Circulatory system disease Flashcards
What is congenital heart disease?
- Disease present at birth
- Breed specific
- Usually detected in first health check
What are the clinical signs of congenital heart disease?
- Poor growth
- Exercise intolerance
- Lethargy
- Dyspnoea
- Coughing
How may congenital heart disease be diagnosed?
- Obtain clinical history
- Clinical examination
- Thoracic x-rays
- ECG
What is patent ductus arteriosus (PDA)?
- Most common congenital defect in dogs
- In the fetus a vessel (ductus arterioles) connects the pulmonary artery to the aorta
- If this fails to close at birth the lungs become overloaded
What are the clinical signs of PDA?
- Loud heart murmur (owner can sometimes hear/feel)
- Poor growth
- Asymptomatic or in heart failure
What is the treatment for PDA and its prognosis?
- Surgical closure of the vessel (easy fix)
- Implantation of a coil
- Excellent prognosis
What is aortic and pulmonary stenosis?
- Narrowing of the aortic or pulmonary valves
- Blood flow leaving the ventricles is obstructed
- Heart muscle needs to work harder
What are the clinical signs of aortic and pulmonic stenosis?
- Heart murmur
- Fainting
- Heart failure
What is the treatment and prognosis for aortic and pulmonic stenosis?
- Dilation of the area using balloon (easy fix)
- Prognosis varies but tends to be good
What is mitral and tricuspid valve dysplasia?
- Valves are malformed and therefore displaced
- Blood regurgitates into the atria
- Workload increases and they enlarge leading to congestion
What are the clinical signs and treatment for mitral and tricuspid valve dysplasia?
Clinical signs:
- Heart murmur
- Heart failure (type dependent on which valve affected)
Treatment:
-Same as heart failure
What is ventricular/atrial septal defects?
- ‘Holes in the heart’ connecting with either the atria or ventricles
- Blood flows through the heart abnormally
What are the clinical signs, treatment and prognosis of ventricular/atrial septal defects?
Clinical signs:
- Heart murmur
- Asymptomatic or congestive heart failure
Treatment:
- Surgery to correct defect
- Same as heart failure
Prognosis:
-Good to guarded
What is an overriding aorta?
- A congenital heart defect
- Aorta is positioned over the ventricular septal defect instead of over the left ventricle
- Resulting in the aorta containing some blood from the right ventricle, which reduces the amount of O2 in the blood
What is a persistent right aortic arch?
- A vascular ring anomaly
- Malformation of the major arteries of the heart
- Traps the oesophagus
What are the clinical signs of a persistent right aortic arch?
- Regurgitation of food (solid food rather than puppies on a liquid diet)
- Aspirational pneumonia
- “Poor doer”
What is the treatment and prognosis of persistent right aortic arch?
Treatment:
- Surgery to ligate and cut remnant
- Feeding from a height or liquid food
Prognosis:
-Usually good if haven’t aspirated
What is tetralogy of Fallot?
- Uncommon
- Some patients can present with a combination of defects:
- > Ventricular septal defect
- > Pulmonic stenosis
- > Compensatory right-sided hypertrophy
- > Overriding aorta
What clinical signs and prognosis is seen with tetralogy of Fallot?
Clinical signs:
- Cyanosis
- Hypoxic
- Collapse
Prognosis:
-Guarded (hard to fix)
What is portosystemic shunt?
- Abnormal single or multiple blood vessels which directly join the blood supply from the intestines to the main circulation (no breakdown of urea)
- Toxic blood then circulates the body (including the brain)
- Ammonia passes around the body
What are the clinical signs for portosystemic shunt?
- Stunted growth
- Poor muscle development
- Disorientation
- Circling/head pressing
- Seizures
What are the nursing management and care implications necessary for portosystemic shunt?
-Emergency nursing care (IVFT, enema to remove intestinal toxins before they are absorbed, anti-convulsant drugs eg. diazepam)
-Diet change (reduce amount of protein and feed only high quality, high digestible protein diets)
-Lactulose (decreases absorption of ammonia/other toxins and makes the intestinal environment unfavourable for toxin-producing bacteria)
Antibiotics (Alter the bacteria; population in the intestines and to reduce intestinal bacterial overgrowth)
-Ameroid constrictor (band placed over shunt during surgery to slowly close the shunt)
-Anti-seizure medication
What is hemangiosarcoma?
- Malignant tumour derived from the cells lining blood vessels
- Common in spleen and heart base
What are the clinical signs for hemangiosarcoma?
