Exam 4 - Cardiovascular Diagnostics

Question 1

when is a home resting/sleeping respiration rate needed?

Answer 1

indicated daily to weekly in cats & dogs at risk for developing CHF in stages B2, C, & D

Question 2

how is a home resting/sleeping respiration rate taken?

Answer 2

taken when sleeping or resting quietly over 30 seconds - > 30/min is abnormal

Question 3

what are some important history findings supportive of cardiac disease?

Answer 3

poor perfusion - exercise intolerance & collapse/syncope

cardiac cachexia - inappetance/anorexia & weight loss/muscle loss

feline saddle thrombus - hind end paralysis & pain

Question 4

what 3 components should be used to characterize a murmur?

Answer 4

timing, PMI, & grade

Question 5

what is a grade 1-2 murmur?

Answer 5

soft-focal with no radiation - only audible at PMI & softer than the heart sounds

Question 6

what is a grade 3-4 murmur?

Answer 6

moderately loud with some radiation

grade 3 = equal to heart sounds
grade 4 = louder than other heart sounds

Question 7

what is a grade 5-6 murmur?

Answer 7

loud with radiation (bilateral) & palpable precordial thrill

Question 8

what acquired heart disease causes mitral regurgitation?

Answer 8

CVD & DCM

Question 9

what acquired heart disease causes tricuspid regurgitation?

Answer 9

CVD

Question 10

what are the rules of thumb regarding murmurs?

Answer 10

99% of murmurs are systolic in cats & dogs

PMI is useful in dogs & not cats

in general - murmur grade (loudness) doesn’t correlate with disease severity, except for VSD (louder the murmur = smaller defect) & CVD, SAS, PS (louder murmur with more severe disease)

Question 11

what makes up profiling in cardiac disease?

Answer 11

clinical utility of signalment history + physical exam

helps to know what heart disease to suspect & provides clues that heart disease or heart failure may be present

Question 12

T/F: the presence of the ‘right’ murmur in the ‘right’ dog is almost pathopneumonic for CVD, & the absence of a murmur rules it out with a high degree of certainty

Answer 12

true - auscultation is both sensitive & relatively specific as a screening test for CVD in dogs

Question 13

T/F: the detection of normal lung sounds in patients with historical or other exam findings suggestive of pulmonary pathology rules-out pathology

Answer 13

false - auscultation isn’t a sensitive test for this

Question 14

what is the limitations of radiographic heart size evaluation?

Answer 14

doesn’t tell you how thick the walls are or if systolic function is normal

doesn’t always tell you what specific chambers are enlarged

Question 15

T/F: cardiomegaly = CHF

Answer 15

false

Question 16

what are the limitations of radiographic heart size evaluation?

Answer 16

limited utility for identification of any form of cardiomyopathy in the dogs or cats

low priority screening because lots of false negatives - not sensitive

false positives are fewer - never ignore cardiomegaly

Question 17

what are the strengths of using radiographs for diagnosing left-sided chf?

Answer 17

routinely available, can be used to assess the response to therapy/confirm diagnosis of left-sided CHF, & current gold standard for diagnosis of left-sided CHF in combo with history & physical exam

Question 18

what are the limitations of using rads to diagnose left-sided CHF?

Answer 18

may not be possible in unstable patients, some findings are non-specific for left-sided CHF, not all animals have signs, & cats have a wide variety of findings associated with CHF

Question 19

what is the use for a spectral doppler using an echo?

Answer 19

measurement of speed of blood flow & estimation of pressure gradients between chambers

Question 20

what is the use for a color doppler using an echo?

Answer 20

identification of turbulent blood flow & semi-quantification of valvular insufficiencies

Question 21

what objective data can be gained from an echo?

Answer 21

left ventricle & left atrial size & left ventricular systolic function

Question 22

when is fluoroscopy of the thorax indicated?

Answer 22

cough suspected to be secondary to the left mainstem bronchial compression or tracheal collapse

Question 23

when is an ecg used?

Answer 23

diagnosing arrhythmias - best in cases where the arrhythmia is persistent and/or audible

Question 24

T/F: a 6-lead right lateral trace ecg provides some information on chamber enlargement

Answer 24

true

Question 25

what are some indications for a holter monitor?

Answer 25

breed screening for arrhythmias associated with breed specific cardiomyopathies, arrhythmia suspected based on history/clinical signs, better characterization of a known arrhythmia to guide treatment recommendations, & evaluation of response to antiarrhythmic treatment

Question 26

what are some indications for evaluation of systemic blood pressure in cardiac patients?

Answer 26

rule out systemic hypertension in patients with known or suspected heart disease

rule out systemic hypotension in patients suspected to have poor perfusion secondary to heart disease or heart failure

Question 27

what is an injury cardiac biomarker? when is it released?

Answer 27

troponin 1 - released from cardiac myocytes following cell death

Question 28

what is an stretch cardiac biomarker? when is it released?

Answer 28

NTproBNP/BNP - produced & secreted mostly from the left ventricle in response to wall stretch & wall stress

Question 29

when would you test for NTproBNP in a cat?

Answer 29

assess risk in an apparently healthy/asymptomatic cat with a murmur, gallop, or arrhythmia that has clinically important heart disease & needs an echo

help support diagnosis of CHF

Question 30

when would you test for NTproBNP in a dog?

Answer 30

help support a diagnosis of left-sided heart failure in a dog with respiratory signs

pre-screening test for pre-clinical DCM in dobermans when a echo is declined

assess the risk that a dog with pre-clinical CVD & heart enlargement will develop left-sided CHF in the next 6-8 months versus 27 months

Question 31

when would you run blood lactate & venous oxygen in a patient with cardiac disease?

Answer 31

indicated if poor perfusion (decreased cardiac output) is suspected

increased lactate supports ddx of poor perfusion
decreased venous O2 < 25mmHg

tests are specific but not sensitive for poor perfusion & can change rapidly

Question 32

when would you test a patient with cardiac disease for chagas, tick titers, & troponin 1?

Answer 32

indicated when myocarditis is suspected in the dog

Question 33

what diagnostic test is indicated if you have an asymptomatic/preclinical (stage B) DCM?

Answer 33

echo!!!!

Question 34

when is echo the best diagnostic test for cardiac disease?

Answer 34

patients with asymptomatic congenital heart disease, asymptomatic cat heart disease, rule out structural heart disease, & suspected pulmonary hypertension

Question 35

when is an ecg the best diagnostic test for cardiac disease?

Answer 35

suspected arrhythmia

Question 36

when are rads the best diagnostic test for cardiac disease?

Answer 36

clinical DCM (stage C), asymptomatic CVD (stage B), clinical CVD-CHF, cough, respiratory problems, suspected cardiogenic pulmonary edema