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CAEM Pt. 2 > Heart Disease/Failure, Congenital Dz > Flashcards

Heart Disease/Failure, Congenital Dz Flashcards

1
Q

Four components that make up stroke volume (SV)

A

1) Systolic function = contractility
2) Diastolic function = how well and how fully the heart relaxes
3) Preload = how much blood is in the heart before it contracts (atrial P, end of diastole)
4) Afterload = resistance to blood leaving the heart (systemic vascular R)

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2
Q

Difference between heart disease and failure

A

> Failure = physical/functional cardiac abnormality
Disease = physical state where CO is inadequate to meet the needs of the organ system metabolism, despite adequate preload (not due to dehydration or hypovolemia)
*Disease = showing clinical signs

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3
Q

True or false - atrial pressure rises with inadequate systolic and diastolic funciton

A

TRUE

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4
Q

What does the S1 heart sound indicate?

A

Blood suddenly stopping at closed AV valves - SYSTOLE

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5
Q

What does the S2 heart sound indicate?

A

Blood suddenly stopping at closed aortic and pulmonic valves - DIASTOLE

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6
Q

What does the S3 heart sound indicate?

A

Sudden end of rapid ventricular filling - DIASTOLE

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7
Q

What does the S4 heart sound indicate?

A

Blood suddenly stopping as the atria contract, forcing blood into the ventricles - DIASTOLE

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8
Q

What does pulse deficits indicate?

A

> Auscultating a heart beat without palpating a peripheral pulse

  • Inadequate filling time = didn’t have enough force to create a pulse
  • Arrhythmia (irregular rhythm) + pulse deficits = most likely pathologic
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9
Q

What does a gallop rhythm indicate?

A

> Summated sound of S3 and S4

*Indicates STIFF VENTRICLES

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10
Q

What three things must you determine with heart murmurs?

A

1) Location
2) Timing - systole, diastole, continuous, sys-diastole
3) Grade (loudness)

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11
Q

What are two main categories of clinical signs that accompany heart disease?

A

1) Low cardiac output signs = decreased forward flow

2) Congestive signs = increased backward pressure

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12
Q

Clinical signs of low cardiac output

A

> Decreased forward flow
*Same signs, no matter which ventricle is at fault
+ Prolonged CRT
+ Weak femoral pulses, distal pulses may not be palpable
+ Cool peripheral limbs, decreased core temp
+ Cyanosis = low CO or R-to-L shunt

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13
Q

What does congestive signs indicate?

A

> > Atrial pressures are elevated due to poor ventricular function

  • Increased pulmonary vasculature pressure due to back up in L. atrium
  • Fluid leaks into lung tissue = pulmonary edema
  • Fluid leaks into body cavities (R. atrium)
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14
Q

Clinical signs of congestive right sided failure

A 
> Increased backward pressure
\+ Jugular distension
\+ Hepatomegaly
\+ Ascites
\+/- Peripheral edema
\+/- Arrhythmias
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15
Q

What does jugular distension indicate?

A

Right sided heart failure - increased right atrial pressures

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16
Q

Clinical signs of congestive left sided failure

A 
> Increased backward pressure
\+ Pulmonary venous congestion (radiographic dx)
\+ Pulmonary edema
\+ Signs of decreased output
\+/- Arrhythmias
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17
Q

Definition and criteria for innocent puppy cardiac murmurs

A
  • Soft = no louder than grade III
  • Systolic murmurs
  • Uncertain etiology
  • Puppies that are 12-16 weeks
  • PMI = left base
  • *NOT associated with clinical signs
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18
Q

Differential diagnoses for left basilar systolic murmurs (5)

A
  • Aortic or subaortic stenosis
  • Pulmonic stenosis
  • VSD - relative
  • Atrial SD - relative
  • Physiologic = anemia, pyrexia
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19
Q

Big three diagnostic tests in cardiology

A 
(PE and history)
1) ECG - electrical info
2) Radiographs = external cardiac abnormalities, vasculature, lungs
3) Echo - internal cardiac abnormalities
\+/- Angiography
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20
Q

Differential diagnoses for right MEA shift

A

1) Right ventricular enlargement/hypertrophy

2) Conduction disease = right bundle branch block (normal P wave)

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21
Q

Differential diagnoses for left MEA shift

A

1) Left ventricular hypertrophy/enlargement

2) Conduction disease = left bundle branch block (normal P wave)

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22
Q

How do you differentiate between bundle branch blocks and hypertrophy patterns on ECG?

