Ex 2 Know it stuff Flashcards
At which interval is the delay in AV node represented?
PR interval
6 steps to preform ECG…GO!?
- Gen assessment
- Calc HR
- Measure RR
- Check out that P,QRS, T
- ID an ectopic complex
- ID any pauses
You look at the ecg and you have P waves with High amplitude…what the heck does this mean?!?
R atrial enlargement
High p..has a peak…think pulmonary…pulmonary is on the right
Now the ecg has a wide P…what does this mean?
L atrial enlarment
Wide, looks like a mound- mound for mitral..and mitral is on the Left
Sinus arrthymia (SA) norm or not normal?
Normal in awake, resting calm DOGS
What would have a wide QRS?
VPC, V tach BBB Vent enlargement Escape beats Electrolyte: HYPERkalemia
You have an animal that presented with SVT (suprventrcular tachy) what drug are you going to give…..
DILTIAZEM
-ca channel blocker class 4
Animal presents with AFib (atrial fibrillation) what is your first choice drug??
DILTIAZEM
-ca channel blocker class 4
Animal presents with Vtach (ventricular Tachycardia) what is your first choice drug?
LIDOCAINE
-Na channel blocker class 1
If animal presents with any of these 3 things… you better get excited because you get to put in a pacemaker…what are they?
AVB: high grade 2nd deg/3rd deg ab block
Sinus sick syndrome: Brady requires it
Primary atrial stand still: ONLY primary
Atrial stand still if primary gets a _______
Atrial stand still would secondly be caused by ________and not require a pacemaker?
Pacemaker
HYPERkalemia
The chicken or the egg..which comes first?
Congestive HF or Low output HF??
YASSSS!!!
Congestive HF happens FIRST then Low output HF!!!
Preload—what in the world is it?
Amount of STRECHING of ventricular myocytes prior to contraction
Afterload— what is this?
The TENSION acting on ventricular myocytes after onset of myocyte shortening
Fluid accumulation.. left sided HF will result in what?
Pumonlary effusion- edema
LEFT is in the LUNGS!!!
Location for fluid accumulation in right sided HF will result in what?
Effusion in the body cavities!!
HF therapy..tell me your 3 goals
- Relieve congestion
- Imp cardiac output
- Prevent progression
Fursoimide is your 1st choice to do what?
Reduce edema
What drug is a k sparing cardioprotective (anti-fibrotic)
Spironolactone
An ACE inhibitor would be better used in a chronic or acute patient?
CHRONIC!!
-will combat chronic effects of RASS
Dog presents with hypertension…whats your go to drug?
Benazepril
Cat presents with hypertension..what’s the drug of choice?
Amlodipine
- Ca channel blocker
Again…what can Diltiazem treat? (2 things)
A fib, supraventricular tachy
Again…what can lidocaine be used for (there are 2)?
Suppress VPC’s ; vent tachy
You have a dog that presents with arrhythmogenic right ventricular cardiomyopathy…tx it with what
Sotolol
- class 3 Anti- arrhythmic
- k channel blocker (some B-block)
That are the 4 classes of drugs?
Class 1: Na channel blocker
Class 2: b- blocker
Class 3: k blocker
Class 4: ca channel blocker
(Stretch before playing catch)
If a patient presents in distress…which drug should you NOT use?
B-blocker
Don’t be an ass hole to the heart and AVOID these in acute HF or ventricular systolic dysfunction
You have a patient with HF and the O think is is a good idea to limit the protein because their breeder said so. Is limiting the protein a solid plan yes/no and explain..
NOOOO this is a bad idea, your breeder didn’t go to vet school!
HF patient should have a HIGH quality protein diet. DO NOT limit the protein- the patient will get cahexia (loss of lean body mass). The breeder may have thought this becuase they heard about that azotemia….but the azotemia we see in HF patients is due to secondary renal failure NOT protein!
You hear split S2 sound.. if this is pathological what is it due to?
Pulmonary hypertension
Animal presents with eyes having Retinal hemorrhage..what is going on!!?
Systemic hypertension
Jug vein distension should NEVER be seen unless high systemic pressure is present. If a patient presents with pulsation of the Jug higher than the distal 1/3 of the neck what problem is going on in their heart?
Right sided heart problem
Tell me about S1
Lub- low pitch
Tricuspid/ mitral closes
Pulmonary/ aortic Open
If a murmur is not a diagnosis then what is it
A murmur is turbulent flow (most systolic occurring between S1 and S2) there is normally something happening that is causing that turbulent flow and that is what we have to figure out
Animal presents with abdominal distension…what side of the heart is failing?
Right sided HF
Primary Sinus tach/ sinus Brady are due to?
Sinus node dysfunction
Sinus sick syndrome
animal has a leasion in the cerebellum will it have CP signs or not?
NO it will not
Animal presents with horizontal nystagmus why does it have this?
Peripheral ear problem
lil’ teeeny tiny kitten comes in and O already knows it has cerebellar hypoplasia, what clinical signs should it have?
Ataxia, cp reflexes okay
Its a tiny drunk kitten 🐱
Animal comes in HBC with crainial trauma…what it the first thing you do?!
Tx the shock 1st before anything else
You got seizures you give….
