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X Clinical Veterinary Nursing Theory > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

what is the function of the heart?

A

to pump blood around the body (via the lungs and systemic circulation)

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2
Q

what is the normal HR of dogs?

A

60-180 bpm

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3
Q

what is the average heart rate of cats?

A

120-240 bpm

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4
Q

when are congenital cardiac diseases present?

A

from birth

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5
Q

in what age group of animals are congenital heart diseases most often seen?

A

young animals

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6
Q

what causes congenital heart diseases?

A

abnormalities of heart development in utero

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7
Q

what are 4 of the common congenital cardiac diseases?

A

aortic stenosis
pulmonic stenosis
patent ductus arteriosus
ventricular septal defect

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8
Q

what is occurring during aortic or pulmonic stenosis?

A

narrowing of valves

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9
Q

what is a patent ductus arteriosus?

A

failure of the closure of a foetal vessel

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10
Q

what is a ventricular septal defect?

A

hole in ventricular septum

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11
Q

when do acquired heart diseases develop?

A

later on in life

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12
Q

what are the most common heart diseases of the valves in dogs?

A

myxomatous mitral valve disease

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13
Q

what is the most common heart disease of the myocardium in dogs?

A

dilated cardiomyopathy

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14
Q

what is the most common heart disease of the pericardium in dogs?

A

pericardial effusion

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15
Q

what is the most common acquired heart disease in cats?

A

hypertrophic cardiomyopathy

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16
Q

what is the other type of cardiac disease apart from congential and acquired?

A

arrhythmias

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17
Q

what are the 2 main types of arrhythmia?

A

bradyarrhythmia and tachyarrhythmia

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18
Q

what tests/assessments form part of the diagnosis of heart disease?

A 
full history
physical exam
blood tests
blood pressure
ECG
Holter monitor
Echocardiography
thoracic radiographs
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19
Q

what is a Holter monitor used for?

A

24h ECG

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20
Q

what is involved in echocardiography?

A

cardiac ECG

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21
Q

how do patients with cardiac disease present?

A 
incidental finding
exercise intolerance
weakness 
syncope
heart failure
sudden death
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22
Q

how may heart disease be found incidentally?

A

heart murmur or arrhythmia detected on vaccination

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23
Q

what are the main signs of left sided heart failure?

A

tachypnoea

dyspnoea

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24
Q

what are the main signs of right sided heart failure?

A

difficulty breathing and/or distended abdomen

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25
Q

what areas should be assessed on physical exam of a patient with suspected heart disease?

A 
body condition
mucous membranes
jugular veins
peripheral pulses
RR
heart auscultation
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26
Q

what may be found when assessing body condition of a patient with suspected heart disease?

A

cardiac cachexia

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27
Q

what is cardiac cachexia?

A

loss of lean muscle mass seen with severe heart disease

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28
Q

what are you assessing when looking at a patients mucous membranes?

A

colour and CRT - perfusion and oxygenation

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29
Q

what may be shown by looking at the jugular veins of a patient with potential heart disease?

A

pulsation

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30
Q

what are you assessing when looking at a patients peripheral pulses?

A

quality of pulse
is it regular
any deficits

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31
Q

what are pulse deficits?

A

HR present but peripheral pulse isn’t (may only be for the odd beat)

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32
Q

what is the normal RR for a sleeping/normal dog?

A

<30 brpm

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33
Q

what may the RR be of a dog with CHF?

A

> 35-40 brpm

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34
Q

when auscultating the heart what are you looking at?

A

HR
rhythm
assessment of pulses alongside

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35
Q

what can be assessed about HR rhythm?

A

regular or irregular

gallop sounds

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36
Q

what are gallop sounds?

A

abnormal extra heart sounds

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37
Q

what should be assessed simultaneously with HR auscultation?

A 
pulse quality (weak/strong)
pulse deficits
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38
Q

what are you listening for if a heart murmur has been detected?

A

timing (at systole or distole)

point of maximal intensity

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39
Q

what valve murmurs have their point of maximal intensity on the left side of the patient?

A

pulmonary
aortic
mitral

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40
Q

what valve murmurs have their point of maximal intensity on the right side of the patient?

A

tricuspid

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41
Q

what are the grades of heart murmur?

