Circulatory pathology and nursing care Flashcards
1
Q
Define AETIOLOGY
A
The cause, or set of causes, of a condition
2
Q
Define PATHOGENESIS
A
The manner of development of a disease i.e. what is the process
3
Q
Define PATHOPHYSIOLOGY
A
The study of the disordered physical processes that accompany a disease
4
Q
What are the two types of cardiac diseases?
A
Cardiac diseases may be acquired, and develop throughout the animal’s lifetime, or congenital, and associated with a defect that is present at birth
5
Q
Define a SINUS BRADYCARDIA
A
A heart rhythm that is slower than expected
6
Q
Define SINUS TACHYCARDIA
A
A regular cardiac rhythm in which the heart beats faster than normal. It may be normal following excitement or exercise but is a concern when the animal is at rest
7
Q
Define ATRIAL FIBRILLATION
A
Abnormal electrical impulses in the atria. These irregular electrical impulses override the heart’s natural pacemaker (the sinoatrial node), causing it to lose control, resulting in a highly irregular pulse rate
8
Q
Define VENTRICULAR FIBRILLATION
A
A type of irregular heart rhythm - the lower heart chambers contract in a very rapid and uncoordinated manner, and as a result blood is not pumped to the rest of the body by the heart
9
Q
Define PREMATURE VENTRICULAR CONTRACTIONS
A
Extra heartbeats that begin in one of the heart’s two ventricles. The extra beat disrupts the heart’s rhythm, causing a sensation of fluttering, or the heart having ‘skipped a beat’
10
Q
Define ATRIAL STANDSTILL
A
Rare but very serious. The absence of atrial electrical and mechanical activity. Can lead to syncope, congestive heart failure and sudden death. May be partial or total, and can be transient or permanent.
11
Q
Define a HEART BLOCK
A
Where the electrical impulses of the heart slow down, and, depending on the severity, sometimes completely stop.
12
Q
What are the different types of heart block?
A
First degree, second degree (which may be Mobitz type 1 or type 2), and third degree
13
Q
What is a first degree heart block?
A
The least severe, and may not even require treatment. The electrical signals slow down as they move from the atria to the ventricles.
14
Q
What is a second degree heart block?
A
The electrical signals between the atria and the ventricles intermittently fail to conduct. There are two different types of second degree heart block: Mobitz type 1 and Mobitz type 2
15
Q
What are the two different types of second degree heart block?
A
Mobitz type 1 - electrical signals get slower and slower between beats, and eventually the heart skips a beat
Mobitz type 2 - the electrical signals may reach the ventricles, but sometimes they do not. No progressive slowing, it is sudden. Can progress to a third degree block
16
Q
What is a third degree heart block?
A
The most severe type of heart block. Electrical signals do not cross from the atria to the ventricles are all - there is no electrical conduction, resulting in a very slow or no pulse at all
17
Q
What are the different acquired heart conditions?
A
Endocarditis, myocardial disease (which may be primary or secondary), pericardial disease, endocardiosis, mitral valve disease, congestive heart failure (which may be right or left sided), and heart murmurs
18
Q
Define ENDOCARDITIS
A
Inflammation of the inner lining of the heart, specifically the heart valves - not particularly common. The valves develop a bacterial infection which result in septic emboli. These septic emboli break off and migrate to other sites.
19
Q
What are septic emboli?
A
A blood clot with bacteria that blocks a blood vessel and causes infection and tissue damage.
20
Q
What does unresolved endocarditis lead to?
A
Myocarditis, which is inflammation of the myocardium - the heart muscle.
21
Q
Define MYOCARDITIS
A
Inflammation of the myocardium, the heart muscle
22
Q
What are some clinical signs of endocarditis?
A
General unwellness, alongside:
- pyrexia
- a worsening heart murmur
- a cough, due to fluid retention and congestion
- dyspnoea
23
Q
What is myocardial disease?
A
General diseases of the cardiac muscle (the myocardium) which affects the heart’s ability to pump effectively. May be dilated (primary) or hypertrophic (secondary)
24
Q
What are the two different types of myocardial disease?
A
Primary - dilated cardiomyopathy
Secondary - hypertrophic cardiomyopathy
25
Describe dilated cardiomyopathy
This is primary cardiomyopathy, a type of myocardial disease.
