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Veterinary Surgery - Study Cards > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the two methods utilized to arrest circulation during an open cardiac procedure?

A

“Venous inflow occlusion provides brief circulatory arrest, allowing short procedures (<4 minutes) to be performed. Longer open cardiac procedures require establishing an extracorporeal circulation by cardiopulmonary bypass to maintain organ perfusion during surgery.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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2
Q

What is considered the induction agent of choice in animals with pericardial construction?

A

“Ketamine combined with diazepam may be appropriate for induction of compromised patients. It should be avoided in animals with mitral insufficiency as it increases the regurgitant fraction by increasing peripheral vascular resistance. However, it is the induction agent of choice in animals with pericardial constriction. ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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3
Q

What diagnostic modality can be used to assess both cardiac function and volume status in the cardiac patient undergoing cardiac surgery?

A

“Transesophageal echocardiography (TEE) can be an invaluable tool for assessing both cardiac function and volume status in the cardiac patient. The use of TEE intraoperatively and immediately postoperatively can guide the choice of pharmacologic intervention and can assist in assessing the effectiveness of therapy. Central venous pressure measurements have been shown to poorly correlate with volume status. When TEE is used, ventricular filling can be visualized and volume replacement modified accordingly.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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4
Q

Generally speaking, between which costal arches is the heart located?

A

“The heart is the largest mediastinal organ. It generally extends from the third rib to the caudal border of the sixth rib; however, variations have been noted among breeds and between individuals.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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5
Q

Where does the azygous vein drain and what is its function?

A

“The azygos vein usually enters into the cranial vena cava; it carries blood from the lumbar regions and the caudal thoracic wall.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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6
Q

What is the first major artery to branch off of the aortic arch?

A

“The brachycephalic trunk is the first large artery from the aortic arch.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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7
Q

What major nerves must be preserved when performing a pericardiectomy?

A

“Phrenic nerves lie in a narrow plica of pleura adjacent to the pericardium at the heart base. Complete pericardiectomy requires that these nerves be elevated to avoid incising them. The vagus nerves lie dorsal to the phrenic nerve. They divide to form dorsal and ventral branches that lie on the esophagus in the caudal thorax. The left recurrent laryngeal nerve leaves the vagus and loops around the aortic arch distal to the ligamentum arteriosum to run cranially along the ventrolateral tracheal surface.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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8
Q

Discuss the pathophysiology of PDA

A

“PDA typically causes a left-to-right shunt that results in volume overload of the left ventricle and produces left ventricular dilation. Progressive left ventricular dilation distends the mitral valve annulus, causing secondary regurgitation and additional ventricular overload. This severe volume overload leads to left-sided CHF and pulmonary edema, usually within the first year of life. Atrial fibrillation may occur as a late sequela because of notable left atrial dilation.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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9
Q

Discuss the pathophysiology of reverse PDA

A

“Occasionally, animals with PDA develop suprasystemic pulmonary hypertension that reverses the direction of flow through the shunt, causing severe hypoxemia and cyanosis (Eisenmenger’s physiology). Right-to-left PDA can occur as a late sequela (6 months) to untreated PDA. When right-to-left PDA is noted in very young animals, it may be due to persistent pulmonary hypertension after birth. Reversal of right-to-left PDA lessens the risk for developing progressive left-sided heart failure but causes severe debilitating systemic hypoxemia, exercise intolerance, and progressive polycythemia.
”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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10
Q

What’s the typical signalment of a patient with PDA?

