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Cardiology and Respiratory SA Med > Diastolic Dysfunction - Primary > Flashcards

Diastolic Dysfunction - Primary Flashcards

1
Q

What is the impact of severe acute arteriolar vasoconstriction on heart rate?

A
  • Increasing your systemic vascular resistance
  • Heart rate should fall dramatically because your blood pressure is increasing
  • reflex bradycardia, which is what happens with dexmedetomidine
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2
Q

Brain perfusion equation

A
  • Systemic blood pressure - intracranial pressure
  • If you have increased intracranial pressure, you will increase blood pressure to try and maintain the intracranial pressure
  • If you have a dog with cerebral trauma and bradycardia, you can assume that your intracranial pressures are very high
  • Cushing’s reflex
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3
Q

Etiology of HCM

A
  • Genetic vs idiopathic
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4
Q

Breeds at risk for HCM

A
  • Maine Coons
  • Ragdolls
  • Forest Cats
  • Sphynxes
  • Bengals and Birmans
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5
Q

Which species gets HCM?

A
  • CATS
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6
Q

Genetic testing for HCM for Maine Coons and Ragdolls

A
  • Myosin-binding protein C
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7
Q

Physical exam findings with HCM

A
  • Systolic murmur MAYBE
  • Gallop sound MAYBE
  • MAY BE NORMAL
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8
Q

Diagnosis of HCM cats

A
  • DIAGNOSIS OF EXCLUSION (like DCM)
  • Echocardiogram
  • Concentric hypertrophy of the LV
  • Thickened left ventricular walls (free wall, septum, +/- asymmetric)
  • Small LV chamber
  • Thoracic rads to look for CHF
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9
Q

What should normal left ventricle wall thickness be?

A
  • <5.5 mm
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10
Q

Which frame should you use to measure wall thickness?

A
  • Diastolic
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11
Q

Causes of concentric hypertrophy to rule out?

A

Causes of systemic hypertension:

  1. Renal disease
  2. Hyperadrenocorticism
  3. Hyperthyroidism
  4. Diabetes mellitus
  5. Medications
  6. Acromegaly
  7. Pheochromocytoma
  8. Hyperaldosteronism?

Other causes of stenosis

  1. Pulmonic stenosis
  2. Aortic stenosis

If a young cat with a normal or low blood pressure, probably primary HCM

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12
Q

Treatment for Stage B1 HCM

A
  • No treatment

- Monitoring

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13
Q

Treatment for Stage B2 HCM

A
  • +/- ACE inhibitor
  • +/- Beta blocker
  • +/- Diltiazem
  • +/- Spironolactone
  • +/- Antithrombotic
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14
Q

Treatment for Stage C HCM with CHF

A
  • Furosemide
  • ACE inhibitor
  • +/- Thoracocentesis
  • +/- Pimobendan
  • +/- Spironolactone
  • +/- Antiarrhythmics
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15
Q

Treatment for Stage C HCM with arterial thromboembolism

A
  • SUpportive Care
  • Pain management
  • Antithrombotics (aspirin, clopidogrel, Low molecular weight heparin)
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16
Q

Signs of left sided heart failure in cats

A
  • Pulmonary edema

- Pleural effusion

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17
Q

What types of effusion can happen in cats with left sided CHF?

A
  • Modified transudate

- chylous effusion

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18
Q

What are three differentials for chylous effusion in cats?

A
  1. Heart failure
  2. Neoplasia
  3. Idiopathic
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19
Q

Signs of right sided heart failure in cats

A
  • Abdominal effusion
  • Pleural effusion
  • Pretty sure that right sided heart failure is unusual in general in cats
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20
Q

Pulmonary edema clinical signs

A
  • Crackles
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21
Q

Pleural effusion clinical signs

A
  • May not hear things ventrally or have dull lung sounds ventrally
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22
Q

Pulmonary edema treatment

A
  • Furosemide and ACE inhibitor
  • Diuretic gets rid of fluid
  • ACE inhibitor to inhibit RAAS
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23
Q

Pleural effusion treatment

A
  • Furosemide not good at getting rid of fluid, but will slow down re-accumulation
  • Thoracentesis
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24
Q

Virchow’s Triad

A
  • Endothelial damage
  • Sluggish blood flow (Blood stasis)
  • Hypercoagulability
  • All of these can lead to thrombosis
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25
Q

Where does feline arterial thromboembolism usually occur?

A
  • At the juncture of the aorta where the external iliac arteries split off
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26
Q

Clinical signs of feline arterial thromboembolism

A
  • Paralyzed back legs
  • No blood supply, so the legs are cold
  • Femoral pulses weak or nonexistent
  • Paw pads can become cyanotic (look at nail beds if paw pads are black)
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27
Q

Prognosis for stage B1 HCM

A
  • fair to good

- May take year to progress

28
Q

Prognosis for stage B2 HCM

A
  • Guarded

- Will likely progress

29
Q

Prognosis for Stage C with Heart failure

A
  • Guarded (1-3 years with therapy)
30
Q

Prognosis for Stage C with ATE

A
  • Guarded to poor
31
Q

Treatment for HCM studies

A
  • No real studies

- We don’t know what works and c doesn’t

32
Q

What is considered Stage C for HCM cats?

A
  • Either HCM OR arterial thromboembolism
33
Q

Critical period for post-ATE

A
  • First 24-72 hours

- Concurrent CHF

34
Q

What causes death in feline ATE?

