cardioresp Flashcards
How do we detect where heart murmur is?
Point of maximal intensity (location) of heart murmurs
Listed to heart
loudest at left apex. what valve?
Left Apex:
- Mitral valve
Listed to heart
loudest at Best base what valve?
Left Base:
- Pulmonic valve
- Aortic valve
Listed to heart
loudest at Left Cranio-Dorsa what valve?
Left Cranio-Dorsal: Patent ductus arteriosus (PDA) Right side of chest: -Tricuspid valve (apex) -VSD loudest on R (cranio-sternal)
Listed to heart
loudest at Right side of chest apex what valve?
Right side of chest:
-Tricuspid valve (apex)
Listed to heart
loudest at Right side of chest craniotomy sternal, what valve?
-VSD loudest on R (cranio-sternal)
Not 100% sure if dog’s backwards heart failure is right or left sided
what is a way to check if right?
explain it
Hepato jugular reflex
Gentle pressure on the caudal abdomen causes increased distention / pulsation of the jugular veins:
Inc Venous return by caudal vena cava to right atrium, if RA failing = reduced drainage from cranial VC = jugular more distension
sign of increased right sided filling pressure (more blood returning to heart via caudal vena cava will lead to head and neck blood damming back).
Useful test
Puppy comes in with a heart murmur what type is it? rough age of pup? grade on murmur what is it due too?
Age:
Young puppies (and kittens), should Diminish with growth
Disappear by 16 – 20 weeks old
Grade and sound?
Usually < grade 3/6
Low pitches, left basular, musical, less loud as pup grows and disappears by 20 weeks
Why?
Due to change from foetal to adult haemoglobin
Can be difficult to distinguish from congenital heart disease
Watchful monitoring or investigate depending on how loud and purpose of dog
Loud often not innocent
Need vagomimetic? what drug
Digoxin
Need positive inotrope?
Pimobendan
Dog with oedema. What do and drug use first
IF pulmonary = Thoraco-centesis immediately!
If ascites don’t need to drain as not life threatening
DIURETICS = life saving
Furosemide = loop diuretic
Then ACE inhibitor - monitor renal function
How can owner monitor if need to inc or dec fursomide drug conc to tackle oedema?
Monitor sleeping or resting rest rate
reduce dose of F is RR stable
inc dose if RR inc
Side affects furosemide
Pre-renal azotaemia
Hypokalaemia - may need to supplement K+
Furosemide no longer works and highest dose possible…
Use ACE inhibitors to improve cardiac function
GIT oedema consider parenteral admin
additional diuretics?
Substitute with more potent loop diruetic torasemide
Role of ACE inhibitors
Angiotensin-convertin enzymes
Balanced vasodilators
Reduce aldosterone release, so reduced Na+ &H2O retention
Prevent Angiotensin II mediated myocardial fibrosis and remodelling
Permissive anti-adrenergic effects
Reduce vasopressin release
Reduce endothelin release
Increased levels of bradykinin & vasodilatory prostaglandins = help with renal function
Prevent glomerular capillary hypertension