Characterised by the dilation of the heart chambers, poor systolic function and heart failure. The heart enlarges, reducing cardiac contractility. Flow of blood is decreased, resulting in congestion and heart failure. The cause is often idiopathic.
26
How is dilated cardiomyopathy diagnosed?
Via an ECG, echocardiography (a cardiac ultrasound) and thoracic radiographs with right lateral or dorsoventral views
27
What breeds is dilated cardiomyopathy most common in?
Large breed dogs including Dobermanns, Irish Wolfhounds, Great Danes, Boxers and Newfoundlands
28
What are the clinical signs of dilated cardiomyopathy?
- acute onset
- anorexia
- weight loss
- lethargy
- reduced exercise tolerance
- signs of left sided heart failure (tachypnoea, dyspnoea, coughing)
- ascites
- a heart murmur
- arrythmias
- sudden death
29
Describe hypertrophic cardiomyopathy
This is secondary cardiomyopathy, a type of myocardial disease.
It is characterised by the thickening of the heart walls which interferes with the relaxation of the heart and prevents normal filling, leading to diastolic dysfunction, decreases in cardiac output and heart failure
30
How is hypertrophic cardiomyopathy diagnosed?
ECG, echocardiography (a cardiac ultrasound), thoracic radiographs (right lateral and dorsoventral views), BP measurements and T4 blood tests to test for hyperthyroidism
31
What are some causes of hypertrophic cardiomyopathy?
Malnutrition, hyperthyroidism (esp in cats), hypertension, and viruses (esp in cats)
32
What are the clinical signs of hypertrophic cardiomyopathy?
Can be 'silent' and present with no clinical signs. May present similarly to congestive heart failure, so dyspnoea, tachypnoea, and a heart murmur
33
How can hypertrophic cardiomyopathy be complicated in cats?
May result in aortic thromboembolism - a blood clot that leaves the heart and most commonly lodges in the caudal aorta, blocking blood flow to the hind limbs, causing paralysis
34
How do patients with an aortic thromboembolism present?
- acute paralysis or paresis of one or both hind limbs
- lack of arterial pulse in the affected limb
- pain
- cool affected limbs
- dyspnoea and tachypnoea
35
How is hypertrophic cardiomyopathy treated?
Treatment often focuses on relaxation of the heart, and slowing heart rate. Medical management involves calcium channel blockers and beta blockers.
In cases of a thromboembolism, analgesia, antithrombotics and vasodilators will be used
36
What are beta blockers?
Medications that slow down the heart - can be used as treatment for hypertrophic cardiomyopathy
37
Describe pericardial disease
Conditions that affect the pericardium - the membranous sac that surrounds the heart
38
What is the pericardium?
A sac that surrounds the outside of the heart
39
Define PERICARDITIS
Inflammation of the serous membrane that surrounds the heart (the pericardium)
40
What often accompanies pericarditis?
Pericardial effusion - an abnormal build of fluid between the heart muscle and the pericardium
41
What is pericardial effusion?
An abnormal build of fluid between the heart muscle and the pericardium. It often accompanies pericarditis. As fluid volume and intrapericardial pressure increase, cardiac tamponade can develop. The pressure causes the heart to be unable to fill, reducing cardiac output and a drop in blood pressure
42
What is a cardiac tamponade?
Compression of the heart due to fluid accumulation in the pericardial sac - reduces the amount the heart can fill, therefore reducing the amount that the heart can pump out, therefore causing a drop in blood pressure.
Associated with pericarditis and pericardial effusion
43
What is the result of a cardiac tamponade?
The pressure build up means the heart is unable to fill with blood, and therefore the amount of blood that the heart can pump out is reduced. There is therefore a drop in blood pressure
44
How is pericardial disease diagnosed?
Via echocardiography (a cardiac ultrasound), thoracic radiographs, and ECG monitoring
45
What are some clinical signs of pericardial disease?
- collapse
- exercise intolerance
- pale mucous membranes
- tachycardia
- muffled heart sounds
- distended abdomen
- a variable pulse quality
46
What are the causes of pericardial disease?
May be idiopathic, or the result of cardiac hemangiosarcoma (cancer of the vascular endothelium, or the blood vessel walls)
47
What is cardiac hemangiosarcoma?
Cancer of the vascular endothelium, or the blood vessel walls
48
What breeds are typically affected by pericardial disease?
