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Small Animal Studies > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What 3 macroscopic changes do you see with MDVD?

A

Valve leaftlets: Deformed, thickened
Chordae tendinae: Elongation and thickening (+/- rupture)
Jet lesions/left atrial tears

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2
Q

What happens to the heart in MDVD and why?

A

Eccentric hypertrophy
Dilated LV and LA
Due to chronic volume overload

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3
Q

What is MDVD? What is it associated with?

A

Nodular thickening of valve leaflets

Associated with accumulation of proteoglycans

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4
Q

What is the main cause of congestive heart failure in MDVD?

A

Mitral valve regurgitation

Activation of the RAAS

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5
Q

In the staging of MDVD, what is:

A? C2? D1?

A

A: At risk
C2: CHF, at home
D1: Refractory, hospitalised

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6
Q

In MDVD (mitral valve), where would you find the PMI of the murmur?

A

Left apex

Systolic

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7
Q

What is the main clinical sign in left vs right-hand sided heart failure?

A

Left: Pulmonary oedema (cough)
Right: Ascites

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8
Q

What is the most common cardiac biomarker used for MDVD and DCM diagnosis?
Why is it released?What does it indicate?

A

NT-proBNP
Released by atrial/ventricular stretch
Indicates heart failure

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9
Q

What would you usually see on echocardiography due to MDVD?

A

LA > LV

Hyperdynamic systolic function

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10
Q

What is pimobendan? What does it do?

A

Positive ionotrope + Vasodilator

increased the strength of muscle contractions

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11
Q

What is a diuretic? Give an example of one

A

Causes increase production of urine, reducing blood volume

Furosemide (+venodilator)

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12
Q

What are the 4 main drugs used for treatment of CHF?

A
  1. Pimobendan
  2. Furosemide
  3. ACE inhibitors
  4. Spironolactone
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13
Q

What are the 4 requirements for endocarditis?

A
  1. Bacteraemia
  2. Damaged endothelium
  3. Ability to adhere
  4. Hypercoagulable states
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14
Q

Which sides of the aortic and mitral valve would you expect to find valvular vegetations on in endocarditis?

A

Aortic: Ventricular side
Mitral: Atrial side

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15
Q

What is clopidogrel?

Give an example of its use

A

Anti-coagulant

Used in feline cardiomyopathy (e.g. HCM) to prevent thromboembolism

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16
Q

What are the 3 main differences between DCM and MDVD?

A
  1. DCM is mild regurgitation, lots of it in MDVD
  2. REDUCED systolic function in DCM, often hyperdynamic in MDVD
  3. LV is LARGER than LA in DCM
    LA is LARGER than LV in MDVD
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17
Q

In DCM, how does the RAAS and sympathetic system further impair systolic function?

A

It increases HR and contractility, in response to reduced cardiac output
This increases oxygen demand and wall stress
This leads to FURTHER myocardial cell death + fibrosis

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18
Q

What causes mitral regurgitation in DCM?

A

Dilatation of the valvular annulus

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19
Q

Which breed of dog has the worst prognosis for DCM?

A

Portuguese water dogs

Very aggressive and juvenile onset

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20
Q

What deficiency causes DCM in Cocker Spaniels?

A

Taurine

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21
Q

Which cardiomyopathy are Boxers prone to?

A

Arrhythmogenic Right Ventricular Cardiomyopathy

Also in English bulldogs, Douge de Bordaeaux

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22
Q

What is the pathology of ARVC? What arrhythmias would you expect?

A

Loss of myocytes with fatty or fibrofatty replacement

VPCs

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23
Q

What is a clear sign on an ECG that a dog is NOT in congestive heart failure?

A

Sinus arrhythmia

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24
Q

What 2 drugs are used to treat Supraventricular arrhythmias?

A

Diltiazem

Digoxin

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25
Q

What drug is used to treat Ventricular arrhythmias?

A

Sotalol

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26
Q

A cat presents dragging one/both hindlimbs, extreme vocalisation, absent femoral pulses, and cold distal limbs.
What is this called, and why does it happen?

A

FATE (Feline aortic thromboembolism)
“Saddle thrombus”
Thrombus formed in the left atrium due to cardiomyopathy
A part of this breaks off (embolism) travels down the aorta and gets lodged at the saddle (the joining of the left and right iliac arteries) cutting off the blood supply to the hindlimb(s)

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27
Q

Which extra heart sounds do you hear in DCM?
What do they mean?
Where would you auscultate them?

