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Internal Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Causes for a murmur?

A

Puppy murmur

Anemia

Fever

High sympathetic tone

Hyperthyroid

Marked bradycardia

Peripheral AV fistulae

Hypoproteinemia

Athletic hearts

Hypertension

15-34% of healthy cats

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2
Q

Normal VHS for most dogs?

A

8.5-10.5

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3
Q

Normal VHS for Minie Schnauzer, greyhounds and whippets?

A

Exceed 11

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4
Q

Normal VHS for boxers?

A

12.6

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5
Q

Upper VHS for long thorax like Dachshund?

A

9.5

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6
Q

VHS for cats?

A

6.7-8.1

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7
Q

What caudal mainstem bronchus is commonly elevated with LA enlargement?

A

Left

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8
Q

Pulmonary edema with relatively normal LA size think what?

A

Rupture Chordae tendinae.

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9
Q

The S1 heart sounds originates from?

A

Closure of AV valves

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10
Q

The S2 heart sounds originate from?

A

Closure of the aortic and pulmonic valves

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11
Q

Speed of sound?

A

1540 m/sec

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12
Q

How does the ultrasound beam get attenuated? 4 things?

A

Beam divergence Absorption Scatter Reflection

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13
Q

Common range for echocardiogram (MHz)?

A

3.5-10MHz

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14
Q

What is a MHz?

A

1 million cycles/sec

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15
Q

Sedation that can be used in dogs and cats?

A

Ace

Butorphaol

Buprenophine

Ket if needed.

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16
Q

Most common views?

A

Right and left parastenal.

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17
Q

RV wall should be no greater than what of the LV free wall?

A

1/2 thickness

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18
Q

Size of the LA in cats in long axis (right ) view?

A

1.5cm - 1.9cm = greater risk for thromboembolism.

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19
Q

M-mode provides a cleaner resolution of the cardiac borders than 2-D due to what?

A

Higher sampling rate.

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20
Q

What is M-mode showing/measuring in this parasternal short axis view?

A

E-Point septal separation

Fractional shortening

LA: Ao ratio

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21
Q

What is FS and what are normals for cats and dogs?

A

FS = Left ventricular internal dimension diastole - LVID systole/ LVIDd (x100)

25-45% in dogs

Cats 35-65%

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22
Q

What happens to E point and A point at high heart rates?

A

They blend together

E is the point of maxium opening during rapid ventricular filling

F is when it starts to close

Then A happens when the atrium contracts.

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23
Q

What does increase e-point to septal separation usually assoicated with?

A

Reduced myocacrdial contractility

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24
Q

M-mode LA: Ao ratio?

A

1:1

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25
Q

Theory of saline microbubbles in echocardiogram?

A

Injection IV then they go to the right heart… they do not cross through the pulmonary capillary bed and therefore should not be seen in the left heart.

If in the left heart than there is a right to left shunt.

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26
Q

In doppler sound returning from cells moving away from the transducer has what type of frequency? Towards the transducer?

A

Low frequency - Away from the transducer

High frequency - Towards the transducer

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27
Q

The angle of the beam to the flow of blood should be less than what? What happens at 90 degrees?

A

20 degrees or less

At 90 degrees = 0 so no flow.

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28
Q

What is the advantage of pulse doppler? Disadvantage?

A

The blood flow velocity, direction and spectral characteristics can be caluclated from A SPECIFIC LOCATION!

Disadvantage - there is a velocity limit. (2x the pulse repetition frequency or Nyquist limit)

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29
Q

What can effect the Nyquist limit?

A

Lower frequency transducers

Closer sample volume placement

Both increase the nyquist limi.

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30
Q

On a Pulse waved doppler (PW) what direction is below base line? Above base line?

A

Below base line = away from transducer

Above base line = towards the transducer

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31
Q

What are the best views for the inflow velocities of the mitral and tricupsid valves?

A

Mitral - Four chamber left parasternal

Tricuspid - left cranial short axis

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32
Q

What is the peak ejection aortic and pulmonary velocity?

A

Pulmonary - 1.4-1.5 m/s

Aortic 1.6-1.7 m/s — Highest 2.0

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33
Q

Peak injection velocity of what across the aortic valve is consistent with aortic stenosis?

A

2.2 m/s

between 1.7-2.2 is the Gray zone!

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34
Q

Best views for pulmonary velocities and aortic velocities?

A

Pulmonary: left cranial view

Aortic: Subcostal or left apical view (pick the highest velocity)

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35
Q

Advantage and disadvantage of continuous doppler (CW)?

A

No max velocity - advantage

Range ambiguity (no idea where the velocity is coming from) - Disadvantage.

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36
Q

What is the the modified bernoulli equation?