Medium to large breed dogs such as Golden Retrievers
49
What is pericardiocentesis?
A procedure to remove fluid from the pericardial space to relieve pressure in cases of pericardial effusion
50
What would be indicated in recurrent pericardial effusion cases?
Surgical removal of the pericardium
51
What is endocardiosis?
Chronic valve disease - it is a progressive nodular thickening of the valves of the heart, causing leakage and poor function. Blood regurgitates into the atria, causing increased work load, congestion and heart failure. Often affects the mitral valve, but can also affect the tricuspid valve
52
What is the opposite condition to endocarditis?
Endocardiosis. Endocardiosis is a thickening of the valves; endocarditis is a flaking away of the valves.
53
What breeds are particularly susceptible to endocardiosis?
Middle to older aged dogs. Small breeds such as poodles, King Charles spaniels, Chihuahuas and Schnauzers are particularly susceptible.
Rare in cats
54
What are the clinical signs associated with endocardiosis?
A heart murmur is common, and the other clinical signs depend on which valve is affected - either the mitral (left sided heart failure) or the tricuspid (right sided heart failure)
55
What is mitral valve disease?
A degenerative condition affecting the mitral valve of the heart in which it can no longer fully close, meaning blood regurgitates back into the atria. At its worst, the chordae tendineae can break and collapse the valve completely.
56
What proportion of dogs are affected by mitral valve disease?
It affects a third of all dogs over the age of 10 years
57
How much more common is MVD in a King Charles spaniel?
21 times more than in another breed - onset is typically much quicker with this breed as well, and it can reach a life threatening stage in as little as 1-3 years
58
How is MVD diagnosed?
All Cavaliers should be screens for a heart murmur once a year from 12 months old. Other diagnostics include: x-rays, echocardiography, and colour Doppler echocardiogram.
59
What is the Kennel Club Heart Scheme?
A scheme that assesses Cavalier King Charles Spaniels for MVD and other potentially significant heart diseases. It advises owners if their dog is affected, and gives advice to breeders on how to lower the risk of producing affected puppies.
Appointed vets are able to carry out heart grading through the scheme
60
What is congestive heart failure?
An acquired heart condition in which the ability of the heart to compensate does not meet the requirements of the animal. The result is pooling of blood (called congestion) at one or more of the vascular beds behind the left or the right side of the heart. Clinical signs develop when the animal is said to have decompensated. Both left and right sided CHF are due to low cardiac output
61
What is the affect of congestive heart failure?
Low cardiac output, which leads to reduced blood flow to the kidneys, and lowered levels of aldosterone, causing further congestion
62
What is aldosterone?
The main mineral corticosteroid hormone produced in the adrenal gland. It helps to manage blood pressure
63
What is right sided heart failure?
A type of congestive heart failure in which there is systemic venous congestion (aka poor venous return to the heart) and ascites. Congestion will occur in specific organs in the abdomen, causing distension as it fills with fluid.
64
What is ascites?
An abnormal build up of fluid within the abdomen - it is a classic characteristic of right sided congestive heart failure
65
What are the clinical signs associated with right sided heart failure?
Ascites, which may specifically result in conditions like hepatomegaly and splenomegaly, a distended abdomen, exercise intolerance, fatigue, lethargy, pale MM, tachycardia, weak pulse, dyspnoea, tachypnoea, cyanosis and a heart murmur
66
Define HEPATOMEGALY
Enlargement of the liver - may be a result of right sided congestive heart failure
67
Define SPLENOMEGALY
Enlargement of the spleen - may be a result of right sided congestive heart failure
68
What is left sided heart failure?
A type of congestive heart failure in which there is congestion in the lungs, pulmonary congestion and oedema. Oedema may be present in the distal limbs
69
What are the clinical signs associated with left sided heart failure?
Coughing, dyspnoea, oedema in the distal limbs, tachycardia, with hypokinetic pulses. The patient will have a heart murmur, be exercise intolerant, lethargic and fatigued. In severe cases they may be cyanotic
70
What are some common causes of congestive heart failure?
Cardiomyopathy, which may be primary or secondary
Valvular stenosis
Pulmonary or aortic stenosis
Cardiac arrythmias
71
What is valvular stenosis?
Narrowing of the heart valves. It may cause congestive heart failure
72
What is pulmonary or aortic stenosis?
