Ch. 6 Cardiovascular Emergencies Flashcards
What are the medical problems that may have a cardiac cause?
Dyspnoea Weakness/syncope/collapse Coughing (dogs) Abdominal Enlargement Paresis Cyanosis
What should one ask with paroxysmal events?
Broad concepts
Pro-dromal behavioural changes Occuring at rest/excercise Careful description of the event: - Flaccid - Rigid? - Tonic/clonic movements Autonomic signs? Time to recover Etc.
What are the goals of assessment using POCUS for the cardiac patient?
RPSLA = mitral flail, LV size, contractility & chamber filling
RPSSA = LA:Ao, contractility, smoke in LA?
Pericardium - fluid?
Liver - hepatic venous congestion?
What are the four types of acute heart failure and their likely causes and treatment?
Warm and dry = compensated Warm and wet = CHF e.g. MVD, DCM, HCM, PE Cold and dry = diuresis, arrhythmias, Cold and wet = - systolic failure: DCM (dogs or cats) - diastolic failure: HCM.
Treatment for CHF?
Diuresis, positive inotropy, vasodilators
Treatment for cold & dry failure?
Cautious fluids, treat arrhythmias, discontinue diuretics
Treatment for systolic failure
Positive inotropes, arteriodilators
Treatment for diastolic failure
Diuretics, venodilators
What are the options for vasodilation?
Pimobendan Sodium nitroprusside ACEi Hydralazine Amlodopine
What is pulsus paradoxus
In the normal animal, inspiration improves venoms return to the right side of the heart. With cardiac tamponade this increased filling of the right side will increase the pressure in the left ventricle thus reducing systolic function and leading to a lack of arterial pressure during inspiration which is known as pulses paradoxus.
Important clinical signs of PCE
- Muffled heart sounds
- Weak pulses
- Distended jugular veins
DDx for pericardial effusion
• Haemorrhagic effusion ◦ Haemangiosarcoma* ◦ Heart base tumour (chemodectoma)* ◦ Mesothelioma ◦ Idiopathic pericarditis* ◦ Lymphoma (cats - also other neoplasia for cats) ◦ Left atrial rupture ◦ Coagulopathy ◦ Trauma • Transudate ◦ CHF (cats) ◦ Hypoalbuminaemia ◦ Toxaemia (uraemia) • Exudate ◦ Migrating FB ◦ Penetrating wound ◦ Lepto, distemper ◦ FIP/Toxo (cats)
Haemangiosarcoma carries the worst prognosis of the different tumours. Chemodectomas and mesotheliomas fare better and can be managed with surgery.
Idiopathic pericarditis is a diagnosis of exclusion. n.b. that bicavity effusion is not predictive of neoplastic vs. non-neoplastic causes.
CHF is the most common cause in cats and carries a guarded prognosis.
Poor prognostic indicators for FATE
For survival to discharge
- Hypothermia <37.2
- Multiple HLs affected
- Abscence of any motor function
- Reduced HR
For Long term
- CHF will reduce long term survival
- 25-50% of cats will get recurrance
- can take days to weeks to improve
Management of FATE
• Analgesia for at least 24-48h
• Anti-clotting therapy
◦ Anti-coagulant - no oral meds yet and IV meds assoc with complications
◦ Anti-plateley = clopidogrel/aspirin (can use both)
‣ Aspiring = COX1 inhibitor which bloc TXA2 needed for platelet recruitment/activation
‣ Clopidogrel = ADP receptor antagonist that prevents PLT aggregation
◦ Thrombolytic therapy - not used as high risk of RPI
◦ Supportive therapy as required
◦ Management of RPI
‣ Frequent HR monitoring
‣ Monitoring serum K
‣ can occur hours to days after event and is not uncommon