog has a heart that is too tall, where is the enlargement?

A

Left ventricular enlargement is more common than a right ventricular enlargement.

52
Q

on the “clockface” where are the following heart structures located at? Lateral positioning

LA

LV

RV

Aortic Arch

A
53
Q

When a VD radiographic picture of a heart is present, where are the structures located in regards to a clock face?

Aortic arch

Left Auricle

LV

RV

RA

A
54
Q

When evaluating a vd and you see a reverse D appearance, what does it indicate

A

Right sided Heart enlargement commonly associated with a:

Right heart pressure overload disease causing enlargement of the Main pulmonary artery, right atrium and right ventricle

55
Q

What are the 3 radiographic features of left sided CHF?

A
  1. Moderate to severe left atrial dilation
  2. Pulmonary venous dilation
  3. Interstitial to alveolar pulmonary pattern (pulmonary edema)
  • increased soft tissue opacity. There is an alveolar pattern
56
Q

What are the radiographic features of right sided congestive heart failure?

A
  • Moderate to severe right heart enlargement
  • Dilated caudal vena cava
  • Fluid accumulation
    • Ascites, pleural effusion, small volume of pericardial effusion
  • Pulmonary vasculature sizes varies depending on the type of right heart disease
57
Q

What side of the heart is affected here?

Describe the changes seen

A

The right side of the heart is affected.

  1. Retraction of the lung lobes away from the thoracic wall or pleural fissure lines
  2. Soft tissue opacity ventrally + scalloped margins created by the lung lobes
  3. Border effacement with the cardiac silhouette and diaphragm
  4. Elevation of the trachea
58
Q

What does dilation of the Caudal vena cava indicate

A

Venous congestion

59
Q

What type of descriptive information is used to stage heart disease patients using the ACVIM classification system?

Structural or Functional?

A

ACVIM classification system - structural descriptions of what the heart looks like

60
Q

you have an 8 year old FS mixed breed dog with mitral valve disease and moderate left atrial enlargement on an echocardiogram. Stage the heart disease using the ACVIM Staging system

A

B2

61
Q

Describe Stage A heart disease

A

These are breeds that are at risk of cardiac disease.

  • no known heart disease
  • no murmur/arrhythmia
  • no cardiomegaly on radiographs
  • no clinical signs
62
Q

Describe Stage B heart disease

A
  • Structural heart disease present
    • Heart murmur or imaging evidence (echo, radiographs)
  • No clinical signs
63
Q

Explain Stage B1 Heart disease

A

No hemodynamic compromise

  • none to mild heart enlargement

Recommendations:

  • no medical treatment or dietary restrictions
  • Annual monitoring
64
Q

Describe Stage B2 heart disease

A
  • Relevant hemodynamic compromise
    • Significant heart enlargement (echo or radiographic)
    • DMVD: specific cutoffs for LA and LV size
    • Recommendations
      • Ace inhibitors
      • Pimobendan
      • Not indicated: Furosemide, spironolactone *no clinical signs yet”
65
Q

Describe Stage C heart disease

A

Patient is currently showing or in the past had signs of CHF.

  • Left-sided: pulmonary edema
  • Right-sided: cavitary effusions

Recommendations: furosemide, pimobendan, Ace inhibitors, spironolactone, dietary Na restrictions

66
Q

Describe Stage D heart disease

A
  • Current or past signs of CHF refractory to standard treatment
    • Furosemide
    • Pimobendan
    • Ace inhibitors
    • Spironolactone
  • Recommendations: “tools in the toolbox”
    • Increase the furosemide dose
    • increase pimobendan dose
    • amlodipine
    • Hydrochlorothiazide
67
Q

What is the definition of “heart failure”?

A

clinical syndrome wherein the heart pumps an inadequate volume of blood to meet O2 demands of tissue and prevent fluid accumulation.

  • occurs in the face of adequate/high venous return
  • Common end result of many different cardiac diseases NOT a primary diagnosis
68
Q

What factors determine cardiac output

A

Heart rate

Stroke volume which is determined by preload, afterload and inotropy

69
Q

What are clinical signs of heart failure with a low output

A

syncope

pallor (pale apperance)

cyanosis

hypokinetic pulses

azotemia

70
Q

What are the exam findings of a patient with congestive heart failure

A

pulmonary edema

pleural effusion

ascites/hepatomegaly

pericardial effusion

peripheral edema

71
Q

Where does the fluid go in Left sided CHF. Differentiate between a dog and a cat.

A

Dog - Pulmonary edema

Cat- pulmonary edema, pleural effusion, pericardial effusion. Cats don’t follow the exact same pattern as dogs do

72
Q

Where does the fluid go for Right sided CHF? differentiate between dogs and cats.

A

Dog- ascites

Cats- Pleural effusion, ascites, pericardial effusion

73
Q

What are long term effects of RAAS activation?

A

Myocardial remodeling and fibrosis

renal and arteriolar sclerosis

cytokine activation

74
Q

What pathophysiologic parameters can we alter pharmacologically to treat heart failure?

A

increase inotropy

decrease preload

decrease afterload

optimize HR

Blunt RAAS

Blunt SNS

75
Q

The presence of fluid accumulation in the form of pulmonary edema, pleural effusion, ascites/hepatomegaly, pericardial effusion and or peripheral edema are clinical signs of ______ heart failure.

A) forward (low output)

B) backward (congestion)

A

B) backward (congestion)

76
Q

What drugs do we use to decrease preload?

A

Furosemide

Spironolactone

Hydrochlorthiazide

77
Q

Which Diuretic is the 1st line in CHF? How does it work.