- Depression
- Lethargy
- Refusal to walk
- Pale MM
- Dyspnoea
- Distended abdomen
What are the nursing care implications and treatment for Hemangiosarcoma?
Nursing care:
- Close monitoring for improvement/deterioration of clinical signs
- Support throughout surgery
- Close monitoring post surgery
Treatment:
- Blood transfusion
- Surgical removal of spleen
- Chemotherapy
- Prognosis poor
What is endocardiosis?
- Progressive condition
- Mitral valve most commonly affected (also tricuspid valve)
- Commonly due to fibrosis which affects function of valves
- Blood regurgitates into the atria increasing workload
- Causes congestion and heart failure
What are the clinical signs, diagnostics and treatment of endocardiosis?
Clinical signs:
- Heart murmur
- Left/right sided heart failure
Diagnostics:
- History
- Thoracic radiographs
- ECC & ECG
- Blood culture
Treatment:
- Same as heart failure
- Broad spectrum AB’s following blood culture results (Endocarditis)
What is myocardial disease?
- Diseases associated with cardiac function
- More common in cats than dogs
What is hypertrophic cardiomyopathy (HCM)?
- Thickening of heart muscle interferes with relaxation of the heart
- Normal filling of heart is prevented
- Poor diastolic function
- Decreased cardiac output
- Heart failure
What are the clinical signs of HCM?
- Silent
- Dyspnoea
- Tachypnoea
- Tachycardia
- Heart murmur
What are the clinical signs of HCM with an aortic thromboembolism complication?
- Acute onset of uni/bilateral paresis/paralysis of the hindlimbs
- Lack of arterial pulse in the affected leg(s)
- Hindlimb(s) cold, pads pale and quiks blue
- Pain
- Dyspnoea/tachypnoea
What diagnostics and treatment is performed for HCM?
Diagnostics:
- ECC & ECG
- Thoracic x-rays
- Blood tests and pressure management (eg. clotting profiles)
- Abdominal USS
Treatment:
- Cardiac relaxation and slowing heart rate
- Pain relief (VITAL - methadyne)
- Antithrombotics and vasodilators
What is dilated cardiomyopathy?
- Dilation of the heart chambers
- Enlargement of the heart
- Poor systolic function
- Congestions and heart failure
What are the clinical signs of dilated cardiomyopathy?
- Anorexia/weight loss
- Reduced exercise intolerance/lethargy
- Ascites (do USS)
- Heart murmur, arrhythmias, atrial fibrillation
- Usually left sided heart failure, sometimes right
- Sudden death
- Common in giant breeds (eg. GSD, Labrador, Great Dane)
What are the diagnostics and treatment performed for dilated cardiomyopathy?
Diagnostics:
- ECC & ECG
- Thoracic radiographs
Treatment:
- Individual assessment
- Same as heart failure
What are arrhythmias?
- Disturbance of electrical activity within the heart
- Possibly due to primary heart disease
- Possibly secondary to another systemic disease
- Broadly categorised
What are the clinical signs, diagnostics and treatments for arrhythmias?
Clinical signs:
- Asymptomatic
- Exercise intolerance/weakness
- Collapse
Diagnostics:
- Blood tests
- ECC & ECG
- Thoracic x-rays
Treatment:
- Antiarrhythmic
- Pacemaker
What is pericardial effusion?
- Effusion accumulates in the pericardial sacs
- Restricts filling of the right side of the heart
- Right-sided heart failure
What are the clinical signs of pericardial effusion?
- Pale MMs
- Muffled heart sounds
- Tachycardia
- Variable pulse quality
- Distended abdomen
- Exercise intolerance/collapse
What are the diagnostics and treatment of pericardial effusion?
Diagnostics:
- ECG
- Thoracic radiographs
Treatment:
- Relieving pressure around the heart
- Fluid removal and analysis
- IVFT
- Tends to reoccur
What are the clinical signs of acute heart failure?
- Reluctance to exercise/collapse
- Pale MMs
- Cyanosis
- Slow CRT
- Weak pulse and quality
- Heart murmur
- Cough/dyspnoea/tachypnoea
What are the treatments and nursing care implications for acute heart failure?
Treatment:
- Medical therapy (thoracocentesis, diuretic, other under VS direction)
- Furosemide (diuretic), no fluids but leave water
Nursing care:
- Cage rest
- Do not stress
- Provide O2
- Monitor RR and vital signs
What are the clinical signs of left-sided heart failure?
