Cardiovascular Diseases Flashcards
1
Q
What is the primary function of the heart
A
To pump blood throughout the body
2
Q
What is the amount of entering the heart called
A
Preload
3
Q
What is the amount of blood exiting the heart called
A
Afterload
4
Q
True or false
Preload should equal afterload
A
True
5
Q
Why should preload equal afterload
A
To ensure proper tissue perfusion
6
Q
If more blood is trying to enter the heart than is leaving, what can happen
A
A damming effect that causes higher pressure “upstream” (preload problem)
7
Q
If there is insufficient blood being pumped out of the heart what can occur
A
A lack of tissue perfusion
8
Q
What does a lack of tissue perfusion mean
A
Tissues do not receive adequate oxygen and nutrients and removal of waste products will be impaired
9
Q
What 2 things result from the heart being unable to pump properly
A
Decreased flow to peripheral tissues (decreased afterload)
Increase in preload which causes hypertension (can back up into the lungs)
10
Q
Describe when heart disease is classified as primary
A
When something goes wrong with the heart itself
Not from recurrent/pre existing disease
Can be congenital or inherited, traumatic or degenerative
11
Q
Describe when heart disease is classified as secondary
A
When something goes wrong elsewhere in the body that either spreads to the heart it puts strain on the heart
Less common
Often due to underlying pathology
12
Q
What are some examples of underlying pathology than can cause cardiac disease
A
Hyperthyroidism Renal disease Neoplasia Infection Parasites Toxicity Metabolic effects Lung disease Over hydration Peridontal disease
13
Q
What is hardware disease in LA and how can you prevent it
A
Accidental ingestion of hardware (nails) in hay
Put magnets in the reticulum to collect them
14
Q
What does the prognosis of cardiac disease depend on
A
Cause and severity of damage
Descreases once clinical signs are present
15
Q
If cardiac disease is left untreated it will lead to
A
Heart failure
16
Q
What are the top 3 common cardiac disease in vet medicine
A
Mitral valve insufficiency (dogs and horses)
Hypertrophic cardiomyopathy (cats)
Endocarditis (cattle)
17
Q
Most of the time, cardiac disease occurs in ____ animals due to degenerative changes
A
Older animals
18
Q
Cardiac disease in young animals are often from ____ issues
A
Congenital
19
Q
What breeds are more susceptible to heart disease
A
Cavalier king charle spaniel
Doberman
Boxer
Manecoon
20
Q
What are the priority presenting concerns for heart disease from owners
A
Decreased energy (exercise intolerance, weakness, lethargy)
Coughing
Syncope
Open mouth breathing in cats
21
Q
When is coughing more common
A
At night and in dogs
22
Q
What is syncope
A
Fainting due to lack of blood flow to the brain (afterload problem)
23
Q
Owners may not notice changes in early stages of heart disease, so it is often discovered during
A
Annual exams
24
Q
What are usually two of the earliest signs of heart disease
A
Arrhythmias
Murmurs
25
What is an arrhythmia
Abnormal or irregular rhythm of heart beats
26
What is tachycardia
Increased heart rate
27
What is bradycardia
Decreased heart rate
28
How are arrhythmias diagnosed
Auscultation
Electrocardiogram (ECG)
29
What is a sinus rhythm
A normal arrhythmia due to changes in respiration
Increases with inspiration and decreases with expiration
30
What is a murmur
Abnormal heart sounds
31
The “whooshing” sound of murmurs are caused by ____ as the blood flows through the heart
Turbulence
32
Turbulence usually occurs around a
Valve
33
True or false
| The presence of a murmur always means there isn heart disease
False
It only tells you there is turbulence
34
How are murmurs described
Subjective
How loud they are
Where they are heard the loudest (left or right)
If the murmur is associated with systole or diastole
35
What is the point of maximal intensity (PMI)
Where a murmur is heard the loudest over the chest
36
How are murmurs graded
Subjective Grades 1-6
```
1= easy to miss
2= faint
3= easy to detect
4= very easy to detect with stethoscope
5= can palpate through chest wall
6= you can heart it without stethoscope
```
37
What is the most important thing to know with murmurs
How it changes over time
38
How do you diagnose a murmur
Echocardiogram (ultrasound) (most accurate)
Radiographs
Electrocardiogram
Blood pressure
39
True or false
| Dilated cardiomyopathy is acquired
TRUE
40
Describe what happens to the heart is dilated cardiomyopathy (DCM)
Muscle of the heart weakens over time, causing the heart to become stretched, flabby and weak.