A

Diastolic gallops: S3 and S4
S3: Rapid ventricular filling (Stiff or increased pressure in LV)
S4: Increased atrial contraction (e.g. in slow v relaxation)
Left apex

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28
Q

What is SAM (systolic anterior motion) in feline HCM?

A

When the anterior mitral valve leaflet is “sucked” into the left ventricular outflow tract (LVOT)

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29
Q

What is the definition of hypertrophic cardiomyopathy?

A

Marked concentric hypertrophy of the left ventricle

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30
Q

What is the characteristic shape of the heart on a DV view in HCM and what is it caused by?

A

“Valentine Heart”

Caused by left atrial enlargement

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31
Q

What is the difference between restricted cardiomyopathy and hypertrophic cardiomyopathy?

A

The left ventricle wall is thickened and stiff in HCM, whereas the LV in RC is normal. The left atrium is massively enlarged in RC.

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32
Q

What are two forms of restrictive cardiomyopathy?

A

Myocardial (unknown cause)

Endomyocardial (previous myocarditis, adhesions + increased echogenicity)

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33
Q

Where does haemangioscarcoma occur in the heart?
What other organs does it affect?
What breed is predisposed to it?
What is the prognosis?

A

Associated with the right atrium
Spleen, liver
German Shepherds
Grave: Palliative treatment

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34
Q

What are the 3 most common neoplastic causes of pericardial effusion?

A
  1. Haemangiosarcoma
  2. Chemodectoma
  3. Mesothelioma
35
Q

What is ventricular interdependence?

A

When the filling of one ventricle affects the filling of the other. Leads to increase in filling in one with a decrease in the other.
Leads to pulsus paradoxus in pericardial effusions

36
Q

How does a pleural effusion causes right-sided CHF?

A

Reduced right ventricular filling

Collapse of right atrium during diastole

37
Q

What is electrical alternans on an ECG?
What does it indicate?
Why does it happen?

A

Alternating QRS amplitudes (different heights of each peak)
Indicates pericardial effusion
Due to mechanical movement of heart in the fluid

38
Q

What is the difference between the treatment of pericardial effusion in dogs and cats?

A

Diuretics are NOT used in dogs. They will further increase the cardiac preload and worsen cardiac tamponade

39
Q

What is cardiac tamponade?

A

Collapse of the right atrium during diastole
Impairs filling and reduces RHS output
Activates RAAS

40
Q

What causes constrictive pericarditis?

A

Thickened, fibrotic pericardium

41
Q

What breeds are predisposed to PPHD (Peritoneopericardial diaphragmatic hernia)

A

Weimaraners

Persians

42
Q

What causes infectious pericarditis in cats?

A

FIP

43
Q

What is the hallmark of most congenital heart diseases?

A

Heart murmur

44
Q

What causes the heart sounds S1 and S2?

A

S1: Closure of the mitral valve (blood in ventricles)
S2: Closure of aortic valve (blood in aorta)

45
Q

Where is the sinoatrial node located? What can stretching it due to atrial enlargement cause?

A

Right atrium

Atrial arrhythmias and accessory pathways

46
Q

What is tricuspid dysplasia?

What does it lead to?

A

Incompetence of the tricuspid valve, leading to regurgitation of blood back into the right atrium
Atrial enlargement and atrial arrhythmias

47
Q

What is the main pathology of an atrial septal defect?

A

Blood is shunted from left to right hand side of the heart

Causes right side volume overload, leading to pulmonary hypertension

48
Q

What is Eisenmenger’s Syndrome? What happens to the pulmonary arterioles over time?

A

The development of pulmonary hypertension (PHT) due to a left to right shunt
They develop vascular resistance and irreversible changes leading to a permanent elevated PHT

49
Q

What are the 4 defects in Tetralogy of Fallot (TOF)?

A
  1. Pulmonic stenosis
  2. Concentric right ventricular hypertrophy
  3. VSD
  4. Dextrapposed aorta
50
Q

How does TOF cause cyanosis

A

Presence of non-oxygenated blood (due to VSD) and less oxygenated blood (reduced pulmonary circulation causing reduced LV output + volume) in systemic circulation

51
Q

What breed is prone to pulmonic stenosis?

What is thought to be the cause?

A

Brachycephalics (English bulldogs and Boxers)
Abnormal origin of left coronary artery
It encircles the pulmonary artery (below the valve)

52
Q

What can the modified Bernoulli equation be used for?

A

Determining pressure gradient across a valve

Used in pulmonary stenosis to classify severity of the stenosis

53
Q

Which congenital heart defect has a murmur grade that is INVERSELY correlated with the severity of the disease?