A

“Small-breed dogs (e.g., bichon frise, Chihuahua, poodle, Pomeranian, Yorkshire terrier) are most commonly affected; however, PDA also occurs commonly in German shepherd dogs and Shetland sheepdogs. Yorkshire terriers were the most common purebred dogs reported in a large retrospective study.8 Females are more commonly affected than males. In the aforementioned study, median age at the time of diagnosis was 5.1 months.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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11
Q

Typical clinical exam findings for patients with PDA

A

“The most prominent physical finding associated with PDA is a characteristic continuous (machinery) murmur heard best at the high left heart base or left axillary region. The left apical cardiac impulse is prominent and is displaced caudally, and a palpable cardiac “thrill” is often present. Femoral pulses are strong or hyperkinetic (water hammer pulse) owing to a wide pulse pressure caused by diastolic runoff of blood through the ductus. Tall R waves (>2.5 mV in lead II) or wide P waves on a lead II ECG are supportive of the diagnosis, but they are not always present. Atrial fibrillation or ventricular ectopy may occur in advanced cases.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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12
Q

Physical exam findings of patients with reverse PDA

A

“Physical examination findings in animals with right-to-left or reverse PDA differ from findings in those with left-to-right shunts. Differential cyanosis is typically present (i.e., most apparent in the caudal mucous membranes), but cyanosis may also be noted in the cranial half of the body in some animals. Cyanosis occurs as a result of mixture of nonoxygenated blood (from the pulmonary artery) with oxygenated aortic blood. Femoral pulses are normal. A systolic cardiac murmur, rather than a machinery murmur, may be present. However, a murmur may not be auscultated if polycythemia is present, if left- and right-sided pressures are nearly equal, and if shunting of blood through the ductus is minimal.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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13
Q

What is the precise anatomic location of a patent ductus arteriosus? What nervous structures surround it and must be protected?

A

“It is located between the aorta and the main pulmonary artery, caudal to the origin of the brachycephalic and left subclavian arteries. The left vagus nerve always passes over the ductus arteriosus and must be identified and retracted during dissection. Often the left recurrent laryngeal nerve can be identified as it loops around the ductus.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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14
Q

Where should the surgical approach be made for the ligation of a patent ductus arteriosus?

A

“Perform a left fourth space intercostal thoracotomy”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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15
Q

Pulmonic stenosis is the most common congenital cardiac defect of dogs. Many affected patients may remain asymptomatic, whereas dogs with severe obstruction may show exercise intolerance, syncope and progressive right sided congestive heart failure. What is the typical signalment for affected dogs?

A

“Female English bulldogs and male bull mastiffs are more commonly affected”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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16
Q

Congenital pulmonic stenosis causes right ventricular hypertrophy and a right axial shift. What ECG abnormality can be expected in these patients?

A

“The ECG may show prominent S waves in leads I, II, III, and aVF, indicative of a right axis shift and right ventricular hypertrophy.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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17
Q

What is the most common congenital heart defect affecting large breed dogs?

A

“Aortic Stenosis (AS)is the most common congenital heart defect affecting large-breed dogs and occurs uncommonly in cats. SAS accounts for more than 90% of canine cases and occurs with widely disparate morphology and severity. ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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18
Q

What are the local consequences of aortic stenosis as well as the potential consequences to the patient?

A

“SAS causes pressure overload on the left ventricle. Varying degrees of left ventricular concentric hypertrophy may develop, depending on severity. Dogs with moderate to severe SAS are at substantial risk for sudden death, presumably as the result of myocardial ischemia and malignant ventricular arrhythmias. Dogs with SAS may also develop CHF, particularly if concurrent mitral insufficiency is present. Lastly, dogs with SAS are at increased risk for bacterial endocarditis of the aortic valve owing to turbulent blood flow and resultant valvular damage.
”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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19
Q

In one breed has a genetic basis been established for aortic stenosis? What other breeds are frequently affected?

A

“Newfoundlands, boxers, golden retrievers, Rottweilers, German shepherds, Samoyeds, and Dogue de Bordeaux are at increased risk for developing SAS. A genetic basis for SAS has been established in Newfoundlands. ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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20
Q

What is the typical clinical history for a young large breed dog affected by the aortic stenosis? what physical exam findings may you encounter?

A

“Dogs with SAS may be asymptomatic or may exhibit exercise intolerance, collapse, or syncope. Lack of clinical signs is not an appropriate reason to delay diagnostic evaluation, because the first clinical evidence of SAS may be sudden death.”

