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Cardiology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Mode of inheritance for HCM in cats?

A

autosomal dominant

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2
Q

Which protein is mutated in HCM?

A

Cardiac myosin binding protein C

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3
Q

2 cat breeds over-represented for HCM?

A

Maine coon

Ragdoll

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4
Q

HCM is a disease of _____ dysfunction

A

diastolic

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5
Q

Name 2 consequences of the altered Ca handling that occurs with HCM

A

1) Ca gets left in cytosol during diastole–>incomplete ventricular relaxation
2) myofibrils become more sensitive to Ca

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6
Q

The hallmark histopath finding for HCM?

A

Myofiber disarray

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7
Q

Is gross examination of a heart that has LV concentric hypertrophy sufficient for a diagnosis of HCM?

A

NO!!

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8
Q

Name 3 reasons murmurs can occur with HCM

A

1) SAM
2) septal hypertrophy leading to LVOT obstruction
3) RVOT obstruction

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9
Q

What arrhythmias are commonly seen with HCM?

A

Arrhythmias are uncommon with HCM!

BUT, VPCs are most common (supraventricular arrhythmias are more rare)

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10
Q

1/2 the cats that develop CHF with HCM get it because of what reason?

A

a precipitating event (i.e. they were sick and then given IV fluid therapy, or went under anesthesia)

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11
Q

As far as lung involvement, is edema or effusion more common in cats with HCM?

A

Edema

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12
Q

Most notable ECG finding for cats with HCM? And the cause?

A

Left axis deviation

Left anterior fasicular block

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13
Q

T/F: if an infiltrative disease causes left ventricular concentric hypertrophy, treatment of the primary disease will resolve the hypertrophy

A

TRUE

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14
Q

What is the primary indication for use of beta-blockers in treating HCM?

A

when there is a LVOT obstruction from SAM

increased filling time helps more blood enter and push valve away from the outflow tract

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15
Q

A contraindication for use of beta-blockers in HCM?

A

when the patient is in ACTIVE CHF… need to maintain CO and beta-blockers will slow HR too much

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16
Q

HCM tends to be more aggressive in?

A

Young, male purebred cats

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17
Q

A disease of diastolic dysfunction due to non-compliant ventricular walls

A

Restrictive cardiomyopathy (RCM)

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18
Q

As fibrosis in RCM progresses, what can develop?

A

can progress to systolic dysfunction

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19
Q

Which thoracic radiograph finding is most common in cats with RCM?

A

left or biatrial enlargement

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20
Q

On ECG, which arrhythmia is most common with RCM?

A

Atrial fibrillation

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21
Q

Concerning Tx of RCM:
1) which medications are indicated if systolic dysfunction is present?

2) if systolic dysfunction is present, which class of drugs may not be the best choice?

A

1) Pimobendan

2) beta-blockers

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22
Q

DCM is a disease of ____ dysfunction

A

systolic

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23
Q

Describe how Mitral/tricuspid regurgitation can occur with DCM

A

when the chambers dilate, they pull the leaflets apart (annular stretch), creating a gap

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24
Q

The most common physical exam finding for cats with DCM?

A

S3 gallop sound

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25
Q

Which two classes of drugs are indicated for use in treating DCM?

A

1) positive inotropes

2) anti-arrhythmias (but not beta-blockers!!)

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26
Q

Two actions of Pimobendan?

A

1) calcium sensitizer (allows less Ca to stimulate a stronger contraction)
2) PDE III inhibitor (vasodilation & increased Ca release and uptake)

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27
Q

T/F: if Taurine deficiency is the cause of DCM, supplementation may return systolic function to normal

A

True

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28
Q

The gold standard for diagnosing taurine-deficient myocardial failure?

A

Myocardial biopsy (but it’s not practical)

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29
Q

The cause of most cases of arterial thromboembolic disease?

A

severe cardiac disease (HCM, RCM, DCM)

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30
Q

Name the 3 components of Virchow’s triad

A

blood stasis
endothelial damage
hypercoaguable state

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31
Q

Which component of Virchow’s triad is most important in cat ATE?

A

Blood stasis

32
Q

What is the most important factor for determining severity and recovery with ATE disease?

A

constriction of collateral circulation

33
Q

Concerning anti-platelet drugs in cats:

1) which is a good sole agent?
2) which is not recommended in cats due to risk of hemorrhage?

A

1) Clopidogrel

2) Warfarin

34
Q

The difference between staging a patient as B1 vs. B2?

A

B1–no cardiomegaly

B2–cardiomegaly is present

35
Q

FIRST sign of R-CHF in:

1) dogs
2) cats

A

1) ascites (comes later in cats)

2) pleural effusion (comes later in dogs)

36
Q

Name the 3 affects of sympathetic stimulation on the heart/vasculature

A

1) stimulates contractility (beta)
2) increases HR (beta)
3) systemic vasoconstriction (alpha)

37
Q

Name the important effects of AT-II (5)

A

1) increases aldosterone (Na retention)
2) increases ADH (saves water)
3) increases thirst and Na cravings
4) activates sympathetic adrenergic system
5) fibrosis of heart and kidney

38
Q

4 classes of drugs commonly used in treatment of CHF?

