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A - Medicine Cardiovascular > Lec 1 - 3 > Flashcards

Lec 1 - 3 Flashcards

1
Q

Define heart disease

A

The presence of any harmful or potentially harmful cardiac finding outside of normal limits

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2
Q

Define heart failure

A

Heart disease that is severe enough to overwhelm compensatory mechanisms of the cardiovascular disease

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3
Q

What does DAMNIT-V stand for?

A 
Degenerative, developmental
Autoimmmune, allergic, anomalous 
Metabolic
Neoplastic, nutritional 
Inflammatory, infectious, immune-mediated, iatrogenic, idiopathic
Toxic, traumatic 
Vascular
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4
Q

What is an innocent murmur?

A

Haemic or physiological murmur

Doesn’t indicate that anything is wrong

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5
Q

What is the most common cardiac disease?

A

Chronic valvular heart disease for small to medium dogs

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6
Q

What form of canine cardiomyopathy is the most common?

A

Dilated from and usually affects large and giant breeds

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7
Q

What type of chronic valvular disease is the most common in dogs?

A

Mitral 62%

Mitral and tricuspid 32.5%

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8
Q

What are 3 common synonyms for chronic valvular heart disease?

A

Mitral/tricuspid endocardiosis
Myxomatous AV valve disease
Progressive myxomatous degeneration of the heart valves

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9
Q

In valvular endocardiosis, what can also rupture?

A

The chordae tendinae

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10
Q

What are some of the aetiologies of chronic valvular heart disease in dogs?

A

Dyscollagenosis (genetic degeneration of collagen)
Response to injury lesions
Inherited predisposition (polygenic inheritance)
Uncertain

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11
Q

Describe the pathophysiology of chronic valvular heart disease in dogs?

A

Nodular valvular lesions grow
Eventually get leakage/ insufficiency/ regurgitation of blood
From the ventricle to the atrium
Start hearing a murmur
Progresses over years
Extra volume of blood regurgitating into the atrium (LS vol. overload)
Heart beats harder
Atrial walls stretch and remodel
Keeps worsening over time
Volume overload leads to ventricular dilation and eccentric hypertrophy
RAAS kicks in
Eventually atrium and veins can’t remodel/ compensate enough
Pulmonary lymphatic drainage increases
Eventually this can’t keep up and oedema develops
Venous pressure rise
Develops into congestive heart failure

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12
Q

Is a dog with a mitral murmur always in heart failure?

A

No.

However it will progress over many years and eventually it will lead to failure

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13
Q

Can you judge a murmur’s severity by loudness?

A

No.

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14
Q

In chronic valvular heart disease the heart muscle is damaged and enlarged and makes what other cardiac condition more likely?

A

Spontaneous depolarisation

  • Rhythm disturbances
  • Supraventricular more likely than ventricular
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15
Q

What are 2 clinical exam findings that you can find in a dog with right sided congestive heart failure, apart from listening to heart?

A

Excessive jugular pulse which will rise over 1/3 up the neck - especially if you press on the cranial abdomen
Ascites
(Also the liver enlarges so that may be palpated if lucky)

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16
Q

What will cause chronic passive congestion of the liver?

A

Mitral and tricuspid valve failure

Right sided heart failure

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17
Q

What type of chronic valvular heart disease is most likely to cause pleural effusion in dogs?

A

Biventricular failure

Although usually will only see pulmonary oedema

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18
Q

How can mitral regurgitation and development of left heart failure predispose to right heart failure? (especially if there is the beginning of lesions on the tricuspid valve)

A

Backup of blood in lungs since LS not pumping properly
Get increased pressure in lungs
Harder for the right side to pump against this

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19
Q

What is the consequence of a ruptured chordae tendinae?

A

Sudden onset of pulmonary oedema
Pale
Collapsed

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20
Q

What is the consequence of an atrial tear of the septum?

A

Blood goes from the left to right side of the heart
Goes into RSHF suddenly
Ascites

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21
Q

What is the consequence of sudden tachyarrhythmia (usually supraventricular)

A

Faint

Die

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22
Q

What do clinical features seen in a dog with chronical valvular heart disease depend on?

A

The stage at which the animal is presented

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23
Q

What are some common findings during a clinical exam of a dog with chronic valvular hear disease?

A 
Murmur - New or worsening
Cough at night, early morning, at exercise
Exercise intolerance
Weakness
Syncope
Dyspnoae, tachypnoea, orthopnoea 
Sudden death
24
Q

What specific things should you look at/do in a physical examination of an animal with suspected heart disease?

A 
Capillary refill time
Mucous membrane colour and temperature
Heart and lung sounds
Presence of an apical beat/thrill
Heart rate and rhythm
Arterial pulse character and rhythm (femoral artery)
Jugular pulse and distension
25
Q

What heart rates are classified as bradycardia in a -medium, large and small dog, and cats?

A 
Heart rate under - 
Medium dog - 70
Large dog - 60
Small dog - 90
Cat - 120
26
Q

What heart rates are classified as tachycardia in a -small dog, and cats?

A

Heart rate over -
Small dog - 160
Cat - 220 (unless very stressed)

27
Q

What causes the first heart sound?

A

Closure of the AV valves

-mitral and tricuspid

28
Q

What causes the second heart sound?

A

Closure of the aortic and pulmonic valves

29
Q

Where is the first heart sound the loudest?

A

Over the heart apex

tip

30
Q

Where is the second heart sound the loudest?

A

Over the heart base

top

31
Q

What causes a ‘split’ heart sound?

A

When the pairs of valves don’t close at exactly the same time

32
Q

What is the cause of a murmur?