“The predominant physical finding in animals with SAS is a systolic ejection murmur heard best at the left heart base. The murmur radiates well to the right base and thoracic inlet. In moderate to severe cases, femoral pulses are noticeably weak or hypokinetic, unless substantial concurrent aortic insufficiency is present. ECGs may show a left cranial axis shift or ventricular ectopy, but these findings are usually unremarkable.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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21
Q

What are the typical radiographic findings for a patient with aortic stenosis?

A

“Thoracic radiographs may reveal a normal cardiac silhouette or mild left ventricular and left atrial enlargement. Enlargement of the ascending aorta is frequently evident.
”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

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22
Q

What is the typical Treatment for a patient with aortic stenosis?

A

Beta-adrenergic blockers (propranolol or atenolol) to decrease myocardial oxygen requirement and suppress ventricular arrhythmias during exercise. Unfortunately a 2014 study found that this therapy did not influence survival in dogs with severe AS.

Symptomatic treatment for CHF

Balloon valvuloplasty (results are still not outstanding and may not affect survival in comparison to medical therapy)

23
Q

Briefly explain the pathophysiology of ventricular septal defect (VSD) as well as its relationship with Eisenmenger’s physiology

A

“The pathophysiology of VSD depends on the size of the defect and PVR. VSD typically causes a left-to-right shunt. A typical VSD overloads the left ventricle and, depending on its size and location, may overload the right ventricle as well. A large VSD can progress to left-sided CHF. Chronic overcirculation of the lungs can cause progressive pulmonary vascular remodeling, leading to severe pulmonary hypertension and right-to-left shunting of blood (Eisenmenger’s physiology). Residence at high altitude likely accelerates the development of pulmonary hypertension.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

24
Q

When is surgical intervention for patients affected by ventricular septal defect recommended? What reasonably simple procedure has been utilized to palliate dogs and cats with VSD?

A

“Surgical intervention can be considered for hemodynamically significant VSD. Concurrent aortic insufficiency is usually progressive and is an indication for surgical intervention. Pulmonary artery banding has been used successfully to palliate dogs and cats with VSD. The goal of pulmonary artery banding is to increase right ventricular systolic pressure, thereby decreasing shunt flow.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

25
Q

List 5 neoplasms known to cause pericardial effusion in the dog

A

“Neoplasms that produce pericardial effusion in dogs include hemangiosarcoma, chemodectoma, mesothelioma, ectopic (heart base) thyroid carcinoma, lymphoma, and metastatic carcinoma to the heart.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

26
Q

What are the cardiac and systemic consequences of pericardial effusion?

A

“progressive right-sided CHF, including jugular venous distention, ascites, peripheral edema, and/or pleural effusion. Cardiac tamponade eventually occurs despite compensatory mechanisms, leading to circulatory collapse.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

27
Q

What is the typical owner complaint with constrictive pericarditis?

A

“The most common owner complaint with constrictive pericarditis is abdominal enlargement. Dyspnea, tachypnea, weakness, syncope, and/or weight loss are noted less frequently. Occasionally, a previous history of idiopathic pericardial effusion is reported.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

28
Q

What is the classic triad of signs associated with cardiac tamponade?

A

“The classic triad of signs of cardiac tamponade (e.g., rapid and weak arterial pulse, distended jugular veins, and diminished heart sounds) ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

29
Q

What electrocardiogram abnormality is observed in over 50% of patients with pericardial effusion?

A

“Electrical alternans may be recorded in as many as 50% of patients with pericardial effusion. If present, electrical alternans is strongly suggestive of pericardial effusion. It is caused by swinging of the heart within large pericardial effusions rather than alterations in conduction within the heart and is most likely to occur at heart rates between 90 and 144 beats/min.”

(Constant variation in the amplitude of R-waves. Short, tall, short, tall, etc…)

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

30
Q

What is the reported sensitivity and specificity of echocardiography for the detection of heart base masses?

