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Veterinary Nursing > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

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1
Q

What are the normal heart rates for dogs and cats?

A 
Dogs = 60-180bpm
Cats = 120-240bpm
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2
Q

What are the main types of cardiac diseases we can check for?

A

Congenital cardiac disease
Acquired heart diseases
Arrhythmias

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3
Q

Give examples of congenital cardiac disease.

A 
Abnormalities of heart development in utero e.g.
Aortic stenosis
Pulmonic stenosis
Patent Ductus Arteriosus
Ventricular septal defect
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4
Q

Give examples of acquired heart diseases in dogs and cats.

A 
Dogs = myxomatous mitral valve disease / dilated cardiomyopathy / pericardial effusion
Cats = hypertrophic cardiomyopathy
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5
Q

How can we diagnose heart disease?

A 
History
Physical examination
Blood tests
Blood pressure
Electrocardiography (ECG)
Echocardiography
Thoracic radiographs
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6
Q

What typical presentations in the history lead us to consider heart disease?

A

Incidental finding - heart murmur/arrhythmia
Exercise intolerance, weakness, syncopal (fainting) episodes
Heart failure (left-sided = difficulty breathing (tachypnoea/dyspnoea) / right-sided = difficulty breathing and/or distended abdomen)
Sudden death

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7
Q

What are we looking for on physical examination?

A 
Loss of body condition
MMs - colour/CRT
Jugular veins - visible/pulsation
Peripheral pulses - quality/regular/deficits
Respiratory rate - > 35-40 breaths/min
Heart auscultation
Lung auscultation
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8
Q

What are we assessing on auscultation of the heart?

A

Heart rate
Rhythm - regular/irregular, gallop sounds
Pulse - quality/deficits
Heart murmurs - timing/point of maximal intensity/grading

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9
Q

What are we assessing on auscultation of the lungs?

A

Respiratory rate
Adventitious sounds
Crackles

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10
Q

What are the typical findings in heart failure?

A 
Reduced cardiac output - weak peripheral pulses, tachycardia, pale MMs, prolonged CRT
Weakness, exercise intolerance, syncope
Heart murmur
Gallop sounds
Arrhythmias +/- pulse deficits
Congestion
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11
Q

Describe left- and right-sided congestion.

A 
Left-sided = lungs (pulmonary oedema, tachypnoea (> 40 breaths/min), dyspnoea)
Right-sided = systemic (distended peripheral veins, ascites (free fluid in abdomen), pleural effusion)
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12
Q

What blood tests can we carry out?

A

Haematology (systemic diseases, anaemia)
Biochemistry (kidney values, electrolytes)
Cardiac biomarkers - cardiac troponin I (cTnI) / N-terminal pro-B-type natriuretic peptide (NT-proBNP)

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13
Q

What is normal systolic blood pressure?

A

120-140mmHg

Consider effects of stress

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14
Q

How do hypertension and hypotension indicate heart disease?

A 
Hypertension = increased cardiac workload, can contribute to progression of disease
Hypotension = might indicate decompensated heart failure, < 80mmHg is concerning
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15
Q

How do we use electrocardiography (ECG) to diagnose heart disease?

A 
Further characterise auscultatory findings:
Bradycardia
Tachycardia
Irregular rhythm
Pulse deficits
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16
Q

How can we use a Holter monitor (24hr ECG)?

A

To investigate intermittent arrhythmias
Clinical importance of arrhythmia - suspected cause of syncope/exercise intolerance, frequency + severity at home
Response to antiarrhythmic therapy

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17
Q

How do we use echocardiography (cardiac ultrasound)?

A 
Diagnose cardiac disease
Treatment options
Severity of disease and prognosis
Progression of disease
Response to treatment
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18
Q

What are the indications for thoracic radiographs?

A

Cough
Dyspnoea
Tachypnoea

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19
Q

What views do we use for thoracic radiographs investigating heart disease?

A

At least two views
Right lateral
Dorsoventral

20
Q

What are we looking for on thoracic radiographs?

A

Congestive heart failure
Lung pathology
Cardiomegaly

21
Q

Where may the narrowing of the vessels in stenosis occur?

A

Subvalvular (below valve)
Valvular
Supravalvular (above valve)

22
Q

Describe aortic stenosis.

A

Subvalvular
Left ventricular hypertrophy (increased workload)
Left-sided congestive heart failure

23
Q

Describe pulmonic stenosis.

A

Valvular
Right ventricular hypertrophy (increased workload)
Right-sided congestive heart failure

24
Q

What clinical signs do we see of stenosis?

A 
Can be asymptomatic
Arrhythmias
Exercise intolerance
Syncope
Congestive heart failure
25
Q

How do we treat stenosis?

A

Beta blocker
Balloon valvuloplasty (pulmonic stenosis)
Standard treatment for congestive heart failure

26
Q

What happens if fetal ductus arteriosus remains patent?