A

P = 4v2

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37
Q

When do you use pressure gradient estimation?

A

Regurgitant jets of the pulmonary valve.

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38
Q

PH (measuring of the tricuspid jet) should be assoicated with what velocity/pressure ?

A

3.5-50mmHg or 2.9-3.5m/sec – Mild

51-75mmHg or 3.6-4.3m/sec — Moderate

>75mmHg or >4.3m/sec — Severe

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39
Q

In color flow (CF) what do the two colors indicate?

A

Red - Towards

Blue - Away

Black - No flow or perpendicular

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40
Q

Aliasing in CF doppler is seen as what?

A

Reversal of color (shifting)

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41
Q

What are the CF characteristics commonly associated with more severe regurgitation?

A

Wide and long jets

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42
Q

Cardiac troponins are attached to cardiac actin filaments and are released (leaked) when what happens?

A

Myocardial injury

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43
Q

What breed has a higher than normal cardiac troponin?

A

Greyhounds

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44
Q

NTproBNP evelation correlates with what?

A

Severity of cardiac disease

and can help differentiate CHF vs noncardiac causes of dyspnea

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45
Q

What can cause elevated NTproBNP artifically?

A

Azotemia

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46
Q

Most common congenital diseases in dogs?

A

PDA and SAS

Pulmonary stenosis is also common.

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47
Q

An endocardial cushion consists of what?

A

High VSD

Low ASD

Malformation of one or both AV valves

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48
Q

Most common congenital heart diseases in cats?

A

AV valve dysplasias

Atrial or ventricular septal defects

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49
Q

Congenital malformations are more prevalent in what breed of cats?

A

Males

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50
Q

Congenital malformations are more prevalent in what group of animals?

A

Purebreds

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51
Q

All congenital heart defects are seen in large breed dogs except for which ones?

A

Mainly PDA (Mixed group of little and big)

Pulmonic stenosis (Mixed group of little and big)

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52
Q

Histopathologically a PDA has what changes that don’t allow it to close?

A

Less smooth muscle.

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53
Q

How many dogs with PDAs get reverse PDAs? Why does this happen?

A

15%

Pulmonary vascular changes and creates high resistance and then pulmonary hypertension and therefore pressures rise over the aortic pressure thus reversing flow.

54
Q

PDAs have a 2-3x higher prevelance in what sex?

A

Female— opposite of what you normally think of congential heart defects

55
Q

What are the clinical signs with PDA?

A

Most are asymptomatic when first diagnosed

Others = Cough, tachypnea, exercise intolerant.

56
Q

What is the classic triad of bulges for a PDA?

A

Left auricle

Pulmonary trunk

Aorta

57
Q

Most helpful echocardiogram view for finding a PDA?

A

Left cranial short axis

DOPPLER FLOW

58
Q

What is this?

A

PDA

59
Q

Why is it contraindicated to close a reversed PDA?

A

It is acting as a pop off valve for the pulmonary hypertension… there for if it closes then the right heart pressures will go up and probably go into heart failure.

60
Q

What type of heart remodeling is seen with valvular stenosis?

A

Concentric due to increase pressure.

61
Q

What is this?

A

This is a PDA.. see the turbulance in the pulmoonary outflow and the arrow is pointing to the PDA.

62
Q

What is the most common type of aortic stenosis?

A

Subaortic stenosis

63
Q

What is commonly compromised in aortic stenosis that can lead to progression of hypertrophy and myocardial ischemic fibrosis?

A

Coronary perfusion

64
Q

Why are animals with SAS thought to be a higher risk for aortic valve endocarditis?

A

The jet causes a lesion injury to the underside of the valve.

65
Q

What is this?

A

SAS

66
Q

What view is the best for seeinig velocities out of the aortic outflow for SAS?

A

Subxyphoid.

67
Q

What is considered abnormal for aortic flow?

A

Over 2.2 m/sec is abnormal

1.7-2.2 m/sec is grey zone. (Normal in boxers, Goldens and Greyhounds)

68
Q

What echo signs are there for SAS?

A

Stenosis of the outflow tract

Poststenotic dilation

Increased LV echogenicity (fibrosis)

Aortic thickening

LA enlargement

LV thickening.

69
Q

Pulmonic stenosis is more common in what size of dog?

A

Small

70
Q

With stenotic lesions what cause dynamic obstruction?

A

Severe enlargement of the myocardium just below the valve (infundibular region)

71
Q

A combination of pulmonic stenosis and what can causes right to left shunting?

A

PS + ASD or paten foramen ovale

The pressure from the PS allows the blood pressure in the RV to be big enough to overcome the left.