A

“Echocardiography is the most reliable procedure for identifying primary cardiac neoplasia; sensitivity and specificity for detecting a right atrial or heart base mass were found to be 82% and 100%, respectively.31”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

31
Q

Describe the procedure for pericardiocentesis

A

“Shave and surgically prepare a large area of the right hemithorax (sternum to midthorax, third to eighth rib). Perform a local block with lidocaine and, if necessary, sedate the animal (e.g., hydromorphone, fentanyl; Box 27.7). Infiltrate the pleura with lidocaine as pleural penetration causes significant discomfort. Place the animal in sternal (preferably) or lateral recumbency, depending on its demeanor. Pericardiocentesis can be accomplished in the standing animal, but adequate restraint is essential to prevent cardiac puncture or pulmonary laceration. Determine the puncture site based on heart location on thoracic radiographs. This is most commonly between the fourth and fifth intercostal spaces at the costochondral junction. Attach a 14- to 18-gauge needle or over-the-needle catheter to a three-way stopcock, extension tubing, and syringe to allow constant negative pressure to be applied during insertion and drainage (Video 27.2). Once the catheter has been inserted through the skin, apply negative pressure. If pleural effusion is present, it will be noted immediately on entering the thoracic cavity. Pleural effusion associated with heart disease is usually a clear to pale yellow color. Advance the catheter until it contacts the pericardium and a scratching sensation is noticed. Then advance the catheter[…]”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

32
Q

What is a first-degree AV block and what is the typical cause?

A

“First-degree AV block, which occurs as a prolongation of conduction through the AV node, usually results from exaggerated parasympathetic influence on the AV node”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

33
Q

What is a second-degree AV block (low grade and high grade) and what is the typical cause?

A

“Second-degree (incomplete) AV block is characterized by intermittent failure of impulse conduction through the AV node. Low-grade (infrequent) second-degree AV block usually results from exaggerated parasympathetic influence on the AV node. High-grade (frequent) second-degree AV block is more likely the result of intrinsic disease of the AV node. ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

34
Q

What is a third-degree AV block? What is the typical cause?

A

“Third-degree (complete) AV block (see Fig. 27.28C) is seen as complete failure of conduction through the AV node and strongly implies intrinsic degenerative or infiltrative disease of the AV node. Third-degree AV block causes complete AV dissociation and development of a slow ventricular escape rhythm. The result is low and unresponsive cardiac output.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

35
Q

What is “sick sinus syndrome” and what is its typical clinical presentation?

A

“Sick sinus syndrome, which is the clinical result of sinus node malfunction, is characterized by frequent syncopal and near-syncopal episodes. Sick sinus syndrome may also be accompanied by frequent supraventricular tachycardia.”

“Small-breed dogs, particularly miniature schnauzers, are predisposed to sick sinus syndrome. ”

36
Q

What is “Atrial standstill”? What are the two most common causes and predisposed dog and cat breeds?

A

“Atrial standstill (Fig. 27.28A) occurs when the atria fail to conduct an electrical impulse. The cardiac impulse may arise in the sinus node and be conducted to the AV node via internodal pathways in the atria (i.e., sinoventricular rhythm), or an escape rhythm may develop. Transient atrial standstill is caused by hyperkalemia. Persistent atrial standstill occurs as the result of a heritable muscular dystrophy syndrome involving the cardiac atria, ventricles, and scapulohumeral skeletal muscles.”

“English springer spaniels and Siamese cats are predisposed to persistent atrial standstill. ”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

37
Q

List two important causes of non-cardiogenic bradycardia

A

Central nervous system disease (increased intracranial pressure)

Abdominal disease

38
Q

What is the preferred application technique/approach for an epicardial pacemaker?

A

“Epicardial pacemaker implantation in small animals is accomplished through a midline celiotomy diaphragmatic incision. The transdiaphragmatic approach has several advantages, including avoidance of a thoracotomy and abdominal placement of the generator.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

39
Q

“A ____________ thoracotomy provides exposure of the right side of the heart (auricle, atrium, and ventricle), cranial and caudal vena cava, right lung lobes, and azygos vein.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=1367916984
This material may be protected by copyright.