A

1-6

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42
Q

describe a grade 1 heart murmur

A

very quiet, takes time to localise

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43
Q

describe a grade 2 heart murmur

A

quiet, less loud than heart sounds

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44
Q

describe a grade 3 heart murmur

A

obvious, as loud as heart sounds

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45
Q

describe a grade 4 heart murmur

A

louder than heart sounds

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46
Q

describe a grade 5 heart murmur

A

very loud with precordial thrill

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47
Q

describe a grade 6 heart murmur

A

very loud, thrill, audible even when lifting stethoscope off chest

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48
Q

what is precordial thrill?

A

feel murmur against hand if placed on chest

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49
Q

what should be assessed when auscultating the lungs?

A

RR
adventitious sounds (anything other than breathing)
crackles

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50
Q

what are the typical findings in a patient with heart failure?

A 
reduced cardiac output
weakness
exercise intolerance
syncope
heart murmur
gallop sounds
arrhythmias
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51
Q

what are the signs of reduced cardiac output?

A 
weak peripheral pulses
tachycardia
pale MM
prolongued CRT
congestion
usually short history of clinical signs
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52
Q

what is congestion due to?

A

blood is not pumped forwards rapidly enough so pressure in the respective atria increases and blood backs up into vessels of the lungs or systemic circulation

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53
Q

what are the signs of left sided (lung) congestion?

A

pulmonary oedema
tachypnoea
dyspnoea
cough

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54
Q

what are the signs of right sided (systemic) congestion?

A

distended peripheral veins
ascites
pleural effusion

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55
Q

what is ascites?

A

fluid build up in abdomen

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56
Q

what types of blood test are used to assess cardiac function?

A

haematology
biochemistry
cardiac biomarkers

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57
Q

what does haematology asses with regards to cardiac function?

A

systemic diseases

anaemia (haemic murmur)

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58
Q

what is a haemic murmur?

A

heart murmur caused by the change in blood flow sounds through the heart due to altered blood composition caused by anaemia

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59
Q

what does biochemistry assess with regards to cardiac function?

A

kidney values

electrolytes

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60
Q

what are the two cardiac biomarkers used to assess cardiac function?

A

cardiac troponin I (cTnI)

n-terminal pro-B-type natriuretic peptide (NT-proBNP)

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61
Q

what is cardiac troponin I (cTnI) a marker for?

A

myocardial cell damage

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62
Q

what is n-terminal pro-B-type natriuretic peptide (NT-proBNP) a marker for?

A

myocardial stretch (increases with heart failure)

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63
Q

what type of test can be used in cats for n-terminal pro-B-type natriuretic peptide (NT-proBNP)?

A

snap test

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64
Q

in what sort of environment should BP be measured?

A

quiet and relaxed

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65
Q

what techniques can be used to indirectly measure blood pressure?

A

doppler or osscillometric

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66
Q

what should the cuff be level with when measuring BP?

A

the heart

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67
Q

what is normal systolic BP?

A

120-140 mmHg

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68
Q

what effect can hypertension have on the heart and heart disease?

A

increases cardiac workload

can contribute to progression of disease

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69
Q

what may be indicated about heart function by BP lower than 80 mmHg?

A

decompensated heart failure

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70
Q

what can ECG be used to do in patients with suspected cardiovascular disease?

A

further characterise findings from auscultation

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71
Q

what may ECG be used to characterise?

A

bradycardia
tachycardia
irregular rhythm
pulse deficits

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72
Q

what may a Holter monitor (24hr ECG) be used to measure?

A

intermittent arrhythmias
clinical importance of arrhythmia
response to antiarrhythmatic therapy

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73
Q

how can a Holter monitor be useful in investigating intermittent arrhythmias?

A

can detect those that may not be seen on a short recording

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74
Q

how can a Holter monitor aid the discovery of the clinical importance of arrhythmia?

A

suspected cause of syncope
exercise intolerance
can assess the frequency and severity of arrhythmia at home

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75
Q

why does hypertension increase cardiac workload?

A

more pressure must be overcome by the heart to push blood forwards from the ventricles

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76
Q

what are thoracic radiographs indicated for?

A

cough
tachypnoea
dyspnoea

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77
Q

how many views should be taken during thoracic radiology?

