Exam 4 - Cardiovascular Diagnostics Flashcards
when is a home resting/sleeping respiration rate needed?
indicated daily to weekly in cats & dogs at risk for developing CHF in stages B2, C, & D
how is a home resting/sleeping respiration rate taken?
taken when sleeping or resting quietly over 30 seconds - > 30/min is abnormal
what are some important history findings supportive of cardiac disease?
poor perfusion - exercise intolerance & collapse/syncope
cardiac cachexia - inappetance/anorexia & weight loss/muscle loss
feline saddle thrombus - hind end paralysis & pain
what 3 components should be used to characterize a murmur?
timing, PMI, & grade
what is a grade 1-2 murmur?
soft-focal with no radiation - only audible at PMI & softer than the heart sounds
what is a grade 3-4 murmur?
moderately loud with some radiation
grade 3 = equal to heart sounds
grade 4 = louder than other heart sounds
what is a grade 5-6 murmur?
loud with radiation (bilateral) & palpable precordial thrill
what acquired heart disease causes mitral regurgitation?
CVD & DCM
what acquired heart disease causes tricuspid regurgitation?
CVD
what are the rules of thumb regarding murmurs?
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)
what makes up profiling in cardiac disease?
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
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
true - auscultation is both sensitive & relatively specific as a screening test for CVD in dogs
T/F: the detection of normal lung sounds in patients with historical or other exam findings suggestive of pulmonary pathology rules-out pathology
false - auscultation isn’t a sensitive test for this
what is the limitations of radiographic heart size evaluation?
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
T/F: cardiomegaly = CHF
false
what are the limitations of radiographic heart size evaluation?
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
what are the strengths of using radiographs for diagnosing left-sided chf?
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
what are the limitations of using rads to diagnose left-sided CHF?
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
what is the use for a spectral doppler using an echo?
measurement of speed of blood flow & estimation of pressure gradients between chambers
what is the use for a color doppler using an echo?
identification of turbulent blood flow & semi-quantification of valvular insufficiencies
what objective data can be gained from an echo?
left ventricle & left atrial size & left ventricular systolic function
when is fluoroscopy of the thorax indicated?
cough suspected to be secondary to the left mainstem bronchial compression or tracheal collapse
when is an ecg used?
diagnosing arrhythmias - best in cases where the arrhythmia is persistent and/or audible
T/F: a 6-lead right lateral trace ecg provides some information on chamber enlargement
true
what are some indications for a holter monitor?
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
what are some indications for evaluation of systemic blood pressure in cardiac patients?
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
what is an injury cardiac biomarker? when is it released?
troponin 1 - released from cardiac myocytes following cell death
what is an stretch cardiac biomarker? when is it released?
NTproBNP/BNP - produced & secreted mostly from the left ventricle in response to wall stretch & wall stress
when would you test for NTproBNP in a cat?
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
when would you test for NTproBNP in a dog?
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
when would you run blood lactate & venous oxygen in a patient with cardiac disease?
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
when would you test a patient with cardiac disease for chagas, tick titers, & troponin 1?
indicated when myocarditis is suspected in the dog
what diagnostic test is indicated if you have an asymptomatic/preclinical (stage B) DCM?
echo!!!!
when is echo the best diagnostic test for cardiac disease?
patients with asymptomatic congenital heart disease, asymptomatic cat heart disease, rule out structural heart disease, & suspected pulmonary hypertension
when is an ecg the best diagnostic test for cardiac disease?
suspected arrhythmia
when are rads the best diagnostic test for cardiac disease?
clinical DCM (stage C), asymptomatic CVD (stage B), clinical CVD-CHF, cough, respiratory problems, suspected cardiogenic pulmonary edema