Stenosis of the pulmonary veins or artery or the aorta
73
What are the general clinical signs of congestive heart failure?
Tachycardia, hypokinetic pulses, pale MM, cyanosis, coughing, oedema, tachypnoea, ascites, exercise intolerance, weight loss
74
What are the nursing considerations for acute congestive heart failure patients?
The key should be to minimise stress for the animal. They should be provided oxygen, cage rested and kept warm, and their vital signs checked regularly.
75
What are the nursing considerations for chronic congestive heart failure patients?
- consider a holistic approach
- cage rest
- limited exercise and stress
- weight management, diet should be low salt and high biological protein
- monitor vitals closely
- take care when administering IV fluids
76
What is the treatment for congestive heart failure?
Medical management includes:
- diuretics, to help manage pulmonary oedema and ascites
- glycosides, to improve cardiac muscle function and contraction
- bronchodilators, to improve breathing
- vasodilators, to reduce circulatory overload
- ACE inhibitors, to decrease the uptake of fluid retention
- potassium supplements to follow diuretics
- anti arrhythmic drugs if required
77
What are diuretics?
Medication used to increase diuresis, the production of urine
78
What are glycosides?
Medication used to increase the force of cardiac contraction
79
What are bronchodilators? Give an example
Used to improve breathing, often used as part of treatment for congestive heart failure. Theophylline is an example
80
What are vasodilators? Give an example
Used to reduce circulatory overload, often used as part of congestive heart failure treatment. An example is vetmedin
81
What are ACE inhibitors? Give an example
Used to decrease the uptake of fluid retention, often used as treatment for congestive heart failure. An example is Fortekor
82
How is heart disease diagnosed?
Using auscultation, radiography, and ECG
83
What is a heart murmur?
Occurs when one of the heart valves is impaired, causing slow closure, an audible whooshing sound, and regurgitation of blood back to the atria. They are graded 1-6 on severity
84
Describe a grade one heart murmur
A very soft murmur that can only be detected after very careful auscultation.
85
Describe a grade two heart murmur
A soft murmur that is readily evident but restricted to a localised area
86
Describe a grade three heart murmur
A moderately intense murmur not associated with a palpable precordial thrill. It is immediately audible
87
Describe a grade four heart murmur
A loud murmur, may have an intermittent precordial thrill
88
Describe a grade five heart murmur
A loud murmur associated with a palpable precordial thrill. The murmur is not audible when the stethoscope is lifted from the chest wall
89
Describe a grade six heart murmur
A loud murmur associated with a palpable precordial thrill. The murmur is audible even when the stethoscope is lifted from the chest wall
90
What are the different types of congenital heart disease?
Patient ductus arteriosus, pulmonary and aortic stenosis, septal defects (may be atrial or ventricular), tetralogy of fallot, and persistent right aortic arch
91
What percentage of total cases does congenital heart disease account for in cats and dogs?
Less than 7% - acquired heart diseases are much more common
92
What is patent ductus arteriosus?
A congenital heart condition - the most common congenital defect in dogs. It is the persistence of foetal vessels (the ductus arteriosus) that connect the aorta and the pulmonary artery. At birth this vessel normally closes, but in cases of PDA, it fails to do so. With it open, blood shunts from the aorta to the pulmonary artery, overloading the lungs. Blood can shunt from left to right or vice versa
93
What are the clinical signs of PDA?
- death at or very soon after birth
- weakness and lethargy
- cardiac cough
- cyanosis
- dyspnoea
- loud, machinery type heart murmur
- underdevelopment and poor growth
94
What treatment options are there for cases of PDA?
Surgery to close the vessel or implantation of a coil
95
Define STENOSIS
A general narrowing of something; often referring to a part of the body such as the nares, spine, or ear canal
96
Describe pulmonary stenosis
Abnormal narrowing of the main pulmonary artery as it leaves the right ventricle. The result is high pressure in the right side of the heart, and hypertrophy of the right ventricle wall, meaning it has to work a lot harder to maintain lung perfusion
97
What is a balloon vavuloplasty?
A procedure to dilate the pulmonary artery, as a treatment to resolve pulmonary stenosis
98
Describe aortic stenosis
Abnormal narrowing of the aorta as it leaves the left ventricle - the ventricle has to work much harder to pump blood around the body and there is resultant hypertrophy of the ventricle wall. Often treated symptomatically
99
What are some clinical signs associated with aortic or pulmonary stenosis?