A

at least 2

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78
Q

what 2 views must be taken for thoracic radiographs?

A

right lateral

dorsoventral

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79
Q

what may be shown by thoracic radiography?

A

congestive heart failure

lung pathology

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80
Q

what may be seen on a thoracic radiograph that indicates congestive heart failure?

A

pulmonary oedema

distended pulmonary veins

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81
Q

give 2 examples of lung pathology that may be shown on thoracic radiographs

A

pneumonia

neoplasia

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82
Q

what is cardiomegaly?

A

increased heart size

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83
Q

what is vertebral heart size?

A

long and short axis of heart measurements are scaled against the vertebrae and then added to give a score

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84
Q

what is the ideal vertebral heart score for dogs?

A

<10.7

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85
Q

what is the ideal vertebral heart score for cats?

A

<8

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86
Q

what factors may indicate cardiomegaly on a thoracic radiograph?

A

vertebral heart size
elevation of trachea
left atrium enlarged
increased sternal contact

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87
Q

does sternal contact vary between species and breeds?

A

yes - heart tends to resemble owner

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88
Q

what are the most important congenital cardiac diseases?

A

stenosis of the great vessels
patent ductus arteriosus
ventricular septal defect

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89
Q

what is stenosis of the great vessels?

A

narrowing

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90
Q

what are the great vessels most often affected by stenosis?

A

aorta

pulmonary

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91
Q

what is the most common congenital heart disease in cats?

A

ventricular septal defect

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92
Q

what are the 3 types of stenosis location?

A

subvalvular
valvular
supravalvular

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93
Q

how is stenosis of great vessels diagnosed?

A

echocardiography

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94
Q

what is occurring during subvalvular stenosis?

A

tissue is blocking blood flow from below the valve

95
Q

what is occurring during valvular stenosis?

A

valve itself is unable to open properly

96
Q

what is occurring during supravalvular stenosis?

A

narrowing is occurring in the great vessel itself

97
Q

what is the most common location of stenosis in the aortic valve?

A

subvalvular

98
Q

what does aortic stenosis result in?

A

left ventricular hypertrophy

left sided congestive heart failure

99
Q

why does aortic stenosis lead to left sided congestive heart failure?

A

the heart cannot cope with the extra work of pushing blood through the valve

100
Q

what is the most common location of pulmonic stenosis?

A

valvular

101
Q

what is the result of pulmonic stenosis?

A

right ventricular hypertrophy

right sided congestive heart failure

102
Q

why does pulmonic stenosis result in right ventricular hypertrophy?

A

due to the excess work required by the heart to force blood through the narrow channel

103
Q

what are the clinical signs and findings of stenosis of the great vessels?

A 
often asymptomatic
arrhythmias
exercise intolerance
syncope
congestive heart failure
104
Q

what are the treatments available for stenosis of the great vessels?

A

beta blockers
balloon valvuloplasty
standard medical management of congestive heart failure

105
Q

how do beta blockers help to treat stenosis of the great vessels?

A

reduces the work of the ventricles and protects the heart

106
Q

what is involved in a balloon valvuloplasty?

A

balloon is placed across the valve and is used to stretch it open

107
Q

what type of great vessel stenosis can balloon valvuloplasty be used for?

A

pulmonic stenosis only

108
Q

what is cutting balloon valvuloplasty?

A

use of balloon to break down sub aortic stenosis

109
Q

what is a ductus arteriosus?

A

normal fetal connection between pulmonary artery and aorta due to the need to bypass the lungs in utero

110
Q

what should happen to the ductus arteriosus after birth?

A

should close after birth when first breaths are taken and form ligamentum arteriosum

111
Q

what happens if the ductus arteriosus remains patent?

A

blood flows from the aorta to the pulmonary artery continuously due to the high aortic and lower pulmonary pressure

112
Q

where is the murmur for patent ductus arteriosus heard?

A

left heart base - under left arm pit

113
Q

what may happen to the patient if ductus arteriosus remains patent?

A

congestive heart failure

114
Q

when is patent ductus arteriosus often found?

A

as an incidental finding potentially at vaccination

115
Q

what are the main treatment methods for patent ductus arteriosus?