A

Blood flow from aorta to pulmonary artery
Loud continuous murmur at left heart base
Incidental finding / congestive heart failure

27
Q

How do we treat patent ductus arteriosus?

A

Interventional closure (ductal occluder)
Surgical ligation
Congestive heart failure therapy

28
Q

Describe a ventricular septal defect.

A

Most common location = upper septum (just below aortic valve)
Usually asymptomatic
Right-sided systolic murmur (small defect = loud murmur, large defect = soft murmur)
Usually no treatment necessary / heart failure treatment
Normal life expectancy if small defect

29
Q

Describe myxomatous mitral valve disease.

A

Idiopathic - hereditary
Small breed dogs e.g. Cavalier King Charles spaniels, Dachshunds etc.
Adult onset
Mitral / tricuspid valve
Left-sided apical systolic heart murmur
Slow progression (long asymptomatic period, incidental finding)
May progress to left-sided congestive heart failure

30
Q

How do we diagnose myxomatous mitral valve disease and what are we looking for?

A

Echocardiography
Thickening of valve leaflets - regurgitation of blood, left atrial dilation, left ventricular dilation
Prolapse of valve leaflets

31
Q

Describe dilated cardiomyopathy.

A

Idiopathic - hereditary
Large breed dogs - Dobermann, Great Dane, Newfoundland
Adult onset
Left apical systolic murmur (not always present)
Long asymptomatic period

32
Q

What does dilated cardiomyopathy cause and how does it progress?

A

Disease of myocardium - left ventricular dilation, decreased systolic function, arrhythmias
Progression may be rapid - arrhythmias, sudden death, congestive heart failure

33
Q

Describe pericardial effusion.

A

Large breed, adult dogs
Causes = idiopathic, neoplasia, etc.
Fluid in sac around heart compromises filling (‘tamponade’) - decreased cardiac output, right-sided heart failure

34
Q

How do we treat pericardial effusion?

A 
Pericardiocentesis (drainage):
Mild sedation, left lateral recumbency
Prepare area 3rd-8th intercostal space
Large catheter
Visualise window (echocardiography)
35
Q

How do we differentiate between blood and pericardial fluid?

A

Check for clotting (should not clot like blood)
Check PCV of fluid (lower than blood)
Measure volume drained
Collect samples (cytology = EDTA, culture = sterile tubes)

36
Q

Describe hypertrophic cardiomyopathy.

A

Most common cardiac disease in cats
Genetic causes, adult onset
Exclude other causes of hypertrophy (hyperthyroidism, systemic hypertension)
Increased myocardial thickness impairs filling in diastole

37
Q

How can hypertrophic cardiomyopathy present?

A

(Right-sided) heart failure - pulmonary oedema, pleural effusion
Incidental finding - heart murmur, gallop sound
Aortic thromboembolism - sudden onset lameness, cold leg, peripheral cyanosis, pain

38
Q

What can heart failure be due to?

A

Disease progression
Decompensation of previously stable heart failure
Development of impedance of cardiac filling, e.g. pericardial effusion

39
Q

What do both left- and right-sided heart failure lead to?

A

Decreased cardiac output
Tachycardia
Weak peripheral pulses
Slow CRT

40
Q

How do cats differ when presenting with heart failure?

A

Cats may present with hypothermia and bradycardia.

41
Q

How do we treat heart failure?

A

Furosemide (diuretic - decrease circulating volume)
Minimise stress
Oxygen
Pimobendane (increases contractility - dogs)
ACE inhibitor (vasodilator, anti-remodelling)
Spironolactone (weak diuretic, anti-remodelling)
Water must always be available

42
Q

What are the signs of improvement in heart failure patients?

A

Decreased respiratory rate and effort
Decreased heart rate
Improved pulse quality
Improved CRT

43
Q

Give some examples of causes of bradycardia.

A

Sinus bradycardia
Atrial standstill
Atrioventricular blocks
Sick sinus syndrome

44
Q

Describe the 3 stages of AV block.

A

1st degree = slow conduction through AV node (longer gap between P and QRS)
2nd degree = non-conducted P waves (some P waves not followed by QRS)
3rd degree = atrial rate 200bpm, ventricular rate 40bpm (wide and bizarre QRS complexes)

45
Q

Describe supraventricular tachycardia.

A

Originate from the atria

QRS complexes are narrow (similar to sinus complexes)

46
Q

What is an example of supraventricular tachycardia?

A

Atrial fibrillation - heart rate 210bpm, irregular rhythm, no P waves

47
Q

Describe ventricular arrhythmia.

A

Originate from the ventricular myocardium
QRS complexes are wide and bizarre
Ventricular tachycardia - heart rate 375bpm

Veterinary Nursing (65 decks)

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