A

Diuretics
ACE-I
Positive inotrope
Vasodilators

39
Q

How is efficacy of diuretics measured?

A

by seeing a 5-8% decrease in body weight (w/in 8-12hrs)

40
Q

Primary site of action for loop diuretics?

And what is their action?

A

Thick ascending loop of henle

Inhibition of Na/K/Cl co-transporter

41
Q

Which loop diuretic it the best choice for rapid diuresis?

A

Furosemide

42
Q

What is the outcome of long-term use of loop diuretics?

A

Tolerance

  • -decreased absorption
  • -hypertrophy of distal tubule cells (get better at saving Na)
43
Q

Site and mechanism of action for Thiazide diuretics?

A

early distal tubule

inhibition of Na/Cl co-transporter

44
Q

Thiazide diuretics are best reserved for what patients?

A

Those that are no longer responding to Furosemide (refractory CHF)

45
Q

Site and mechanism of action of K-sparing diuretics?

A

Late distal tubule & early collecting duct

Aldosterone antagonist (competitive inhibition)

46
Q

Which class of diuretics is weak on its own and should therefore always be used in combination?

A

K-sparing (spironolactone)

47
Q

2 impacts of RAAS activation on the myocardium?

A

1) induces apoptosis of healthy cardiomyocytes

2) induces cardiac fibrosis

48
Q

Give two advantages of Benazapril

A

1) not eliminated entirely in the kidneys (better choice if renal dysfunction is present)
2) can be give once a day (good for cats!!)

49
Q

Why are K-sparing diuretics useful in treating PLN?

A

cause dilation of the efferent renal arteriole (decreases GFR)

This is also why they have the potential to cause kidey damage

50
Q

What class of drug is Dobutamine?

A

Catecholamine

51
Q

What is the action of dobutamine and how does it change with dose?

A

increases cAMP & Ca levels

1) low dose: inotropy with little vascular effects
2) high dose: increases vascular resistance

52
Q

An L-type Ca channel blocker that causes arterial specific vasodilation

A

Amlodipine

53
Q

Which drug is able to cause dilation of both arteries and veins?

A

Nitroprusside

54
Q

Which vasodilator:
1) should be used cautiously in patients with liver dz?

2) can cause cyanide toxicity with prolonged use?
3) causes the most profound decreased in BP?

A

1) Amlodipine
2) Nitroprusside
3) Hydralazine

55
Q

Which drug increases venous capacitance to decrease preload?

A

Nitroglycerin

56
Q

Contraindication for vasodialtors in acute L-CHF?

A

outflow tract obstruction

57
Q

Increased pulmonary arterial pressure

A

pulmonary hypertension

58
Q

What is cor pulmonale

A

Right heart disease that develops secondary to pulmonary disease (usually PH)

59
Q

Gold standard for diagnosis of PH?

A

pulmonary catheterization

invasive and not practical

60
Q

Two goals of PH therapy?

A

1) treat underlying disease

2) prevent vasoconstriction and improve oxygen delivery

61
Q

Main drug used to treat PH and it’s MOA?

A

Sildenafil

PDE-V inhibitor (prevents cGMP breakdown so NO can stay around longer)–>improved vasodilation

62
Q

Main site of storage for Pro-BNP and pro-ANP peptides?

A

Atrial myocytes (as granules)

*pro-ANP&raquo_space; pro-BNP

63
Q

When cleaved, which end of the peptide is the active hormone?

A

C-terminal end

64
Q

How do natriuretics work?

A

promote Na (water) excretion by inhibiting tubular Na uptake in collecting ducts

65
Q

What stimulus causes the release of natriuretic peptides?

A

atrial stretch and volume overload stress

66
Q

Which natriuretic peptide is significantly upregulated with CHRONIC volume overload?

A

pre-pro-BNP

67
Q

Two methods for removal of natriuretic peptides?

A

1) bind to clearance receptors

2) Neutral endopeptidases

68
Q

What causes the release of cTnI?

A

cardiomyocte damage

69
Q

Two important sources of stem cells in the heart?

A

Pericardium

R atrium

70
Q

Two causes of increased pericardial pressure?

A

Severe pericardial effusion

Stiff pericardium (constrictive pericarditis)

71
Q

Two most common causes of pericardial effusion:

1) Dog
2) Cat (has 3)

A

1) Neoplasia & Idiopathic

2) Neoplasia (lymphoma), R-CHF, FIP

72
Q

4 tumors that can occur in the heart

A

1) hemangiosarcoma
2) heart base tumors
3) lymphoma
4) mesothelioma

73
Q

Name the most common location for each of the cardiac tumors

A

1) hemangiosarcoma–R auricle
2) heart base tumors–great vessels (aorta, pulmonary artery)
3) lymphoma–LV myocardium
4) mesothelioma–doesn’t form a mass

74
Q

3 ECG findings associated with cardiac tamponade

A

1) sinus tachycardia (100%)
2) Low QRS amplitude (100%)
3) Electrical alterans (alteration in R wave amplitude… 25%)

75
Q

From which side should you approach when performing pericardiocentesis?

A

RIGHT

might hit coronary artery if come from left

Cardiology (5 decks)

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