A

interventional closure
surgical ligation of artery
congestive heart failure therapy

116
Q

how is interventional closure of patent ductus arteriosus performed?

A

insertion of catheter and device into femoral artery which is then floated up to the heart and placed within ductus arteriosus

117
Q

what is the most common location of a ventricular septal defect?

A

upper septum just below the aortic valve

118
Q

are ventricular septal defects usually symptomatic?

A

no - often picked up as an incidental finding

119
Q

describe the murmur associated with a ventricular septal defect

A

right sided systolic

120
Q

what murmur is heard with a small ventricular septal defect?

A

loud

121
Q

what murmur is heard with a large ventricular septal defect?

A

soft murmur

122
Q

why do larger ventricular septal defects lead to softer murmurs?

A

the larger the defect the lower the pressure of the blood that is pushed through meaning that it makes less noise

123
Q

how are ventricular septal defects diagnosed?

A

echocardiography

124
Q

how are ventricular septal defects often treated?

A

usually none necessary

heart failure treatment

125
Q

what is the normal life expectancy of an animal with a ventricular septal defect?

A

normal if it is small

126
Q

what are the main acquired cardiac diseases of dogs?

A

myxomatous mitral valve disease
dilated cardiomyopathy
pericardial effusion

127
Q

what are the main acquired cardiac diseases of cats?

A

hypertrophic cardiomyopathy

128
Q

what is the most common cardiac disease of dogs?

A

myxomatous mitral valve disease - makes up 75% of cases

129
Q

what causes myxomatous mitral valve disease?

A

idiopathic with hereditary/genetic element

130
Q

what types of dogs often have myxomatous mitral valve disease?

A

small breed (>20kg)

131
Q

what are examples of 2 breeds that commonly suffer with myxomatous mitral valve disease?

A

cavalier king charles spaniel

dachshunds

132
Q

at what age does myxomatous mitral valve disease often set in?

A

adult - 7 to 8 years

133
Q

what valve is most commonly affected by myxomatous mitral valve disease?

A

mitral

134
Q

what other valve can be affected by myxomatous mitral valve disease?

A

tricuspid (right AV)

135
Q

how is myxomatous mitral valve disease diagnosed?

A

echocardiography

136
Q

what are the 2 key effects of myxomatous mitral valve disease?

A

thickening of valve leaflets

prolapse of valve leaflets

137
Q

what are the effects of thickening of valve leaflets due to myxomatous mitral valve disease?

A

regurgitation of blood into atria from ventricles
left atrial dilation
left ventricular dilation

138
Q

what happens during prolapse of valve leaflets due to myxomatous mitral valve disease?

A

valve is looser so is pulled back into atria at points during the cardiac cycle

139
Q

what heart murmur is associated with myxomatous mitral valve disease?

A

left sided apical systolic heart murmur

140
Q

how rapidly does myxomatous mitral valve disease progress?

A

slowly - long asymptomatic period

141
Q

what may myxomatous mitral valve disease progress to?

A

left sided congestive heart failure

142
Q

what is a common cardiac disease of larger dogs?

A

dilated cardiomyopathy

143
Q

what causes dilated cardiomyopathy?

A

idiopathic and hereditary

144
Q

what large breed dogs are predisposed to dilated cardiomyopathy?

A

doberman
great dane
newfoundland

145
Q

what age does onset of dilated cardiomyopathy begin?

A

4-5

146
Q

what type of murmur is present with dilated cardiomyopathy?

A

left apical systolic murmur - not always present

147
Q

what is dilated cardiomyopathy a disease of?

A

the myocardium

148
Q

what does dilated cardiomyopathy lead to?

A

left ventricular dilation
decreased systolic function
arrhythmias

149
Q

how is dilated cardiomyopathy diagnosed?

A

echocardiaography

150
Q

can dilated cardiomyopathy be asymptomatic?

A

yes - often for years

151
Q

what is the prognosis of dilated cardiomyopathy?

A

guarded - progression may be rapid, particularly in certain breeds

152
Q

in what breeds can advance of dilated cardiomyopathy be rapid?

A

doberman

153
Q

what can dilated cardiomyopathy lead to?

A

arrhythmias
sudden death
congestive heart failure

154
Q

what may cause pericardial effusion?

A

idiopathic
neoplasia
bacterial
(many causes really!)