A

Furosemide - Loop diuretic targeting the ascending loop of henle. Targets the Na/K/2Cl cotransporter

Side effects: activates RAAS (need Ace inhibitors), azotemia, hypokalemia

78
Q

What is DMVD?

A

degeneration of the heart valves that results in valve regurgitation. This causes a progressive heart dilation and ultimately results in congestive heart failure.

79
Q

What is the order that heart valves are affected for DMVD?

A

Mitral > tricuspid > aortic >> Pulmonic in dogs

80
Q

What is another name for Endocarditis

A

Degenerative mitral valve disease

Degenerative valve disease

81
Q

what type of hypertrophy occurs with DMVD?

A

eccentric hypertrophy due to the volume overload

82
Q

What is the common signalment for DMVD?

A

CKCS in particular -> More common in small breeds

middle aged to old

Male > Female dogs

83
Q

How would you desecribe Stage B2 DMVD?

A

Murmur with moderate or severe left atrial dilation. This is at risk for progression to stage C

84
Q

When evaluating radiographs for DMVD, what do you look for?

A

You look at the structure of the heart. A leaky mitral valve would result in a dilation of the left side of the heart

85
Q

When diagnosing a dog with DMVD, what does stage B1 look like on Echocardiography

A

thickened valve leaflets with mitral regurgitation

Normal heart size or mild L atrial dilation

86
Q

When diagnosing a patient with DMVD with Echocardiography, what would stage B2 look like?

A

Eccentric hypertrophy that appears as dilated LA and LV with normal wall thickness

Thickened valve leaflets with regurgitation

+/- valve prolapse or ruptured chordae tendinae

87
Q

What can you look for on the electrocardiogram for a patient with DMVD in regards to chamber enlargement patterns?

A

Wide P wave is indicative of Left atrial enlargement

Tall R wave, wide QRS indicates left ventricular enlargement

88
Q

How do you recommend treating a patient in Stage B2 DMVD?

A

pimpbendan with an ACE inhibitor

+/- antihypertensive therapy if indicated by the BP

Avoid high salt diets and treats.

Re-evaluate the patient every 6-12 months while it remains assymptomatic. follow up with thoracic radiographs, etc.

89
Q

What is the treatment protocol for a stage C DMVD?

A

Left sided CHF: diuretic (furosemide, spironolactone), ACEi, pimobendan

90
Q

What can the ECG tell us?

A

heart rate, arrhythmias, conduction abnormalities

Good at chamber enlargement

91
Q

true/false An ECG tells us about the mechanical activity of the heart

A

false

92
Q

what is an arrhythmia

A

electrical activity that has an irregular rhythm and/or an abnormal heart rate

93
Q

What does each wave in an electrocardiograpm tell us about the electrical activity? (polarization/depolarization)

P wave

PR interval

QRS complex

T wave

A

P wave = atrial depolarization

PR interval = electric activity moves Slowly through AV node

QRS complex = ventricular depolarization

T wave = ventricular replarization

94
Q

how long is a BIC pen?

A

150 mm

95
Q

what is bradyarrhythmia

A

Low calculated heart rate

96
Q

What does it mean to have a regularly irregular rhythm?

A

This is an irregular rhythm with a discernable pattern to the regularity. This is a characteristic of sinus arrhythmias.

97
Q

What is an irregularly irregular arrhythmia?

A

Irregular rhythm without a discernable pattern to the irregularity.

This is a characteristic of atrial fibrilation

98
Q

Evaluate the heart rhythm

A

Supraventricular heart rhythm.

99
Q

Evaluate the heart rhythm

A

Ventricular rhythm

Wide and bizarre QRS

QRS does not have an associated P wave

100
Q

Transient atrial standstill differentials

A

Seen in patients with severe hyperkalemia.

Dogs= Addisons

Cats= Urethral blockage

Treatment: atrial standstill can be resolved by correcting the hyperkalemia and underlying cause

this ECG: atrial standstill with evidence of right ventricular enlargement (with a deep S wave)

101
Q

What are indications for echocardiography

A

To assess the cardiac structure and function

  • assess the heart chamber size
  • wall thickness
  • systolic and diastolic function
  • valve anatomy and valve regurgitation

Provides definitive diagnosis of most cardiac diseases

102
Q

Where on a thoracic cavity is a parasternal view in regards to echocardiography?

A

next to the sternum

103
Q

How do you achieve a subcostal view for echocardiography?

A

place the transducer on the abdomen and direct it cranially. The ultrasound should go through the liver and diaphragm

104
Q

What is the difference between a long axis and short axis echardiography orientation?

A

Long axis shows all 4 chambers

105
Q

What do you evaluate on a Right parasternal Long axis view?

A

LV should be 3-4x the size and thickness of RV in long-axis

LA and LV should be roughly the same maximum height

LA and Ao should be roughly same diameter

Valve thickening/regurgitation?

LV systolic function

106
Q

what do the colors on dopler mean?

A

B.A.R.T.

Blue = away

Red = towards

Party colors = turbulance

107
Q

What is fractional shortening in regards to Echocardiography

A

echocardiographic index of LV systolic function

108
Q

what is the green arrow pointing to in this Right Parasternal Short axis M mode view?

A

Mitral valve as it opens and closes

109
Q

Identify each Letter

A
110
Q

What is a benefit of using the subcostal approach during echocardiography?

A

It allows you to see the aorta and aortic valve

111
Q

Name the chambers of this LA 4-chamber view

A

Small animal Medicine- Cardiology (3 decks)

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