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Small Animal Cardiology > General Principles > Flashcards

General Principles Flashcards

1
Q

What does cardiac coughing occur?

A

At night - compression of the corina

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2
Q

When does respiratory coughing occur?

A

During exercise / excitement

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3
Q

What do you want to ask about in a cardiac specific history?

A 
Coughs
Dysnpnoea
Tachypnoea
Exercise tolerance 
Syncope
Mm colour
Resting respiratory rate
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4
Q

What is the normal respiratory rate for a dog?

A

20-30

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5
Q

How should you categories dysponea?

A

Inspiratory / expiratory
Restrictive - LRT
Or obstructive - URT

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6
Q

What should you check on a cardiac exam?

A

CO
Pulse quality, mm colour, CRT, warmth of extremities

Assess for signs of heart failure 
Forward:
- reduced pulses 
- slow CRT and pale mm
- cold extremities

Left sided congestive:

  • pulmonary crackles
  • cough
  • restrictive inspiratory and expiratory breathing pattern

Right sided congestive:

  • positive hepatojugular reflex
  • ascites
  • subcut oedema and muscle wastage
  • hepatomegaly
Cardiac auscultation 
Respiratory auscultation 
Palpate the larynx and trachea 
Thoracic percussion 
Thoracic compressibility - more useful in cats
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7
Q

What are eye clinical signs of forward heart failure?

A 
= signs of poor cardiac output
Lethargy and exercise intolerance 
Weak femoral pulse
Unable to detect distal pulses
Pale MM and slow CRT
Cold extremities 
Hypothermia
Cardiogenic shock
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8
Q

How should you treat forward heart failure?

A

DO NOT GIVE FLUIDS

Give positive inotropes

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9
Q

What are the signs of right sided congestive heart failure?

A 
Ascites 
Distended jugular veins
Positive hepatojugular reflex 
Pleural effusion 
Subcutaneous oedema 
Muscle wasting
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10
Q

What are the signs of left sided congestive heart failure?

A

Tachypnoea
Inspiratory and expiratory restrictive breathing pattern
Cough due to left atrial enlargement
Soft respiratory crackles on auscultation

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11
Q

What is the normal heart rate in dogs?

A

70-160

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12
Q

What is the normal heart rate in cats?

A

160-240

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13
Q

How should you describe a heart murmur?

A

PMI - left or right, base or apex
Timing - systolic, diastolic, continuous
Character - plateau, descrescendo, crescendo descrescendo, brief mid systolic, blowing
Radiation
Grade - I - VI

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14
Q

How do you grade heart murmurs?

A

I - very quiet murmur
II - murmur quieter than the heart sounds
III - murmur as loud as the hear sounds
IV - murmur louder than the heart sounds
V - louder the heart sounds and you can palpate precordial thrill
VI - louder than the heart sounds, precordial thrill, can heart murmur with the stethoscope lifted off the chest wall slightly

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15
Q

What is a diastolic gallop?

A

S3 and S4 heart sounds that are not normally audible in small animals

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16
Q

How can you auscultate diastolic gallops?

A

Using the bell of the stethoscope

Applying very little pressure over the left apex

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17
Q

What are normal lung sounds called?

A

Bronchovesicular lung sounds - harsher when there is an increased respiratory rate

18
Q

Describe some adventitious lung sounds.

A

= abnormal lung sounds

Crackles - inspiratory - smaller airways opening
Wheezes - expiratory - due to narrowed airways - pulmonary fibrosis

19
Q

What does dull thoracic percussion suggest?

A

Pleural effusion

20
Q

What does resonance on thoracic percussion suggest?

A

Pneumothorax

21
Q

What can reduced thoracic compressibility in a cat mean?

A

Cranial mediastinal mass

22
Q

What is preload?

A

Venous return to the heart

Determines the end diastolic stretch on the atrial cardiomyocytes before contraction

23
Q

What is afterload?

A

The resistance to ventricular ejection during systole

24
Q

What are the major consequences of congestive heart failure?

A 
Oedema and effusions
Peripheral vasoconstriction 
Tachycardia
Arrhythmias
Remodelling
Fibrosis of the myocardium
25
Q

What are the pathophysiological events that occur in response to a reduced CO in heart failure?

A

Vasoconstriction
Increased heart rate
Myocardial remodelling and fibrosis via RAAs
Na+ and water retention via aldosterone - oedema and effusion

26
Q

What adrenoreceptor as are involved in the baro-reflex?

A

Beta 1 adrenoreceptors

27
Q

What cardiac decompensation does increasing the heart rate via the baroreflex cause?

A

Increases myocardial oxygen consumption

Reduces coronary perfusion

28
Q

What cardiac decompensation does vasconstriction via the baroreflex cause?

A

Increases blood pressure

29
Q

What does sympathetic stimulation of the beta 2 adrenoreceptors in the kidney cause?

A

Renin secretion

30
Q

What is the effect of angiotensin II on the body

A 
Potent vasoconstrictor 
Myocardial hypertrophy and fibrosis 
Causes ADH release
Increases GFR 
Increases sympathetic activity
Stimulates aldosterone release

= attempts to increase preload by increasing venous return

31
Q

What substances in the body naturally counter-act the RAAs system?

A

Atrial natriuretic peptide - released following atrial stretch
Brain natriuretic peptide - released following ventricular stretch

  • antagonise the RAAs - vasodilation, cause diuresis and sodium excretion
32
Q

What clinical pathology tests are available for heart failure?

A

Pro-BNP - longer half life than normal BNP - can be assayed

Endothelin - possibly a future assay

33
Q

What are the major pathological consequences of congestive heart failure?

A

Oedema and effusions
Peripheral vasconstriction
Tachycardia / arrhythmias
Remodelling and fibrosis of the myocardium

34
Q

What are the mediators of vasoconstriction?

A

Noradrenaline
Angiotensin II
Reduced bradykinin levels vasopressin
Endothelin

35
Q

What mediators stimulate cardiac remodelling?

A

Angiotensin II
Aldosterone
Endothelin
Catecholamines

36
Q

What kind of hypertrophy does volume overload cause?

A

Eccentric hypertrophy = chamber dilation

37
Q

What kind of hypertrophy does pressure overload cause?

A

Concentric hypertrophy - wall thickened

38
Q

What cardiac diseases cause eccentric hypertrophy?

A 
Mitral valve regurgitation 
Ventricular septal defects 
Patent ductus arteriosus 
Tricuspid regurgitation 
Anaemia 
Exercise
39
Q

What cardiac disease cause concentric hypertrophy?

A 
Aortic stenosis
Systemic hypertension
Pulmonic stenosis
Pulmonary hypertension 
Exercise
40
Q

Define maladaptive remodelling.

A

Changes in relative wall thickness + altered geometry of the heart chamber

41
Q

Why do tachycardia and arrhythmias occur during heart failure?

A

Elevated catecholamine levels
Increased sympathetic drive
Reduced vagal tone
Myocardial fibrosis and ischaemia due to remodelling

Small Animal Cardiology (9 decks)

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