72
Q

What defect is important to look for in Boxers and bulldogs with PS?

A

Anomalous coronary artery (R2A) which wraps around the pulmonary artery thus if ballooned will kill the dog.

73
Q

When does syncope or cyanosis happen in dogs with pulmonary stenosis?

A

When there is a concurrent VSD or ASD causing right to left shunting.

74
Q

What is this?

A

Pulmonary stenosis

75
Q

When is PS considered severe?

A

100mmHg jet.

76
Q

The prognosis for pulmonary stenosis is worse with what other findings?

A

Tricuspid regurgitation

Atrial fib

Tachyarrhythmias

CHF

77
Q

Where are most VSD located?

A

The membranous part of the septum just below the aortic valve.

78
Q

VSD cause volume overloading of what side of the heart?

A

Left side

79
Q

Very large VSD causes ventricles to function as what?

A

A common chamber and induces RV changes.

80
Q

Best view to see a VSD?

A

Right parasternal long axis

81
Q

Small VSDs will cause high-velocity shunting with what velocity and why is this important?

A

4.5-5m/sec

Important due to prognosis.. smaller VSD is better so higher velocity is better.

82
Q

What is this?

A

VSD

83
Q

What can low peak shunt velocity in a VSD mean?

A

Large VSD

Pulmonary hypertension

Pulmonary stenosis

84
Q

How can a VSD close?

A

Spontaneously

The left heart hypertrophies so much it closes it

Sealed by a tricuspid leaflet or aortic leaflet.

85
Q

Where are ASD most likely to be located in a dog vs cat?

A

Dog - fossa ovale

Cat - Lower septum

86
Q

ASDs cause volume overload of what part of the heart?

A

Right side… due to the left to right shunting in the atrium

87
Q

Why are ASDs hard to find on doppler?

A

Thin fossa ovalis region may look like one

Venous inflow can cause doppler to suck

88
Q

Mitral dyplasia is commonly seen in what animals… why is this important?

A

Large young dogs

Cats

In dogs this important because of the fact that we call cardiomyopathy in big dogs with big left hearts… Therefore this should also be on the list if it is a young dog.

89
Q

Tricuspid dysplasia is most common in what type of dogs?

A

Labs (large breed dogs)

90
Q

What is the most common finding in these dogs and cats on rads?

A

HUGE right hearts - DDX pericardial effusion and DCM

91
Q

What are the most common cardiac anomalies that cause cyanosis?

A

Tetrology of fallot

Pulmonary hyerptension secondary to PDA, VSD or ASD

92
Q

What is tetralogy of fallot (T of F)?

A

VSD

Pulmonary stenosis

RV hypertrophy

Malpositioned aorta (over the septum causing right to aortic shunting)

93
Q

What breed is predisposed through inheritance to T of F?

A

Keehond.

94
Q

What is this?

A

Tricuspid dysplasia

95
Q

What is this?

A

Reversal of a PDA

The first image is in the LV and looks normal, the second is in the RV and the aorta is opacified. The LV or LA is not ruling out VSD or ASD reversal.

96
Q

Malformation that allow deoxygenated blood to reach circulation (Right to left shunting (reversals or T of F)) cause what?

A

Hyperviscosity syndrome secondary to erthrocytosis secondary to hypoxia.

97
Q

What is the most common vascular ring anomaly in dogs?

A

PRAA

98
Q

What is cor triatriatum?

A

Membrane divides the right or left atrium into two chambers

99
Q

What is cor triatriatum sinister vs dexter?

A

Sinister = left atrium

Dexter = right atrium

100
Q

What is the main radiographic sign of cor triatraum dexter?

A

Enlarged CVC with no heart enlargement.

101
Q

What cat breeds get endocardial fibroelastosis?

A

Burmese and siamese

Left sided changes.

102
Q

Chronic valvular disease is the cause of what percentage of heart disease in dogs?

A

70%

103
Q
  1. What breed of large breed dogs may have a higher prevalence of mitral valve degeneration?
    1. Labs
    2. Great Dane
    3. Rotties
    4. GSD
A

GSD

104
Q
  1. What are causes of acutely worsening pulmonary edema in dogs with chronic AV valve disease?
    1. Arrhythmias
    2. Increased cardiac load
    3. Hot, humid environment
    4. Ruptured chordae
A

All of them

105
Q
  1. What bronchus is commonly associated with collapse in dogs with AV valve disease?
    1. Caudal right
    2. Right middle
    3. Left cranial
    4. Caudal left
A

left caudal bronchus

106
Q
  1. What is the maximal TR regurg jet velocity allowed before it is considered abnormal?
    1. 1.7m/s
    2. 2.0m/s
    3. 2.2m/s
    4. 2.5m/s
A

2.2m/s

107
Q
  1. What are potential sequelae of infectious endocarditis?
    1. Infarcts (splenic, renal)
    2. Immune-mediated polyarthritis
    3. Myositis
    4. Pneumonia
    5. Thrombosis
A

All of them

108
Q
  1. What congenital heart disease has an increased risk for infectious endocarditis?
    1. PDA
    2. VSD
    3. Tricuspid dysplasia
    4. SAS
A

SAS

109
Q
  1. T/F Hypertrophic osteopathy has been associated with bacterial endocarditis?
A

True

110
Q

What is the common bacteria that causes endocarditis?