A

Right intercostal

40
Q

Describe the lateral intercostal thoracotomy approach

A

“With the dog in lateral recumbency, select the site for incision (Video 29.1). Locate the approximate intercostal space, and sharply incise the skin, subcutaneous tissue, and cutaneous trunci muscle. The incision should extend from just below the vertebral bodies to near the sternum. Deepen the incision through the latissimus dorsi muscle with scissors (Fig. 29.3A), then palpate the first rib by placing a hand cranially under the latissimus dorsi muscle. Count back from the first rib to verify the correct intercostal space. “The ribs cranial to an intercostal incision are more easily retracted than the caudal ribs; therefore choose the more caudal space if you must choose between two adjacent intercostal spaces. Transect the scalenus and pectoral muscles with scissors perpendicular to their fibers, then separate the muscle fibers of the serratus ventralis muscle at the selected intercostal space (Fig. 29.3B). Near the costochondral junction, place one scissor blade under the external intercostal muscle fibers, and push the scissors dorsally in the center of the intercostal space to incise the muscle (Fig. 29.3C). Incise the internal intercostal muscle similarly. Notify the anesthetist that you are about to enter the thoracic cavity and, after identifying the lungs and pleura, use closed scissors or a blunt instrument to penetrate the pleura. This allows air to enter the thorax, causing the lungs to collapse away from the body wall. Extend the incision dorsally and ventrally to achieve the desired exposure. Identify and avoid incising the internal thoracic vessels, as they course subpleurally near the sternum. Moisten laparotomy sponges and place them on the exposed edges of the chest incision. Use a Finochietto retractor to spread the ribs

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

41
Q

List two surgical methods to decrease post-operative discomfort following lateral intercostal thoracotomies

A

“A muscle-sparing technique may also be performed in cats and small dogs. Here, rather than incising the latissimus dorsi muscle, the muscle is sharply separated along its ventral fascial attachments and elevated. Puppies may be more willing to ambulate shortly after thoracotomy if the latissimus dorsi muscle has not been incised. A 2015 study in 20 dogs found the muscle-sparing technique was associated with a less painful recovery during the first 7 days after surgery when compared to the traditional technique.1 In addition, the muscle-sparing technique did not compromise exposure of thoracic viscera.Transcostal sutures have also been reported for closure of intercostal thoracotomies; small holes are drilled in the caudal rib through which the suture is passed to avoid entrapment of the intercostal nerve against the rib. This closure method appears to result in markedly less postoperative pain; however, it is time consuming and may be associated with rib fracture in smaller animals.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=1367916984
This material may be protected by copyright.

42
Q

What cardiovascular precaution / close monitoring should always be taken in patients with thoracic trauma? Discuss timing of onset and pathophysiology

A

“Animals with thoracic trauma should be examined for delayed-onset cardiac arrhythmias. Cardiac arrhythmias, particularly premature ventricular contractions and ventricular tachycardia, may occur after either blunt or penetrating thoracic trauma. These arrhythmias may not begin until 12 to 72 hours after the trauma and may be associated with myocardial contusion, myocardial ischemia that occurs secondary to shock, or neurogenic injuries that result in sympathetic overstimulation. Cardiac contusions are frequently overlooked in injured patients because (1) attention is directed toward visually obvious injuries, (2) there is no external evidence of thoracic trauma, or (3) there is no evidence of thoracic trauma at the initial examination. Cardiac function, therefore, should be evaluated frequently in most trauma patients.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=1367916984
This material may be protected by copyright.

43
Q

What percentage of thoracic trauma dogs with normal breathing will have radiographic evidence of pulmonary injury?
What can be see on these rads? How about rib fractures? Any better diagnostic if multiple injuries are suspected?

A

“A 2015 study sustaining thoracic bite trauma found 22% of dogs and cats with normal respiratory patterns had lesions apparent on thoracic radiographs.10 Thoracic radiographs should be carefully evaluated for pulmonary contusions, pneumothorax (see p. 936), pleural effusion (see p. 938), and diaphragmatic herniation (see p. 927). Rib fractures are easily missed on thoracic radiographs if careful attention is not paid to the rib contour, particularly if the fractured segment is minimally displaced. Orthogonal radiographic views should be evaluated. Evidence of other bony trauma should be sought by carefully examining the vertebrae, scapulae, and proximal forelimbs. Full-body CT can be considered instead of multiple radiographs if multiple injuries are suspected.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

44
Q

What is the reported mortality rate for thoracic bite wounds in dogs? Is there a difference between stabilization Vs. Conservative management of flail segments?