Phenobarbital
Tiny k9 PDA murmur is…
Femoral pulse is….
Can we cure PDA?
Continous H-murmur @ left heart base
Femoral pulse: bounding
we CAN cure PDA!!
Subaortic stenosis essentric or concentric
Concentric!! Pressure builds up
PDA essentric or concentric?
essential vol overload
Subaortic stenosis we treat with?
Atenolol
B-blocker to dec the myocardial demand
Subaortic stenosis (SAS) is at risk for what?
Endocarditis
Pumlmonic stenosis essentric or concentric
Concentric
Ventricular septal defect essentric or concentric?
Essentric
WAIT A SECOND!! Do you know what
Essentric mean?
Concentric means?
Essential: vol overload (assoc. w/ diastole)
Concentric: pressure overload (assoc. w/ systole)
If you stuggle remembering this think pressured to consent!
Cute young animal presents with REGURGITAION!! What is your first thought
Persistent Right aortic arch
-will have left curvature of trachea on rads and congenital megaesophagus
Innocent heart murmur..to send to a cardiologist or not to send you tell me?
Well its innocent…so there is your answer- do not send
- norm low grade systolic murmur L heart base
- monitor until 6 mos (if still there…then freak out)
What is the most common acquired in the cats?
Hypertrophic cardiomyopathy
Which acquired disease can be indicated by arteriosclerosis and possible sudden death
Hypertrophic cardiomyopathy
Which disease can BNP be used as a supplemental test
Hypertrophic cardiomyopathy (HCM) - high Dilated cardiomyopathy (DCM)
How do you differentiate restrictive cardiomyopathy and hypertrophic cardiomyopathy
Restrictive cardiomyopathy: diastolic dysfunction and NO wall hypertrophy
Hypertrophic cardiomyopathy: (cats): diastolic dysfunction an INC all thickness
Restrictive cardiomyopathy..what do you know
Focal, diffuse fibrosis
NORM ventricular wall
2nd most common cardiomyopathy
Dilated cardiomyopathy…what are the highlights
2nd most common in dogs A fib/ v-tach/ VPCs Sudden death due to vent arrhythmias LOW output HF BPN supplemental test NO CURE
Arrhymogenic right ventricular cardiomyopathy
Syncope/ exercise intolerance
VPCs from the right ventricle
SOTALOL
Animal presents with muffled heart sounds..what is your first thought?
Pericardial effusion: if tamponade present do a pericardiocentsis
NO FURSOIMIDE
Degenerative valve disease..signs and tax stage B1 Stage B2 Stage C Stage D
B1: NO signs & no rad/ echo evidence - just watch it
B2: NO signs, but significant valve regurge SEEN on rads & echo
(Tx: ACE inhibitor/ pimobendan)
C: past/ present clinical signs structural heart dz- depend acute/ chronic
D:HAS clinical signs, end stage- >12mg furosemide
Criteria for diagnosis L sided HF (3 things)
- Moderate or severe Left atrial enlargement
- Interstitial +/- alveolar infiltrates
- Enlargement of the cranial and or caudal pulmonary veins
Most common breed affected by ARVC (arrhymogenic right ventricular cardiomyopathy)?
BOXER
2 MOST COMMON CARDIAC TUMORS IN DOG?
Hemangiosarcoma
Idiopathic pericarditis
Hemangiosarcoma location
Right atrium/ auricle most common
what is one giant clue it is HCM
Arthrosclerosis
HCM..is it usually symptomatic or asymptomatic?
Asymptomatic….It hits like a bus you isn’t see coming
DCM can be caused by what in cats
…..need a hint think of Dr. Hammond
Taurine deficiency
Dog comes in and it is a boxer….(you should already know the answer)…but O provides extra info and tells you that the dog had syncope and exercise intolerance. You run PCR and find out the boxer has a gene mutation in STRIATIN…..okay what does it have
Arrhythmogenic right ventricular cardiomyopathy
ARVC
Alrighty so your Boxer with ARVC..you make a smart Dr move and decide to put a holter monitor on it.. there are 2 scenarios of doing this what are they
- . put it on to check for VPCs 24 hours (because VPCs could occur 1x in that time frame and you need to find them)
- . when you put the boxer on the DOC (sotalol) to monitor and assure the VPCs dec by 80%..so keep the holter on for 2-3 weeks
Welll… your boxer with ARVC…it died….so now you do a histo. What 3 things will you see?
Fatty infiltration
Myocyte vacuolization
Myocyte loss
Dog comes in with pericardial effusion…you just hired a fresh vet and they approached you to confirm furosemide is the best bet to help the cutie…what will you say to this baby dogtor?
NO no NO no NO no NO no
Are you nuts- DO NOT TX pericardial effusion with FUROSIMIDE
Better off to use crystalloid fluids, and do a pericardiocentsis
Dog comes in , presents with contralateral signs, behavior probs and bad menace response…what is your first thought
Cortex
Dog presents-ipsilateral with cr n issue, and you are sooooo smart you know it dec rass- where is the leasion
Brain stem
How in the world do you know the difference between
🧠 Contusion
🧠 Concussion
Contusion: there will be hemorrhage + edema in brain. More confusion, unconscious longer,
Concussion: nothing on physical, transient unconsciousness, confusion and ataxia