A

Bartonella.

111
Q

What dog breed has the highest prevalence of DCM?

A

Dobies.

112
Q

DCM in dogs commonly causes what type of heart enlargment?

A

Left sided.

113
Q

What is the criteria for occult DCM on echocardiogram?

A

LVIDd greater than 4.6cm <42kg

5.0cm >42kg

LVIDs >3.8cm

VPCs

EPSS >0.8cm

114
Q
  1. What chemo drug commonly cause secondary myocardial disease?
    1. 5FU
    2. Chlorambucil
    3. Doxorubicin
    4. Vincristine
A

C and A

115
Q
  1. Strict vegetarian diet can cause secondary myocardial disease due to the lack of what nutrient?
    1. Vit C
    2. L-carnitine
    3. Taurine
    4. Vit B
A

L-carntine

116
Q
  1. Atherosclerosis of the coronary arteries is cause by what endocrine disease?
    1. Hypoadreno
    2. Hyperadreno
    3. Hyperthyroid
    4. Hypothyroid
A

Hypothyroid

117
Q
  1. What viruses can cause myocarditis in dogs?
    1. Coronavirus
    2. Distemper
    3. Rabies
    4. West Nile
    5. Parvovirus
A

Distemper

WN

parvo

118
Q
  1. Noninfectious myocarditis can be caused by what?
    1. Thyroid homone
    2. Wasp venom
    3. Immune mediated disease
    4. Phyochromocytoma
A

All of them

119
Q
  1. What is a major complication off cats with myocardial disease?
    1. Coronary infarction
    2. Right atrial rupture
    3. Arterial thromboembolism
    4. Endocarditis
A

Arterial Thromboembolism

120
Q
  1. HCM is most common in what type of cat?
    1. Old, female
    2. Middle age, female
    3. Old, male
    4. Middle age, male
A

Middle aged males

121
Q
  1. What is the normal FS for a cat?
    1. 25-65%
    2. 35-55%
    3. 35-65%
    4. 25-55%
A

35-65%

122
Q
  1. Who knew there was steroid-associated heart failure in cats?
    1. Me
    2. Not me
A

Not me

123
Q

Where are the four most clinically recognized places for a thromboembolic event?

A

Cranial vena cava

Distal aorta

Pulmonary arteries

Heart

124
Q

What are the three things in Virchows triangle?

A

Endothelial damage

Stasis of blood

Hypercoaguability

125
Q

The common reason for cats to get PTEs is?

A

HWD

126
Q

A LA dimension of what may have increased risk of TE disease?

  1. 1.2mm
  2. 1.5mm
  3. 2.0mm
  4. 2.2mm
A

2.0mm

127
Q

What is the difference between the clinical signs in dogs with an aortic thrombus and a cat?

  1. Dogs are usually bilateral, while cats are usually unilateral
  2. Dogs commonly show signs of self-mutilation and cats do not
  3. Dogs have chronic signs while cats are acute
  4. This disease is common in young dogs while it is common in older cats
A

Dogs have chronic clinical signs

128
Q

What does claudication mean?

  1. Cold feet secondary to ischemia
  2. Blue/white appendages secondary to ischemia
  3. Muscle pain secondary to ischemia
  4. Sloughing of tissue secondary to ischemia
A

Muscle pain secondary to ischemia

129
Q

List the four target organs in chronic systemic hypertension?

A

Heart

Kidneys

Eyes

Brain

130
Q

An proximal ascending aortic diameter:aortic valve annulus diameter ratio is commonly seen in cats with systemic hypertension?

  1. 1.05
  2. 1.75
  3. 2.25
  4. 1.25
A

1.25

131
Q

What group of dogs can have normally higher blood pressure than other breeds?

  1. Basset hounds
  2. Terriers
  3. Labs
  4. Sighthounds
A

Sighthounds

132
Q

What factor has been associated with high blood pressure in dogs and cats?

  1. Brown eyes
  2. Athletic event animals
  3. A raw food diet
  4. Obesity
A

Obesity

Internal Medicine (12 decks)

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