A

15%
No difference in outcome whether a flail segment is stabilized or not.

45
Q

What conditions are also frequently encountered in patients with cranial abdominal wall defects?

A

“If you identify a cranial abdominal wall defect in a young animal, consider that it may also have PPDH, a congenital cardiac abnormality, or both.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

46
Q

Typical signalment and affected breeds (dogs and cats) for PPDH?

A

“Although PPDH is congenital, it is not uncommon for the diagnosis to be made when the animal is middle-aged or older because clinical signs vary and may be intermittent. Weimaraners and cocker spaniels may be at increased risk. Domestic longhair and Himalayan cats may be predisposed. PPDH is one of the most common congenital cardiac defects diagnosed in cats 2 years of age and older. There is no sex predisposition in cats or dogs.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

47
Q

Most common clinical signs/physical exam findings associated with PPDH (peritoneal-pericardial diaphragmatic hernia)

A

“Physical examination findings in animals with PPDH may include muffled heart sounds, ascites, murmurs caused either by displacement of the heart by visceral organs or by intracardiac defects, and concurrent ventral abdominal wall defects. The most commonly herniated organ is the liver, and associated pericardial effusion is common.”

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

48
Q

List five radiographic abnormalities associated with Peritoneopericardial hernias

A

Enlarged cardiac silhouette
Dorsal elevation of the trachea
Overlap of the heart and diaphragmatic borders
Discontinuity of the diaphragm
Gas-filled structures in the pericardial sac
Sternal defects
Dorsal peritoneopericardial mesothelial remnant

Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.

49
Q

What does the P-R interval represent on the ECG?

A

The conduction delay between SA and AV nodes

50
Q

What direction of conduction is assessed by leads I, II and III respectively?

A

I: Right arm to Left arm
II: Right arm to Left leg
III: Left arm to left leg

51
Q

According to Bascuñán et al (veterinary Surgery 2020), what is the most common vascular ring anomaly diagnosed in cats? What is the recommended treatment and expected outcome? Include overall success rate, and most likely complication.

A

= 20 cats
- Vascular ring anomalies were most commonly (75% [15/20]) diagnosed in cats less than 1 year old, with no breed or sex predilection.
- Regurgitation was the most common clinical sign, present in 18 of 20 (90%) cats. A persistent right aortic arch was diagnosed in 17 of 20 (85%) cats, with concurrent aberrant left subclavian artery in four of the cats.
- Surgical treatment was associated with survival to discharge in 18 of 20 (90%) cats.
- Persistent clinical signs were reported in 69% of cats, and radiographic evidence of megaesophagus persisted in four of 13 (31%) cats, with a median follow-up of 275 days after discharge.

Conclusion

Persistent right aortic arch was the most commonly diagnosed VRA in cats in this series, although multiple anomalies were observed. Surgical treatment of VRA in cats was associated with a high survival to discharge, although persistence of clinical signs and megaesophagus was noted in 69% and 31% of the cats, respectively.

Bascuñán, A, Regier, PJ, Case, JB, et al. Vascular ring anomalies in cats: 20 cases (2000-2018). Veterinary Surgery. 2020; 49: 265– 273. https://doi.org/10.1111/vsu.13327

52
Q

Alternative suture passing technique for PDA

A

Jackson-Handerson

53
Q

What are the proposed mechanisms behind the development of ventricular arrhythmias in patients with splenic masses undergoing surgery?

A

Myocardial ischemia secondary to hypokalemia and hypoxemia

The compressive effect of the mass upon the caudal vena cava, leading to diminished venous return

Micro-thrombi

Myocardial depressant factor released from a ischemic pancreas

Veterinary Surgery - Study Cards (29 decks)

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