- a heart murmur
- syncope, particularly when exercising
- signs of general heart failure
- sudden death
100
Define SYNCOPE
Fainting or collapse - it is a sign associated with pulmonary or aortic stenosis
101
What is a septal defect?
A condition in which the septum between either the ventricles or the atria doesn't grow fully, and causes a hole. Blood flows through the heart abnormally, leading to heart failure and death if not corrected. The larger the lesion, the more guarded the prognosis - animals with small holes can lead normal lives
102
What species are ventricular septal defects most common in?
Most common in cats
103
What is tetralogy of fallot?
A congenital heart condition comprised of a combination of heart defects - there is a ventricular septal defect, pulmonary stenosis, compensatory right sided hypertrophy and a displaced aorta
104
In what breed is tetralogy of fallot genetically inherited in?
The Keeshond
105
What are the clinical signs of tetralogy of fallot?
Cyanosis, weight loss, exercise intolerance, a harsh systolic murmur, and heart failure
106
What is persistent right aortic arch?
A congenital heart condition in which there is a malformation of major arteries within the heart. This forms a stricture, trapping the oesophagus and trachea, and preventing boluses of food from reaching the stomach
107
Define a STRICTURE
Abnormal narrowing of a bodily passage
108
What are the clinical signs associated with a persistent right aortic arch?
Clinical signs may not be evident when the animal is young - the patient will fail to thrive, and regularly regurgitate food. They will develop megaoesophagus, and potentially the complication of aspiration pneumonia
109
What is megaoesophagus?
Abnormal enlargement of the oesophagus, which may be a result of PRAA
110
How can megaoesophagus be managed?
Positioning during feeding and small meals. It can also be surgically repaired via ligation and cutting of the remnant.
111
What breed is predisposed to megaoesophagus?
German Shepherds
112
What nursing care is involved for patients with PRAA?
- generally the same as CHF patients
- fed at height, usually standing upright
- small, frequent meal feeding
- soft foods to prevent pocketing
- reduced excitement and stress around meals
113
What are some common haemopoietic system diseases?
Anaemia ( may be regenerative or non-regenerative), clotting disorders (primary or secondary), neoplastic disorders (including leukaemia, lymphosarcoma, and FIA)
114
Define ANAEMIA
A reduced number of RBCs or reduced quantity of haemoglobin. Lots of different causative agents
115
Define ERYTHROCYTOSIS
Increased numbers of red blood cells
116
Define LEUCOCYTOSIS
Increased number of white blood cells
117
Define LEUCOPENIA
Decreased number of white blood cells
118
Define THROMBOCYTOPAENIA
Decreased number of platelets
119
Define LYMPHOCYTOSIS
Increased number of lymphocytes
120
Define LEUKAEMIAS
Distorted proliferation and development of leucocytes and their precursors in blood and bone marrow
121
Describe anaemia
A reduced number of red blood cells or haemoglobin. A clinical sign, not a full diagnosis. There are two types: regenerative and non-regenerative
122
What are the two different types of anaemia?
Regenerative and non-regenerative
123
What is regenerative anaemia?
A type of anaemia in which the kidneys release erythropoietin to stimulate bone marrow to make an appropriate response to the anaemia. RBC production is increased and immature RBC (reticulocytes) are released into circulation.
124
What is a distinguishing feature of regenerative anaemia?
The presence of immature red blood cells (reticulocytes)
125
What are some causes of regenerative anaemia?
Haemorrhage (internal or external), and haemolysis (which may be immune mediated)
126
What is non regenerative anaemia?
A type of anaemia in which there may be no erythropoietin released by the kidneys in response to anaemia. This may be due to renal dysfunction or bone marrow unable to respond (indicating neoplastic bone marrow changes). There are no reticulocytes
127
What are some causes of non-regenerative anaemia?
Medullary disorders such as bone marrow neoplasia, or extramedullary diseases such as chronic disease or renal failure
128
What are some clinical signs associated with anaemia?
Chronic cases may show no signs. Acute cases may present with:
- collapse, weakness
- lethargy
- inappetence
- pale MM or jaundice
- tachypnoea and tachycardia
- an anaemia induced heart murmur
129
What nursing care is involved for anaemia patients?
