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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
What drug is used to treat Ventricular arrhythmias?
Sotalol
26
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?
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)
27
Which extra heart sounds do you hear in DCM? What do they mean? Where would you auscultate them?
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
28
What is SAM (systolic anterior motion) in feline HCM?
When the anterior mitral valve leaflet is "sucked" into the left ventricular outflow tract (LVOT)
29
What is the definition of hypertrophic cardiomyopathy?
Marked concentric hypertrophy of the left ventricle
30
What is the characteristic shape of the heart on a DV view in HCM and what is it caused by?
"Valentine Heart" | Caused by left atrial enlargement
31
What is the difference between restricted cardiomyopathy and hypertrophic cardiomyopathy?
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.
32
What are two forms of restrictive cardiomyopathy?
Myocardial (unknown cause) | Endomyocardial (previous myocarditis, adhesions + increased echogenicity)
33
Where does haemangioscarcoma occur in the heart? What other organs does it affect? What breed is predisposed to it? What is the prognosis?
Associated with the right atrium Spleen, liver German Shepherds Grave: Palliative treatment
34
What are the 3 most common neoplastic causes of pericardial effusion?
1. Haemangiosarcoma 2. Chemodectoma 3. Mesothelioma
35
What is ventricular interdependence?
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
How does a pleural effusion causes right-sided CHF?
Reduced right ventricular filling | Collapse of right atrium during diastole
37
What is electrical alternans on an ECG? What does it indicate? Why does it happen?
Alternating QRS amplitudes (different heights of each peak) Indicates pericardial effusion Due to mechanical movement of heart in the fluid
38
What is the difference between the treatment of pericardial effusion in dogs and cats?
Diuretics are NOT used in dogs. They will further increase the cardiac preload and worsen cardiac tamponade
39
What is cardiac tamponade?
Collapse of the right atrium during diastole Impairs filling and reduces RHS output Activates RAAS
40
What causes constrictive pericarditis?
Thickened, fibrotic pericardium
41
What breeds are predisposed to PPHD (Peritoneopericardial diaphragmatic hernia)
Weimaraners | Persians
42
What causes infectious pericarditis in cats?
FIP
43
What is the hallmark of most congenital heart diseases?
Heart murmur
44
What causes the heart sounds S1 and S2?
S1: Closure of the mitral valve (blood in ventricles) S2: Closure of aortic valve (blood in aorta)
45
Where is the sinoatrial node located? What can stretching it due to atrial enlargement cause?
Right atrium | Atrial arrhythmias and accessory pathways
46
What is tricuspid dysplasia? | What does it lead to?
Incompetence of the tricuspid valve, leading to regurgitation of blood back into the right atrium Atrial enlargement and atrial arrhythmias
47
What is the main pathology of an atrial septal defect?
Blood is shunted from left to right hand side of the heart | Causes right side volume overload, leading to pulmonary hypertension
48
What is Eisenmenger's Syndrome? What happens to the pulmonary arterioles over time?
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
What are the 4 defects in Tetralogy of Fallot (TOF)?
1. Pulmonic stenosis 2. Concentric right ventricular hypertrophy 3. VSD 4. Dextrapposed aorta
50
How does TOF cause cyanosis
Presence of non-oxygenated blood (due to VSD) and less oxygenated blood (reduced pulmonary circulation causing reduced LV output + volume) in systemic circulation
51
What breed is prone to pulmonic stenosis? | What is thought to be the cause?
Brachycephalics (English bulldogs and Boxers) Abnormal origin of left coronary artery It encircles the pulmonary artery (below the valve)
52
What can the modified Bernoulli equation be used for?
Determining pressure gradient across a valve | Used in pulmonary stenosis to classify severity of the stenosis
53
Which congenital heart defect has a murmur grade that is INVERSELY correlated with the severity of the disease?
Ventricular septal defect (VSD) | Small defects maintain the pressure difference, fast turbulent flow causes LOUDER heart murmur
54
What is the most common congenital heart defect in dogs? | In cats?