A
  • Enlargement = narrow and upright QRS, normal

- Conduction disease = wide QRS = takes longer to conduct

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23
Q

ECG findings with pulmonic stenosis

A

Right MEA shift = due to right ventricular hypertrophy

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24
Q

Radiographic findings with pulmonic stenosis (2)

A

1a) Right ventricular enlargement (VD)
1b) Wide heart with apical elevation (lateral)
2) Main pulmonary artery bulge (1 o’clock)

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25
Q

Echo findings with pulmonic stenosis (5)

A
  • Right ventricular hypertrophy
  • Right atrial enlargement
  • Thick leaflets and incomplete opening of pulmonic valve
  • Distal (to the stenosis) dilation of the pulmonary artery
  • Small left heart
  • Fractional shortening = 29% = measure of contractility
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26
Q

Breed/sized dogs at risk for pulmonic stenosis

A
  • Small breed dogs = maltese, beagle, boxer, chihuahua, etc.

- Larger brachycephalic breeds = english bulldog, etc.

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27
Q

Reason for right ventricularhypertrophy and atrial dilation with pulmonic stenosis

A

> Hypertrophy = need to overcome the pressure of the stenotic pulmonary valve
Dilation = increased volume of blood from fluid back-up, ventricle doesn’t empty completely

28
Q

Source of the right basilar murmur with pulmonic stenosis

A

Stretching of the tricuspid valve due to increased pressure of the right ventricle - hearing the regurgitation

29
Q

Possible complications of right ventricular hypertrophy (2)

A
  • Ischemia from coronary artery trying to perfuse the thick and stiff ventricular wall
  • Fibrotic endocardium can lead to decreased elasticity and hypoxia can cause arrhythmias
30
Q

Clinical signs of pulmonic stenosis heart failure

A

+ Ascites
+ Jugular distension
+ Pleural effusions
+ Hepatomegaly

31
Q

Heart murmur heard with aortic stenosis

A

Left basilar systolic murmur

32
Q

Breeds/sized dogs associated with aortic stenosis

A

Large breed dogs, Ex: boxer, bull terrier, german shepherd, golden retrievers, etc.

33
Q

Which chamber(s) would be thickened with aortic stenosis?

A

Left ventricle

34
Q

Which chamber(s) would be dilated with aortic stenosis?

A
  • Left atria

- Post stenotic dilation after the aortic valve

35
Q

What secondary problems do you see with aortic stenosis? (2)

A
  • Fibrosis of the left ventricle = decreased elasticity, hypoxia and risk of arrhythmias
  • Severe stenosis can lead to sudden death
36
Q

Which clinical signs of heart failure do you expect to see with aortic stenosis?

A

+ Pulmonary edema = crackles
+ Coughing
+ Dyspnea
+ Shortness of breath or exercise intolerance

37
Q

Therapy and treatment for pulmonic stenosis (3)

A
  • Nothing with mild to moderate lesions
  • Medical therapy
  • Balloon valvuloplasty
  • Surgical palliation = stretch valve or pericardial patch graft
38
Q

Medical therapy used to treat pulmonic and aortic stenosis

A
  • CHF meds = furosemide, pimobendan, ACE inhibitor
  • Anti-arrhythmics
  • Beta blockers
39
Q

Therapy and treatment for aortic stenosis

A
  • No therapy with mild to moderate cases
  • Medical therapy
  • Balloon valvuloplasty - more difficult to stretch than pulmonic, chance of recurrence
  • Surgical removal of obstruction
40
Q

How do beta blockers help treat pulmonic and aortic stenosis?

A

> Slow the HR enough to allow for the ventricles to fill between heart beats
Increase coronary perfusion during diastole

41
Q

Do we commonly use vasodilators for treatment of pulmonic and aortic stenosis?

A

NO - animal has no way of compensating the drop in BP with vasodilation, with an increase in CO or HR (with a outflow obstruction)

42
Q

Which condition are arrhythmias more common in - pulmonic or aortic stenosis?

A

Aortic stenosis - reason is unknown

43
Q

Which condition do we more commonly see endocarditis with - pulmonic or aortic stenosis?