155
Q

in what animals is pericardial effusion often seen?

A

large breed, adult dogs

156
Q

what is happening during pericardial effusion?

A

fluid builds up in the pericardial sac and compromises filling of the heart

157
Q

what is cardiac tamponade?

A

collapse of right atrium due to high external pressure from filled pericardial sac

158
Q

how does pericardial effusion affect the heart?

A

decreases cardiac output

right sided heart failure

159
Q

why is the right side of the heart usually more affected by pericardial effusion than the left?

A

lower pressures in the right side of the heart than in the left

160
Q

how is pericardial effusion diagnosed?

A

echocardiography

161
Q

how is pericardial effusion treated?

A

pericardiocentesis

162
Q

what position should animals be in for pericardiocentesis?

A

left lateral

163
Q

what area of the chest should be surgically prepared for pericardiocentesis?

A

3rd to 8th intercostal space

164
Q

what level of sedation is required for pericardiocentesis?

A

mild

165
Q

what equipment is used to drain the pericardium?

A

large catheter or chest drain

166
Q

how can the correct placement of the catheter in the pericardium be ensured?

A

echocardiography

167
Q

what should be checked about the fluid drained from around the heart during pericardiocentesis to ensure that it is from the pericardial sac and not the heart itself?

A 
check for clotting (faster if blood)
check PCV (should be lower than blood)
168
Q

what should be measured with regards to fluid drained during pericardiocentesis?

A

volume drained

169
Q

what samples of pericardial fluid should be collected?

A

cytology - EDTA

culture - sterile

170
Q

what is the most common cardiac disease in cats?

A

hypertrophic cardiomyopathy

171
Q

what are the main causes of hypertrophic cardiomyopathy?

A

genetic

172
Q

what age does hypertrophic cardiomyopathy usually set on in cats?

A

adult - wide age range

173
Q

what must be excluded before determining hypertrophic cardiomyopathy as the cause of cardiac hypertrophy?

A

other causes of hypertrophy

174
Q

what are 2 other causes of cardiac hypertrophy in cats aside from hypertrophic cardiomyopathy?

A

hyperthyroidism

systemic hypertension

175
Q

what effect does hypertrophic cardiomyopathy have on cardiac output?

A

increased thickness of myocardium impairs filling in diastole

176
Q

how is hypertrophic cardiomyopathy diagnosed?

A

echocardiography

177
Q

how may hypertrophic cardiomyopathy be discovered?

A

incidental finding

178
Q

what sounds are often heart on auscultation of the heart in a patient with hypertrophic cardiomyopathy?

A

murmur

gallop sounds

179
Q

what are gallop sounds?

A

abnormal extra heart sound

180
Q

how may animals with hypertrophic cardiomyopathy present?

A

in heart failure with pleural effusion and pulmonary oedema

with aortic thromboembolysm

181
Q

what can cause a compensated cat to progress to heart failure rapidly?

A

stress
anaesthesia
IVFT

182
Q

what are the signs of aortic thromboembolysm?

A

sudden onset lameness
cold leg
peripheral cyanosis
pain

183
Q

where do blood clots often originate from in animals with hypertrophic cardiomyopathy?

A

atria and ventricles

184
Q

what is heart failure due to?

A

disease progression
decompensation of previously stable cardiac failure
development of impedance of cardiac filling (e.g. pericardial effusion)

185
Q

what are the signs of left sided heart failure?

A 
congestion of pulmonary circulation 
pulmonary oedema
tachypnoea
dyspnoea
pulmonary crackles
cough
186
Q

in what animals is a cough seen during left sided heart failure?

A

dogs

187
Q

what are the signs of right sided heart failure?

A 
congestion of systemic circulation
distended peripheral veins
positive hepatojugular reflex
ascites
pleural effusion
188
Q

what is the hepatojugular reflex?

A

compression of the liver leading to fluid movement up the jugular

189
Q

what doe left and right sided heart failure lead to?

A

decreased cardiac output

190
Q

what are the physiological signs of decreased cardiac output?

A

tachycardia
weak peripheral pulses
slow capillary refill time

191
Q

how may cats in heart failure present that is different to dogs?

A

with hypothermia and bradycardia

192
Q

what must be remembered when handling and treating all heart failure patients?