A
  • Reperfusion injury often due to hyperkalemia
  • Potassium in the cell leaks out with necrosis from all of the cells that have died
  • Once the clot breaks down and you re-establish blood flow, the potassium goes to the rest of the body

-

35
Q

Sodium and potassium inside of the cell

A
  • Na+: 12

- K+: 140

36
Q

Sodium and potassium outside of the cell

A
  • Na+: 145

- K+: 4

37
Q

What causes death ultimately with hyperkalemia?

A
  • Cardiac arrest
38
Q

4 ECG changes that occur with yperkalemia?

A
  1. Tented T waves
  2. Decreased amplitude to no P waves
  3. Increased PR interval
  4. Wide QRS complexes

ULTIMATELY ATRIAL STANDSTILL

39
Q

Atrial standstill

A
  • Lack of P waves
  • Just ventricular escape complexes
  • Can lead to death ultimately
40
Q

Treatment for hyperkalemia secondary to Feline Arterial Thromboembolism

A
  • Dextrose +/- insulin
  • Bicarbonate
  • Calcium
  • Furosemide
  • IV fluids (BE CAREFUL)
41
Q

Prognosis for arterial thromboembolism

A
  • guarded to poor
  • <40% survival
  • HOWEVER, you CAN SAVE THESE CATS
  • It’s worth trying
42
Q

Negative prognostic indicators for feline ATE

A
  • Number of legs affected + stiffness of legs
  • Low Rectal temperature affected
  • If you lose blood supply to GIT; brain; renal arteries
  • Other sites
43
Q

Regain of function for feline ATE

A
  • Can happen!

- 3-6 months

44
Q

Complications for feline arterial thromboembolism

A
  • Necrosis
  • Self mutilation
  • Need for amputation
45
Q

Things to monitor for cats with feline arterial thromboembolism

A
  • Need to hospitalize for pain

- Monitor hyperkalemia

46
Q

Recurrence rate for feline ATE

A
  • 25-50% on clopidogrel
47
Q

Hypertrophic obstructive cardiomyopathy etiology

A
  • Idiopathic
  • Might be a special type of HCM?
  • Papillary muscle dysplasia?
48
Q

Who gets HOCM?

A
  • Cats mainly
49
Q

Diagnosis of HOCM?

A
  • DIAGNOSIS OF EXCLUSION!
  • Echocardiogram
  • Systolic anterior motion of the mitral valve
  • If transient with stress –> no hypertrophy
  • If obstruction –> concentric hypertrophy –> HOCM
  • Obstruction of the aortic outflow tract during systole (dynamic stenosis)
  • Can also have mitral regurgitation too
  • Thoracic radiographs (r/o CHF)
50
Q

Treatment for Stage B1 and B2 HOCM

A
  • Slow heart rate to reduce SAM
  • Beta blocker
  • Diltiazem
51
Q

Treatment for Stage C HOCM with CHF

A
  • Furosemide
  • ACE inhibitor
  • +/- slow heart rate
  • +/- Thoracocentesis
  • +/- Pimobendan
  • +/- Spironolactone
  • +/- Anti-arrhythmics
52
Q

Treatment for Stage C HOCM with ATE

A
  • SUpportive care
  • Pain management
  • Antithrombotics (Aspirin, clopidogrel, low molecular weight heparin)
  • Slow heart rate (Beta blocker, diltiazem)
53
Q

Prognosis for Stage B1 and B2 HOCM

A
  • Guarded to good

- Depends on response to decreased HR

54
Q

Prognosis for Stage C HOCM with CHF

A
  • Guarded 1-3 years
55
Q

Prognosis for Stage C HOCM with ATE

A
  • Guarded to poor
56
Q

Etiology of restrictive cardiomyopathy

A
  • Idiopathic
  • AMyloidosis
  • Fibrosis
57
Q

Who gets restrictive cardiomyopathy?

A
  • mainly cats
58
Q

Diagnosis of restrictive cardiomyopathy

A
  • Rule out secondary causes - DIAGNOSIS OF EXCLUSION (same list as with HCM)
  • Echocardiogram
  • Chest rads to check for CHF
59
Q

Echocardiogram findings of restrictive cardiomyopathy

A
  • Normal wall thickness (e.g. not HCM)
  • Normal to reduced systolic dysfunction (e.g. not DCM)
  • Diastolic dysfunction
60
Q

Treatment for Stage B1 RCM

A
  • No treatment

- Monitor

61
Q

Treatment for Stage B2 RCM

A
  • +/- ACE inhibitor
  • +/- Beta blocker
  • +/- Diltiazem
  • +/- Spironolactone
  • +/- Antithrombotic
62
Q

Treatment for Stage C RCM with CHF

A
  • Furosemide
  • ACE inhibitor
  • +/- Thoracocentesis
  • +/- Pimobendan*** (if evidence of systolic dysfunction)
  • +/- Spironolactone
  • +/- Anti-arrhythmics
63
Q

Treatment for Stage C RCM with Arterial thromboembolism

A
  • Supportive care
  • Pain Management
  • Antithrombotics (aspirin, clopidogrel, low molecular weight heparin)
64
Q

Prognosis for Stage B1 RCM

A
  • Guarded to good

- May take years to progress

65
Q

Prognosis for Stage B2 RCM

A
  • Guarded
66
Q

Prognosis for Stage C RCM with CHF

A
  • 6-12 months?

- Guarded; may be worse than with HCM or HOCM

67
Q

Prognosis for Stage C RCM with Arterial thromboembolism

A
  • Guarded to poor

Cardiology and Respiratory SA Med (15 decks)

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