A

Turbulent blood flow within the heart

33
Q

How should you describe a murmur? (4 things)

A

Loudness/grade (out of 5/6)
When during the cardiac cycle
Where it can be heart
Quality - musical, frequency, blowing etc.

34
Q

When during the cardiac cycle are you most commonly going to hear a murmur?

A

Systolic contraction

35
Q

What are 4 causes of syncope?

A

Bradyarrhythmia
Tachyarrhythmia (heart doesn’t fill properly)
Long bout of coughing (prevents venous return)
Severe left mainstem bronchus collapse

36
Q

What are 5 differential diagnoses for chronic valvular heart disease in dogs?

A 
Primary respiratory disease
Cardiomyopathy
Infective endocarditis
Sick sinus syndrome
Late-presenting congenital disease
37
Q

How do you make a diagnosis of chronic valvular heart disease in a dog?

A 
Systolic murmur in small to medium dog (esp. mitral)
\+/- cough
Exercise intolerance
Weakness, syncope
Dyspnoea, tachypnoea
Lung crackles
Ascites etc. 
Radiography looking for cardiomegaly 
\+/- Echocardiography, ECG (not essential for common CVHD)
38
Q

What should you offer the client to perform if you find a murmur in a happy, healthy dog?

A

Baseline thoracic radiographs
Arterial blood pressure measurement
Baseline basic blood work and urine analysis (PCV, TPP, creatinine)
-If all normal then re-examine in 6-12 months and keep an eye on it

39
Q

What are the treatment principles for canine chronic valvular heart disease?

A

Control signs of CHF
Limit the excessive neurohormonal activation that contributes to disease progression
Try to decrease LV size
Promote forward flow of blood
Halt progession of valvlular degeneration (not yet possible)

40
Q

How should you treat a dog with chronic valvular heart disease that has no other clinical signs?

A

Client education
Routine health maintenance
Monitoring
Avoid high salt foods

41
Q

How should you treat a dog with chronic valvular heart disease that is showing mild to moderate heart failure?

A 
As a dog with no clinical signs PLUS
Exercise restriction until under control
ACEI - vasodilator, apposes RAAS)
And/or Pimobendan - inodilator 
Frusemide - enough to improve breathing (NOT on its own)
Moderate dietary salt restriction 
\+/- Digoxin for tachyarrhythmias
If frusemide stops working - Spironolactone
42
Q

One week after starting or increasing the dose of an ACEI, what must you do?

A

Check that the drug has not raised serum creatinine substantially
Also measure Na/K

43
Q

How should you treat a dog with chronic valvular heart disease with a severe, acute presentation?

A 
Supplemental 02
Cage rest
Close monitoring
Drain large effusion
I/V Frusemide 
Oral pimobendan
\+/- Oral ACEI
Nitroglycerine ointment and nitroprusside infusion (vasodilators)
Dopamine/dobutamine infusion (positive inotropes)
44
Q

What are two synonyms for infective endocarditis?

A

Bacterial/fungal endocarditis

Vegetative (valvular)endocarditis

45
Q

What are the vegetations in infective endocarditis made of?

A

Made of fibrin and platelets

With some bacteria/pathogen inside

46
Q

In infective endocarditis, where to the circulating organisms colonise and damage?

A

The endocardium and heart valve

47
Q

What two valves are most commonly affected in infective endocarditis?

A

Mitral or aortic

48
Q

Is infective endocarditis associated with chronic, degenerative AV valve disease?

A

No

49
Q

What is a prerequisite of getting infective endocarditis?

A

A blood-borne infection

50
Q

What are the 4 most common infective agents responsible for infective endocarditis?

A

Staphylococcus
Streptococcus
E.coli
Pseudomonas aeruginosa

-Bartonella in hard-to-diagnose cases maybe

51
Q

Describe the pathogenesis of infective endocarditis?

A

Blood-borne infection
Damages mitral and aortic valves most commonly
Valve leaflet endothelium ulcerates
Platelets adhere to sub-endothelial collagen
Fibrin deposition
Enlargement - vegetations
Flimsy, friable at first and turn into calcified and fibrous
Cause valvular insufficiency and/or stenosis
Young vegetations can break off and lodge in kidneys mainly (also brain if aortic valve affected)
Process is quick and develop Left sided CHF in days

52
Q

What are some clinical features that you will see in a patient with infective endocarditis?

A 
Fever usually
New/changing heart murmur
Stiffness, lameness, +/- joint swelling
Lethargy
anorexia, weight loss 
GI signs
\+/- signs of congestive heart failure
\+/- syncope
Very unhappy, sick animal
53
Q

In infective endocarditis what causes stiffness, lameness and possible joint swelling?

A

Antigen-antibody complexes enter the joints.

Makes synovial fluid less viscous

54
Q

What kind of murmur are you most likely to hear in a dog with infective endocarditis?

A

Diastolic murmur
At the heart base
(aortic valve affected)

55
Q

How do you diagnose a dog with suspected infective endocarditis?

A

Echocardiograph - see flopping vegetations or valve destruction
New murmur that is definitely new
Positive blood cultures
ECG and blood tests not that helpful

56
Q

How do you collect blood for culture in a suspected infective endocarditis case?

A

Sterile venipuncture
Large volume over 10mL if possible
From different veins more than an hour apart
Blood goes into a special culturing bottle for aerobic incubation

57
Q

How do you treat a dog with infective endocarditis?

A

Aggressive therapy with bactericidal antibiotics that are capable of penetrating fibrin
E.g. Beta lactam & aminoglycoside OR a fluoroquinolone
IV for the first week
6-8 weeks (watch for aminoglycoside toxicity since nephrotoxic)
Supportive care - CHF, arrhythmias

A - Medicine Cardiovascular (5 decks)

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