- regular TPRs to monitor progression
- possibly a blood transfusion
- monitor urine output and give IVFT if necessary
- encourage eating - the patient will be anorexic
- exercise restriction, reduce stress
130
What are clotting disorders?
Conditions associated with clotting factors and the body's ability to stem bleeding. They may cause anaemia, and may be primary or secondary in nature
131
What may clotting disorders arise from?
The haemopoietic defect may be primary or secondary
132
What are primary haemostatic defects?
A type of clotting disorder where there is a vessel defect - there is an decreased number of thrombocytes seen, or an increased consumption of them
133
What is an example of a primary haemostatic defect?
von Willebrand's disease
134
What breeds is von Willebrand's disease commonly seen in?
Dobermanns, Rottweilers, poodles and Golden retrievers
135
What are some signs of a primary haemostatic defect?
Often they can present with no clinical signs until the patient starts to bleed for some reason e.g. in surgery, or during oestrus. Signs may include epistaxis, petechiae, and vaginal or penile bleeding
136
Define PETECHIAE
Pinpoint haemorrhage - can develop into ecchymosis which is a large area of subsurface bleeding that presents like a bruise
137
What is a secondary haemostatic defect?
A clotting disorder in which there is decreased levels of clotting factors, which may be due to decreased production (due to liver disease or warfarin poisoning for example) or increased consumption (which may be a result of DIC)
138
What is disseminated intravascular coagulopathy?
A serious condition in which blood clots form throughout the blood vessels in the body, leading to excessive consumption of platelets and clotting factors. This then leads to a paradoxical increased risk in bleeding, as the clotting factors and platelets are used up and become depleted. Often secondary to other issues
139
Is DIC a pathology?
No, it is secondary to other disorders such as sepsis, trauma, or certain cancers
140
What nursing care is involved for patients with clotting disorders?
- gentle handling to prevent injury
- padded bedding and kennels
- blood sampling from a peripheral vein only by an experienced nurse/vet, with sufficient pressure applied afterwards
- no IM injections
- monitor vitals closely
- monitor for haematuria or melaena, as it indicates internal bleeding
141
Define HAEMATURIA
Blood present in the urine
142
Define MALAENA
Dark, tarry stools, indicating the passage of digested blood
143
What are some examples of neoplastic diseases of the haemopoietic system?
Leukaemia, lymphosarcoma, FIA
144
What is leukaemia?
A condition in which primitive white blood cells (blast cells) grow in an uncontrolled way in bone marrow and overflow into the blood. The marrow can then not make normal mature white cells, red blood cells or platelets as it should - the lack of red cells causes anaemia, the lack of platelets can cause bruising and bleeding, and the lack of mature white cells means the body is incapable of fighting infection
145
What three cell types are produced in bone marrow?
Red blood cells (erythrocytes), white blood cells (leucocytes), and platelets (thrombocytes)
146
What are common symptoms of leukaemia?
Tiredness, fever, infections, bruising, and bleeding. Enlarged lymph nodes or a swollen abdomen may also be seen as the blast cells invade the lymph glands, the spleen and the liver
147
What are blast cells?
Primitive white blood cells that cause leukaemia if they grow in an uncontrolled way
148
What is lymphosarcoma?
A malignant tumour arising from lymphocytes. It may form solid tumours in lymph nodes and other white blood cell tissue such as in the spleen or the liver
149
What is feline infectious anaemia?
A condition caused by infection with mycoplasma haemofelis, an epicellular erythrocytic parasite, that results in regenerative anaemia. The causative agents are gram negative, and are usually found in varying numbers on the surface of RBCs but can also be seen free in plasma
150
What is the causative agent of FIA?
Mycoplasma haemofelis, an epicellular erythrocytic parasite.
151
How is FIA transmitted?
Via cat bites, fleas, in utero, in the milk, or via ticks
152
What are the symptoms of FIA?
Cats exposed may be asymptomatic, and may become carriers, shedding the disease in times of stress or immunosuppression.
Acute signs include:
- lethargy and weakness
- anorexia
- pale MM
- tachycardia
- tachypnoea
- splenomegaly
153
What is the treatment and nursing care involved in a patient with FIA?
Antibiotics (tetracyclines), blood transfusions, stress reduction, and flea treatment
154
What is FIA associated with?
FeLV (Feline Leukaemia Virus), and FIV (Feline Immunodeficiency Virus)
