ECC: Cardiovascular

Question 1

Causes of pale/white mucous membranes

Answer 1

Anemia
Vasoconstriction
Shock

Question 2

Causes of injected mucous membranes

Answer 2

Vasodilation
Sepsis
Heatstroke
Cyanide poisoning
Carbon monoxide toxicity
Side effect of certain drugs

Question 3

Cause of brown mucous membranes

Answer 3

Oxidation injury to the blood cell causing methemoglobinemia

Question 4

Causes of yellow/orange mucous membranes

Answer 4

Heaptic disease
Bile duct obstruction
Excessive hemolysis

Question 5

Pulse deficit

Answer 5

A heartbeat is heard with no associated pulse

Question 6

BP cuff sizing

Answer 6

Width: 40-60% of limb circumference

Length: 60% of limb circumference

Question 7

Causes of hypotension

Answer 7

Hypovolemia
Poor cardiac output
Systemic vasodilation

Question 8

Normal canine/feline BP

Answer 8

Systolic: 100-160
Diastolic: 60-110
MAP: 80-120
Pulse pressure: 40-80

Question 9

Mean arterial pressure: definition

Answer 9

Average blood pressure over time (through both systole and diastole)

Question 10

MAP: formula

Answer 10

MAP= [(2 x diastolic) + systolic] ÷ 3

Diastole counts twice as much as systole because 2/3 of the cardiac cycle is spent in diastole

Question 11

Pulse pressure

Answer 11

The difference between systolic and diastolic pressure

Question 12

Normal blood lactate

Answer 12

<1.0 mmol/L

Question 13

Cause of increased lactate

Answer 13

Inadequate tissue oxygenation associated with impaired perfusion

Question 14

2 major sources of increased lactate (systems)

Answer 14

Skeletal muscle

GI system

Question 15

Heart failure: definition

Answer 15

A heart that pumps an inadequate volume of blood to all tissues resulting in inadequate oxygenation

Question 16

Congestive heart failure

Answer 16

Impaired cardiac function resulting in elevated venous and capillary pressures

Causes organs to become congested with blood or edematous fluid

Question 17

Right ventricular failure

Answer 17

Caused by reduced cardiac output and systemic venous hypertension

Question 18

Right sided failure: history

Answer 18

Periods of weakness, exercise intolerance, or syncope

Question 19

Right sided failure: presentation

Answer 19

Pale mucous membranes
Jugular venous distension/pulsations 
Liver and/or spleen enlargement
Tachypnea
Peritoneal or pleural effusion

Question 20

Left sided failure: history

Answer 20

Similar to right sided, plus:

Coughing
Orthopnea
Hemoptysis
Oliguria

Question 21

Left sided failure: presentation

Answer 21

Arrhythmia
Heart murmur
Lung crackles
Cyanosis

Question 22

Biventricular heart failure

Answer 22

Combination of symptoms of left and right sided failure

Question 23

Loop diuretics

Answer 23

Decrease the re-absorption of sodium and chloride and increase the excretion of potassium

Act within loope of Henle

Increase renal excretion of water, sodium, chloride, calcium, magnesium, hydrogen, ammonium, and bicarbonate

Question 24

Most common loop diuretic

Answer 24

Furosemide

Question 25

Furosemide dosing for cardiogenic or pulmonary edema

Answer 25

2-4 mg/kg every 1-8 hours CRI: 0.1mg/kg/hr

Question 26

Potassium-sparing diuretics

Answer 26

Act by inhibiting the action of aldosterone on distal tubular cells Can be used in conjunction with loop diuretics

Question 27

Most common potassium-sparing diuretic

Answer 27

Spironolactone

Question 28

Spironolactone onset of action

Answer 28

2-3 days of therapy to reach peak effect Used primarily for long-term treatment

Question 29

Spironolactone dosing

Answer 29

2-4mg/kg/day PO

Question 30

Dobutamine

Answer 30

Causes increased myocardial contractility and stroke volume Increases cardiac output

Question 31

Dobutamine dosing

Answer 31

5-20 mcg/kg/min

Question 32

Dobutamine side effects

Answer 32

``` Nausea Vomiting Tachycardia Hypertension Arrhythmias ```

Question 33

Positive inotropes

Answer 33

Increase the strength of contraction of the myocardial muscle, there by increasing cardiac output

Question 34

4 groups of inotropic drugs

Answer 34

Sympathomimetic amines: dobutamine and dopamine Phosphodiesterase inhibitors: sildenafil and vetmedin Calcium sensitizers Digitalis glycosides

Question 35

Dopamine

Answer 35

Precursor of norepinephrine

Question 36

Dopamine dosing

Answer 36

Low dose: 1-5 mcg/kg/min High dose: 6-10mcg/kg/min

Question 37

Cannot be used in conjunction with dopamine or dobutamine

Answer 37

Beta blockers

Question 38

Sildenafil

Answer 38

Potential benefits in CHF In human studies: Increased myocardial contractility Blunted adrenergic stimulation Reduced left ventricular afterload Improved lung diffusion capacity

Question 39

Pimobendan

Answer 39

Both a phosphodiesterase inhibitor and calcium sensitizer Positive inotropic effect + vasodilation Used for long-term treatment of CHF

Question 40

Pimobendan dosing

Answer 40

0.1-0.3 mg/kg BID

Question 41

Types of vasodilators

Answer 41

Ace inhibitors: Enalapril, benazepril Calcium channel blockers: Amlodipine, diltiazem

Question 42

Indications for ACE inhibitors

Answer 42

Hypertension | CHF

Question 43

ACE inhibitor mechanism of action

Answer 43

Block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor May slow or reverse the progression of pump dysfunction and pathologic remodeling that occurs with heart failure

Question 44

Primary use for amlodipine

Answer 44

Systemic hypertension

Question 45

Indications for diltiazem

Answer 45

Supraventricular tachycardias Atrial fibrillation Hypertrophic cardiomyopathy

Question 46

What type of drug are amlodipine and diltiazem?

Answer 46

Calcium channel blockers

Question 47

Cardio effects of beta-1 stimulation

Answer 47

Increased HR Increased AV node conduction velocity Increased strength of myocardial contraction

Question 48

Cardio effects of beta-2 stimulation

Answer 48

Vasodilation in skeletal muscles | Bronchodilation in airways

Question 49

Propranolol

Answer 49

Blocks both beta-1 and beta-2 receptors Decreases HR and contractility, slows conduction Decreases cardiac output at rest and during exercise

Question 50

Why should patients with respiratory issues be monitored closely on propranolol?

Answer 50

It blocks beta-2 receptors as well as beta-1, causing bronchial constriction

Question 51

Atenolol and metoprolol

Answer 51

Selectively block b-1 receptors Decrease cardiac output, myocardial oxygen demand, and BP

Question 52

Atenolol and propranolol in diabetic patients

Answer 52

Both drugs prolong the hypoglycemic effects of insulin Closer monitoring of BG

Question 53

Beta blocker dosing

Answer 53

Canine: 12.5-50mg q12-24h Feline: 6.25-12.5mg q12-24h

Question 54

Esmolol

Answer 54

Ultrashort acting beta-1 blocker available only as injectable Generally used as a "test"drug for beta blocker therapy or as an infusion for supraventricular tachyarrhythmias