A

Ventricular septal defect (VSD)

Small defects maintain the pressure difference, fast turbulent flow causes LOUDER heart murmur

54
Q

What is the most common congenital heart defect in dogs?

In cats?

A

Dogs: Pulmonic stenosis
Cats: Ventricular septal defect

55
Q

What cat breed is commonly affected by Supravalvular mitral stenosis?

A

Siamese

56
Q

What do red, blue and green/yellow mean on a colour doppler ultrasound?

A

Red - flow towards the transducer
Blue - flow moving away from the transducer
Green/yellow - turbulent flow

57
Q

What ventricular and aortic changes would you expect to see in a PDA?

A

Eccentric left ventricular hypertrophy
Left atrial dilation
+/- dilation of aorta and pulmonary artery

58
Q

What is congenital cardiac disease is heritable in Newfoundlands?

A

Subaortic stenosis

59
Q

What other cardiac abnormality do you need to differentiate sub-aortic stenosis from?

A

HOCM

60
Q

How can sub-aortic stenosis cause sudden death?

A

Lethal ventricular arrhythmia

61
Q

What 2 types of drug should you NEVER use in sub-aortic stenosis?

A 
Positive inotropes (Pimobendan)
Arteriodilators
62
Q

What can cause a vascular ring anomaly?

What would you expect to see on a radiograph?

A

Persistent right aortic arch

Oesophageal body dilation (cranial to heart base)

63
Q

Which breed of dog has a naturally high BP than normal?

A

Sighthounds

64
Q

What is retinal detachment caused by in cardiac disease?

A

Systemic hypertension

65
Q

What is hyphaema

A

Blood in anterior chamber of eye

66
Q

What are the 3 main drugs used to treat systemic hypertension?

A
  1. Amlodipine
  2. ACE inhibitors
  3. Telmisartan
67
Q

What are the components of Virchow’s triad?

A
  1. Circulatory stasis
  2. Endothelial injury
  3. Hypercoagulable state
68
Q

How would you diagnose pulmonary thrombo-embolism?

A
  1. Identify clot breakdown products (D-dimers, FDPs)

2. identify areas of Ventilation: perfusion mismatch

69
Q

What causes heartworm disease?

A

Dirofilaria immitis

70
Q

What is the Modified Knott’s test used for?

A

Demonstrating the concentration of microfilariae (Dirofilaria immitis) in blood stream
(Takes 6 months from onset of infection to demonstrate!)

71
Q

What bacteria is associated with Heartworm Disease?
How is it involved?
How does it affect your treatment of HWD

A

Wolbachia
Found in the uterus of female dirofilaria immitis
May play a role in pathogenesis of HWD
Treat HWD with doxycycline prior to melarsomine

72
Q

What are two parasites associated with cardiac disease?

What are their intermediate hosts?

A

Dirofilaria immitis (heartworm)
IH: Mosquitoes
Angiostrongylus vasorum (lungworm)
IH: Slugs/snails

73
Q

Name a drug to treat lungworm (angiostrongylus vasorum)

A

Fenbendazole (best, slow killing of worms)
(Milbemycin, Moxidectin)
(+/- prednisolone if risk of anaphylaxis)

74
Q

What is Wolff-Parkinson White Syndrome?

What would you see on an ECG?

A

Supraventricular tachycardia associated with an accessory pathway. By-passing of the AV node causing ventricular pre-excitation
Delta waves seen on ECG

75
Q

What is the goal in treatment of atrial fibrillation?

A

Modify (slow) the ventricular response rate, by SLOWING the conduction through the AVN
Not to convert the abnormal atrial rhythm

76
Q

What does a negative chronotrope do? Give an example of one and what it is used in

A

Slows the heart rate
Digoxin
Used in atrial fibrillation

77
Q

What sort of arrhythmia can be caused by release of catecholamines (stress, pain)

A

Ventricular tachycardia

78
Q

What is atrial standstill caused by?

A

Hyperkalaemia

79
Q

What is the main treatment for ventricular tachycardia?

A

Sotalol (Beta-blocker)

80
Q

What would you expect on an ECG with atrial standstill?

What breed does it commonly present in?

A

No P waves, variable R-R interval

WHWT (also predisposed to sick sinus syndrome; sinus arrest)

81
Q

Which AV block is a sign of high vagal tone?

What animal is it normal in?

A

2nd Degree AV block
Mobitz type I (Wenckback phenomenon)
Horses

82
Q

How do you tell if a bradyarrhythmia is vagally mediated?

A

Atropine response test

83
Q

What do you use for the emergency treatment of bradyarrhythmias?

A

Terbutaline (B2 agonist)

Small Animal Studies (10 decks)

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