- Reluctance to exercise/fatigue/lethargy
- Pale MMs
- Cyanosis
- Heart murmur
- Tachycardia
- Dysrhythmias
- Cough/dyspnoea/tachypnoea
What are the clinical signs for right-sided heart failure?
- Ascites
- Abdominal distention
- Hepatomegaly/splenomegaly
- Reluctance to exercise/fatigue/lethargy
- Pale MMs
- Cyanosis
- Heart murmur
- Tachycardia/dysrhythmias
- Dyspnoea/tachypnoea
What are the treatments and nursing care for left/right-sided heart failure
Treatment:
-Medical therapy (diuretics, anti-arrhymics, other under VS direction)
Nursing care:
- Reduce exercise
- Reduce obesity (if applicable)
- Low salt diet
- O2
- Keep warm
- Monitor RR and vital signs
What are the nursing care for chronic heart failure cases?
- Decrease stress and exercise
- Weight loss management
- Monitor vital signs
- Blood tests (dehydration and electrolytes imbalances)
- Palatable diets
Prognosis poor depending on owner compliance
Myocarditis
Inflammation of the muscular walls of the heart (rare)
Endocarditis
inflammation of the endocardium, most commonly involving the heart valve
Pericardia
Inflammation of the pericardium (sac around the heart)
Cardiomyopathy
Primary disease of the heart muscle
Cardiac tamponade
Compression of the heart due to fluid accumulation in the pericardial sac (emergency)
Define shock
A state of acute circulatory collapse where the circulation is unable to transport sufficient oxygen to meet the tissue needs
What are the main types of shock recognised?
- Hypovolaemic
- Distributive
- Cardiogenic
- Obstructive
What clinical signs are seen with hypovolaemic shock?
- Tachycardia
- Slow CRT
- Pale MMs
- Poor pulse
- Low blood pressure
- Hypothermia
What treatment and nursing care can be done for hypovolaemic shock?
- Fluid replacement (electrolytes)
- Arrest iof haemorrhage
- O2 supply
- Warmth and monitor glucose levels
- Monitor urine output
- Monitor lactate (2-2.5mm/s/litre - expect high lactate levels, if lactate not decreasing is poor prognosis)
What is hypovolaemic shock?
Secondary to significant loss of circulatory fluid volume and is the most common
What is distributive shock?
Generalised release of inflammatory mediators that promote vasodilation so the body is unable to control where blood volume is distributed
-Egs. Anaphylactic, toxic and septic shock
What are the clinical signs off distributive shock?
- Tachycardia
- Poor pulse quality
- Warm extremities
- RED MMs
- FAST CRT (both due to vasodilation)
What treatment and nursing care can be done for distributive shock?
- Underlying cause (antibiotics, antihistamines)
- IVFT (electrolytes)
- O2 supply
- Warmth
- Monitor urine output
- Monitor lactate
What is cardiogenic shock?
Condition where heart can no longer pump effectively, commonly seen in degenerative conditions of the heart muscle
What are the clinical signs of cardiogenic shock?
- Heart mururs
- Irregular pulses (AV block)
- Blue MMs
- Diagnose with ECC, ECG and X-rays
What treatment and nursing care can be done for cardiogenic shock?
- Underlying cause
- IVFT
- O2 supply
- Warmth
- Monitor urine output and lactate
What is obstructive shock and identify some examples
Associated with physical obstruction of large vessels or the heart (RARE)
-Egs. Pericardial effusion (fluid around heart), Pulmonary embolism, GDV
Syncope
Temporary loss of consciousness caused by fall in blood pressure
- Sudden
- Reduction of O2 to the brain
What are the levels of unconsciousness?
- Normal
- Depressed/obtunded (diminished awareness)
- Stupor (aware of surroundings but with some difficulty)
- Coma (all body functions are present but patient cannot be roused)
What may cause syncope?
- Bradycardia
- Tachcardia
- Reduced cardio output
- Increase vagal tone (overstimulation causes blood vessels to dilate and blood pressure to drop)
- Situational syncope (profound coughing, hard swallowing, vomiting or difficultly urinating and/or defecating
What nursing care can be done for an unconscious patient?
- Maintain the airway
- Ensure patient conserves heat
- Minimise shock
- Confine to quiet, warm and dark kennel
- Turn patient to avoid secondary complications
- Assess levels of consciousness