A

Aortic stenosis

44
Q

PE findings consistent with a PDA

A
  • Continuous murmur at the left heart base
  • Systolic murmur
  • Bounding pulses = feel stronger than normal
  • Exercise intolerance
    +/- Left apical murmur
45
Q

What does bounding pulses indicate? Esp with PDA’s

A

Wide pulse pressure = large difference between systolic (higher than normal in descending) and diastolic (less than normal in the main pulmonary artery) pressures

46
Q

Pathology and blood flow abnormalities of PDA’s

A

> Blood is diverted from the main pulmonary artery to the descending aorta

  • Continuous murmur = due to blood flowing during systole and diastole
  • Left sided overload = blood coming from the left atrium is from the lungs AND the pulmonary artery
  • High aortic pressure compared to the pulmonary artery, in systole and diastole
47
Q

ECG abnormalities with PDA’s (4)

A

> Premature (ectoptic) beats = tall and narrow = supraventricular, due to atrial stretching

  • Normal sinus rhythm + tachycardia
  • Wide P waves = atrial enlargement
  • Tall R waves = LV enlargement pattern
48
Q

Radiographic findings with PDA’s (4)

A
  • Left ventricular enlargement
  • Left atrial dilation
  • Pulmonary overcirculation = pulmonary vein and artery enlargement
  • “Ductus” bump = bulge in descending aorta
49
Q

Three main disorders that lead to volume overload

A

1) Shunts = PDA, VSD, ASD
2) AV valve dysplasia (mitral or stenosis)
3) Semilunar valve malformations = aortic or pulmonic insufficiency (rare)

50
Q

Which side of the heart fails with PDA’s?

A

Left side = has to deal with the extra volume from the lungs and the pulmonary artery

51
Q

PE findings with VSD’s

A
  • Right SYSTOLIC murmur at the sternum
  • RELATIVE left basilar systolic murmur (suspect pulmonic valve)
    + Signs of left sided CHF
52
Q

Which side fails, normally, with VSD’s?

A
  • Left side needs to pump to the aorta + right side (lower pressure)
  • Both sides squeeze at the same time = blood goes out the pulmonary artery (right side doesn’t enlarge)
    **Pulmonary artery sees the blood from the right side AND some from the left side, dumps it on the left side
    » LEFT SIDE FAILS
53
Q

Radiographic findings of VSD

A
  • Left ventricular enlargement and left atrial dilation
  • Variable right sided enlargement
    + Pulmonary edema, consistent with L. CHF
  • Pulmonary overcirculation
54
Q

ECG abnormalities with VSD’s

A

*Often normal

+/- Left sided heart enlargements = left MEA shift, tall R waves

55
Q

Why do we hear both a systolic R sternal murmur and a left basilar systolic murmur with VSD’s?

A
  • Systolic sternal right sided = VSD mumur
  • RELATIVE left basilar murmur, suspect the pulmonic valve because more blood is going through the valve (valve is normal)
56
Q

Which side fails with ASD’s?

A

> RIGHT SIDE

- Blood from the left side is shunted to the right side = volume overload

57
Q

What heart murmurs do we hear with atrial septal defects?

A

*DON’T hear basilar murmur because the pressure differences between the atria is minimal
- Left systolic basilar murmur = relative pulmonic murmur due to volume overload
+/- Tricuspid valve regurg murmur

58
Q

Radiographic signs of ASD’s

A
  • Right sided enlargement
  • Right CHF = hepatomegaly, pleural effusion
  • Pulmonary overcirculation
59
Q

ECG abnormalities of ASD’s

A

+/- Right axis shift due to enlargement
- Tall P waves = atrial dilation
- Sinus tachycardia
+/- Other arrhythmias

60
Q

Treatment for PDA’s

A
  • Surgical ligation from the outside (open chest)
  • Intravascular coil or Amplatz occluder from the inside (via the femoral a.)
  • Medical therapy (like in humans) doesn’t work = lining of the ductus isn’t normal that PGF’s will work to close it
61
Q

Cause of reversed PDA

A

> Right to left shunting

  • Intima thickening and medial hypertrophy in pulmonary artery due to excessive flow = increased vascular resistance
  • Pulmonary artery P exceeds aortic P = shunt occurs
62
Q

Clinical signs of reversed PDA

A
  • Front end (mucous membrane) = pink
  • Hind end = blue MM
  • Right ventricular hypertrophy
  • Rear limb weakness with exercise
  • Long standing cases have cyanosis
  • Clin path = polycythemia due to chronic hypoxia

> > Due to oxygenated blood goes to the brain, unoxygenated blood goes to the limbs

63
Q

Most common congenital disease in cats (2)

A

1) Mitral valve dysplasia
2) VSD’s
* Stenoses are not common

64
Q

Four components of tetralogy of Fallot

A

1) Pulmonic stenosis
2) Right ventricular hypertrophy
3) Overriding aorta
4) VSD

65
Q

What decides which direction the blood flows through a VSD with tetralogy of Fallot? Presence of cyanosis?

A

> > Degree of pulmonic stenosis

  • Severe pulmonary stenosis = R-to-L shunting = CYANOSIS
  • Mild stenosis = L-to-R shunting = behaves like a VSD (no stenosis)

CAEM Pt. 2 (27 decks)

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