Outline of the heart becomes larger and rounded and the ventricles are enlarged
41
True or false
| The right side fo the heart is usually affected first in DCM
FALSE
it is the left side that is affected first
42
What happens due to the weakened heart in DCM
The conductive fibers of the heart become spread out and lose the ability to coordinate muscle contraction
Cardiac vessels become spread out and cause less tissue perfusion
Decreased stroke volume = less peripheral perfusion
43
What are some clinical signs of DCM
```
Weakness
Lethargy
Exercise intolerance
Coughing
Syncope
Sudden collapse or death
```
44
True or false
| Dogs with DCM often dont show clinical signs until they are already in heart failure
True
45
What is the goal of treatment for DCM
Increases the strength of the heart muscle contraction to increases contractility and cardiac output
to decrease the heart rate to prevent exhaustion
46
True or false
| There is a cure for DCM
False
| You can only treat and prolong death
47
What is the prognosis of DCM
Poor
The disease is progressive and you cannot reverse the heart muscle damage
Will die from lack of tissue perfusion, heart muscle exhaustion or it will progress to congestive heart failure with pulmonary effusion
Sudden death often occurs
48
Why was DCM the most common cardiac disease in cats in the 1980s
Because of cat diets did not contain taurine
49
Why is taurine important in cats diets
Taurine is an essential amino acid that cats cannot produce on their own and must get from their diet
50
Where is taurine found
```
Raw meat
Commercial cat foods (200-250mg/day)
Birds
Seafood
Insects
```
51
What is DCM usually associated with in dogs that are typically not predisposed to it
Legumes or potatoes, peas or lentils, used as the main ingredient
Could be connected to taurine
52
What is hypertrophic cardiomyopathy (HCM)
Abnormally increased growth of the heart muscle
53
Describe what causes HCM as a primary disease
Inherited primary condition in cats
Abnormal myosin or abnormal calcium transporters in heart cells
54
What are some diseases that cause secondary HCM
Hyperthyroidism
Causes of high blood pressure
Primary mitral valve insufficiency (causes heart muscle to thicken)
55
Describe the pathology of hypertrophic cardiomyopathy
Concentric thickening of the walls
Muscles thinkens inwards (starts in the left ventricle)
Ventricles chambers become smaller
Decreases stroke volume (heart can hold less blood)
Decreases tissue perfusion
Blood backs up into the lungs (if hypertrophy of the left ventricle) (pulmonary hypertension, pulmonary effusion, pleural effusion) decreases ability to breath
Blood backs up into the vena cava and liver (causes abdominal effusion)
Heart has to pump faster to make up for decreased volume (heart muscle gets even thicker) increases risk of clots
Can develope saddle thrombi in cats
56
What are the presenting complaints by the owners in HCM
```
Syncope
Exercise intolerance
Open mouth breathing
Swollen bellies and limbs
“Ain’t doing right”
Sudden collapse
Hind end weakness or paralyzed
```
57
What are the clinical signs of HCM upon physical exam
```
Murmurs
Arrhythmia (tachycardia)
Dyspnea
Crackles in the lungs
Open mouth breathing
Cyanosis
Swollen abdomen
```
58
What are the 3 most clinically emergent signs
Sudden collapse
Hind end weakness or paralyzed
Open mouth breathing (cyanosis)
59
Why should you never stress an animal with HCM out
The increased heart rate can kill them
60
What are the goals of treatment for HCM
Treat underlying primary disease
Decrease contractility and rate to decrease work effort
Keep blood pressure down (to prevent pulmonary edema and pleural effusion)
Treat/prevent thromboemboli in cats
Avoid stress
61
What is the prognosis of HCM
Very poor
Most die of asphyxiation or heart muscle failure
62
Define effusion
Fluid in 3rd spaces
63
What is pulmonary edema
Fluid accumulates in the alveoli. Prevents oxygen uptake
Most common cause is hypertension
64
What is plueral effusion
Fluid in the space around the lungs, prevents filling with air
65
What is abdominal effusion
Fluid in the abdominal free space
66
What is ascites
Clear fluid in the abdominal space from blood vessels
Common cause is hypertension
67
Valvular disease can be a primary condition due to
Congenital valve defects and mitral valve insufficiency
68
Valvular diseases can be secondary to disease such as
Bacterial endocarditis from a primary infection elsewhere in the body
69
Bacterial endocarditis is a common complication of
Hardware disease and rumenitis in cattle and dental disease in all species
70
What is endocardiosis
A disease where the valves are thickened and distorted
Usually due to degenerative changes
Neither infection or inflammation are involved
71
What is endocarditis
Inflammation of the endocardium (inner lining of the heart including chambers and valves)
72
What is valvular endocarditis
Endocarditis specifically involving the heart valves
Due to any cause
Inflammation is present
73
What is bacterial endocarditis
Endocarditis caused by bacterial infection of the heart valves
74
What is the pathology of mitral valve insufficiency (or mitral valve endocardiosis)
Degenerative disease -Occurs through natural wear and tear
The mitral valve thickens and stiffens (become rough and thick due to fibrotic tissue)
Valves stop closing properly and leads to back flow from the LV into the LA
75
What are the initial effects of mitral valve insufficiency
Increased pressure in the left atrium causes LA enlargement
Less filling into the LV, LV has to work harder to move the same amount of blood
76
What are the long term effects of mitral valve insufficiency
If there is enough pressure in the LA, pressure backs up into the lungs (pulmonary edema: increased RR, coughing)