A

they are very fragile (especially cats) and so need to be in a low stress and calm environment

193
Q

how is heart failure treated?

A 
diuretic
minimise stress
oxygen
Pimobendan
ACE inhibitor
Spironolactone
water available at all times
194
Q

what is the name of the commonly used diuretic for heart failure patients?

A

Furosemide

195
Q

what is the role of Pimobendan in treating heart failure?

A

increases heart contractility

196
Q

what animals is Pimobendan most commonly used in?

A

dogs

197
Q

what is the role of ACE inhibitors in treating heart failure?

A

vasodilator

anti-remodelling

198
Q

what is the role of Spironolactone in treating heart failure?

A

weak diuretic and anti remodelling

199
Q

why must water always be available to patients on diuretics?

A

risk of AKI if dehydrated

200
Q

what is the target RR for patients with heart failure?

A

<40 bpm

201
Q

what is the target systolic BP for patients in heart failure?

A

> 100 mmHg

202
Q

what are the signs that a patient with heart failure is improving?

A

decreased RR and effort
decreased HR
improved pulse quality
improved CRT

203
Q

why should heart failure patients be sent home as soon as possible?

A

less stressful at home

life expectancy is reduced so they should be home with their family as much as possible

204
Q

what must owners be warned about heart failure treatment?

A

is lifelong

205
Q

what can be assessed when looking at ECG?

A 
heart rate
whether sinus complexes are normal
is HR regular or irregular
anything abnormal
early or late complexes
timings
206
Q

what are supraventricular complexes?

A

normal rhythms

207
Q

what are ventricular complexes?

A

abnormal ECG complexes

208
Q

what is the name used for early ECG complexes?

A

premature

209
Q

what is the name used for late ECG complexes?

A

escape

210
Q

Identify this ECG trace

A

normal sinus

211
Q

what is sinus bradycardia?

A

physiologically normal slow heart rate (e.g. during sleep)

212
Q

what are the 3 main types of abnormal bradycardias?

A

atrial standstill
atrioventricular blocks
sick sinus syndrome

213
Q

what are the 3 types of AV block?

A

1 to 3

214
Q

what is happening during atrioventricular block?

A

AV node is not functioning correctly

215
Q

how would second degree heart block appear on an ECG?

A

some P waves not followed by QRS

216
Q

what is the difference between 1st and 2nd degree AV block?

A

first is due to slow conduction so there will be and increased P-Q interval
second will involve some conducted P waves and others not

217
Q

identify the abnormality in this ECG trace

A

2nd degree AV block

218
Q

what are the atrial and ventricular heart rates during 3rd degree AV block?

A

atrial - 200 bpm

ventricular - 40 bpm

219
Q

what are QRS complexes like in 3rd degree AV block?

A

wide and bizzare

220
Q

identify the abnormality shown in this ECG trace

A

3rd degree AV block

221
Q

where does supraventricular tachycardia originate?

A

from the atria

222
Q

what are the QRS complexes like during supraventricular tachycardia?

A

narrow but similar to sinus complexes

223
Q

identify the abnormality shown in this ECG trace

A

supraventricular tachycardia

224
Q

describe atrial fibrillation

A

HR 210 bpm
irregular rhythm
no P waves on ECG

225
Q

identify the abnormality shown in this ECG trace

A

atrial fibrilation

226
Q

where do ventricular arrhythmias originate from?

A

ventricular myocardium

227
Q

describe the QRS complexes associated with ventricular arrhythmia

A

wide and bizzare

228
Q

identify the abnormality shown in this ECG trace

A

ventricular arrhythmia

229
Q

what occurs during ventricular premature complexes?

A

earlier than expected QRS complex seen on ECG

230
Q

are ventricular PVC always an issue?

A

no - unless they are regular / frequent

231
Q

identify the abnormality shown in this ECG trace

A

ventricular premature complex

232
Q

what heart rate is associated with ventricular tachycardia?

A

375 bpm

233
Q

what is happening during ventricular tachycardia?

A

run of ventricular PVC which shorten diastole and affect coronary and global perfusion

234
Q

identify the abnormality shown in this ECG trace

A

ventricular tachycardia

X Clinical Veterinary Nursing Theory (70 decks)

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