Dogs: Pulmonic stenosis Cats: Ventricular septal defect
55
What cat breed is commonly affected by Supravalvular mitral stenosis?
Siamese
56
What do red, blue and green/yellow mean on a colour doppler ultrasound?
Red - flow towards the transducer Blue - flow moving away from the transducer Green/yellow - turbulent flow
57
What ventricular and aortic changes would you expect to see in a PDA?
Eccentric left ventricular hypertrophy Left atrial dilation +/- dilation of aorta and pulmonary artery
58
What is congenital cardiac disease is heritable in Newfoundlands?
Subaortic stenosis
59
What other cardiac abnormality do you need to differentiate sub-aortic stenosis from?
HOCM
60
How can sub-aortic stenosis cause sudden death?
Lethal ventricular arrhythmia
61
What 2 types of drug should you NEVER use in sub-aortic stenosis?
``` Positive inotropes (Pimobendan) Arteriodilators ```
62
What can cause a vascular ring anomaly? | What would you expect to see on a radiograph?
Persistent right aortic arch | Oesophageal body dilation (cranial to heart base)
63
Which breed of dog has a naturally high BP than normal?
Sighthounds
64
What is retinal detachment caused by in cardiac disease?
Systemic hypertension
65
What is hyphaema
Blood in anterior chamber of eye
66
What are the 3 main drugs used to treat systemic hypertension?
1. Amlodipine 2. ACE inhibitors 3. Telmisartan
67
What are the components of Virchow's triad?
1. Circulatory stasis 2. Endothelial injury 3. Hypercoagulable state
68
How would you diagnose pulmonary thrombo-embolism?
1. Identify clot breakdown products (D-dimers, FDPs) | 2. identify areas of Ventilation: perfusion mismatch
69
What causes heartworm disease?
Dirofilaria immitis
70
What is the Modified Knott's test used for?
Demonstrating the concentration of microfilariae (Dirofilaria immitis) in blood stream (Takes 6 months from onset of infection to demonstrate!)
71
What bacteria is associated with Heartworm Disease? How is it involved? How does it affect your treatment of HWD
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
What are two parasites associated with cardiac disease? | What are their intermediate hosts?
Dirofilaria immitis (heartworm) IH: Mosquitoes Angiostrongylus vasorum (lungworm) IH: Slugs/snails
73
Name a drug to treat lungworm (angiostrongylus vasorum)
Fenbendazole (best, slow killing of worms) (Milbemycin, Moxidectin) (+/- prednisolone if risk of anaphylaxis)
74
What is Wolff-Parkinson White Syndrome? | What would you see on an ECG?
Supraventricular tachycardia associated with an accessory pathway. By-passing of the AV node causing ventricular pre-excitation Delta waves seen on ECG
75
What is the goal in treatment of atrial fibrillation?
Modify (slow) the ventricular response rate, by SLOWING the conduction through the AVN Not to convert the abnormal atrial rhythm
76
What does a negative chronotrope do? Give an example of one and what it is used in
Slows the heart rate Digoxin Used in atrial fibrillation
77
What sort of arrhythmia can be caused by release of catecholamines (stress, pain)
Ventricular tachycardia
78
What is atrial standstill caused by?
Hyperkalaemia
79
What is the main treatment for ventricular tachycardia?
Sotalol (Beta-blocker)
80
What would you expect on an ECG with atrial standstill? | What breed does it commonly present in?
No P waves, variable R-R interval | WHWT (also predisposed to sick sinus syndrome; sinus arrest)
81
Which AV block is a sign of high vagal tone? | What animal is it normal in?
2nd Degree AV block Mobitz type I (Wenckback phenomenon) Horses
82
How do you tell if a bradyarrhythmia is vagally mediated?
Atropine response test
83
What do you use for the emergency treatment of bradyarrhythmias?
Terbutaline (B2 agonist)

Small Animal Studies (10 decks)

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