Because LV is working harder, it leads to secondary HCM
77
If left long enough, mitral valve insufficiency will lead to
Left sided congestive heart failure
78
What is mitral valve regurgitation
Backflow or leaking of blood into the left atrium
79
Who is mitral valve insifficiency more common in
Dogs, horses
Small breeeds, and older dogs
80
What are the clinical signs of mitral valve insufficiency
Very subtle murmur (becomes louder with time)
Exercise intolerance
Tachycardia
Wet cough
81
When is the heart considered to be in heart failure
When the heart is unable to pump out enough blood to meet the body’s needs
82
True or false
| All forms of cardiomopathy, valvular disease and/or hypertension will eventually lead to heart failure
True
83
True or false
| Heart failure is not progressive
False
| It is always progressive
84
What are the ways heart failure is classified
Subclinical vs clinical vs congestive
Left sided or right sided
Degree of signs (stages 1-4)
85
What happens in congestive heart failure
As the heart begins to fail, the amount of blood leaving the heart decreases than what is entering
Results in less tissue perfusion and back up of blood into the peripheral or lungs
86
What is subclinical heart failure (AKA asymptomatic heart failure)
Has compensatory mechanisms to help maintain blood pressure and tissue perfusion (vasoconstriction, water retention, increased heart rate)
No clinical signs
Heart is unable to pump effectively
Life long disease
87
When do you start to treat subclinical heart failure
When you see heart enlargement on radiographs
88
When does subclinical heart failure progress to clinical heart failure
When compensatory mechanisms are not sufficient enough to maintain blood pressure to tissues and organs
And eventually begins to show signs
89
What is clinical heart failure
Occurs as soon as the patient shows sigsn (exercise intolerance, dyspnea, cough)
No longer has compensatory mechanisms
90
What is the pathology of clinical heart failure due to decreased output (after load) which leads to decreased tissue perfusion
Less cardiac output results in decreased blood pressure and decreased tissue perfusion
This predisposes patient to:
Kidney damage
Syncope
Exercise intolerance and weakness
91
What is the pathology of clinical heart failure due to increased input (preload) (blood backs up before the heart)
Blood backs up into the ventricles, into the atria, and into the vessels
Causes hypertension
If BP is high enough, fluid is pushed out of the capillaries and into the interstitial space (now considered congestive heart failure)
If interstitial volume is exceeded, fluid enters 3rd spaces (alveoli, pleural space, abdominal space, SQ space)
92
Where fluid ends up in heart failure depends on
Which side of the heart is failing
Left: lungs
Right: body
93
What happens in left sided congestive heart failure
The left ventricle cannot pump blood out effectively, so blood backs up into the left atrium, then the pulmonary vein, then capillaries of the lung and then alveoli
Thisnis pulmonary EDEMA (fluid in the lungs)
94
What does pulmonary edema prevent
Prevents Air exchange and the animal essentially suffocates/drowns from the inside out
95
Excess fluid in the lungs can eventually get pushed out to the plueral space, what is this known as
Pleural effusion (fluid in the plueral space/around the lungs)
96
What does plueral effusion prevent
Prevents the lungs from expanding
97
What are the clinical signs related to decreased tissue perfusion and effects on breathing in left sided congestive heart failure
Open mouth breathing
Short breaths
Increased respiratory effort (abdominal, rapid, shallow)
Can only breath easily when standing (they resist lying down)
Cyanosis
98
What happens in right sided congestive heart failure
The right ventricle cannot pump blood out effectively, blood backs up ino the right atrium, then the vena cava, then the liver
Fluid accumulates in the liver
99
What happens in right sided congestive heart failure if fluid exceeds the interstitial volune
The fluid will move into the abdominal space, called abdominal effusion
100
What is abdominal effusion also known as
Ascites
101
What are the clinical signs related to hypertension in the systemic venous return in right sided congestive heart failure
Abdominal distension (peritoneal effusion) (pot bellies)
Jugular vein distension (common in cattle)
Liver enlargement (fluid in liver) and signs associated with liver failure
Edema in SQ, limbs, brisket
Cachexia (wasting)
102
What is it considered if both sides of the heart fail
What signs would you see
Generalized heart failure
Signs associated with both right and left sided heart failure
103
What is the prognosis for heart failure
Guarded
This is a progressive disease -rate of progression depends on the patient
This will eventually lead to death
104
What are the main reasons heart failure will lead to death
1. Output failure (organ failure, circulatory shock)
2. Pulmonary and plueral effusion leading to hypoxia/anoxia
3. Cardiac infarct (heart attack) due to lack of blood flow to the heart (more common if there are thromboemboli)
105
What is the goal of treatment of heart failure
To slow down the rate of progression and treat symptoms
106
What does treatment of heart failure include
Rest, restricted activity/excitement (to keep heart calm)
Reduced salt intake: Na increases BP and pulls in water and makes heart work harder
Vasodilators: decreases BP
Diuretics: pee out fluid to decrease BP
drugs to slow down the heart and prevent arrhythmias
Prevent thromboemboli
107
What is another word for heart attack
When does it occur
Myocardial infarction
When blood flow to the myocardium is interrupted causing necrosis to the muscle
