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Cardiology > Small animal cardiology > Flashcards

Small animal cardiology Flashcards

1
Q

What is orthopnoea

A

Change in breathing related to position i.e shortness of breath when lying down

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2
Q

What is a cough from heart disease like compared to primary respiratory disease

A

Heart disease cough is softer and moister (due to some pulmonary oedema)

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3
Q

What is cyanosis

A

Blue/grey discolouration of mucous membranes due to increased quantity of deoxygenated Hb
i.e pA O2 <40mmHg, arterial saturation <70%

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4
Q

What does a more distended jugular vein indicate

A

Increased systemic venous pressure i.e higher right ventricular pressure

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5
Q

What type of heart failure is ascites a sign of

A

Right sided
Because increased pressure in right side of heart so impairment of pumping blood to the lungs

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6
Q

WHen might we have a decreased pulse pressure

A

Heart failure
Hypovolvaemia

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7
Q

When might we have an increased pulse pressure

A

Anaemia
Patent ductus arteriosus
Aortic regurgitation

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8
Q

What is a pulse deficit

A

Where a heart beat does not generate a palpable pulse e.g in some tacharrhythmias

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9
Q

What is the precordial impulse

A

Apex beat
Usually found at LIC4/5

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10
Q

What is the diaphragm used for hearing

A

High frequency sounds

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11
Q

What is the bell used for (stethoscope)

A

Low frequency sounds e.g 3rd and 4th heart sounds in a dog

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12
Q

What valve does the L apex beat correspond to

A

Mitral valve
= first heart sound

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13
Q

What do we hear at the base beat

A

Aortic and pulmonic valves; hard to differentiate them on small dogs and cats

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14
Q

Where do we hear the tricuspid valve

A

Right heart apex

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15
Q

When might the second heart sound be split

A

Pulmonary hypertension

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16
Q

Which heart sound becomes very dominant in stress/exercise

A

First heart sound (AV valve closure)
Because it is dependent on ventricular contractility

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17
Q

What is the third heart sound and when might we hear it

A

Noise from rapid ventricular filling during diastole
- get noise where there is vibration in a stiffer than normal ventricular wall e.g if it hasn’t emptied fully such as dilated cardiac myopathy

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18
Q

What is the fourth heart sound and when might we hear it

A

Occurs in atrial systole when blood is forced into an over distended ventricle e.g in feline hypertrophic cardiac myopathy

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19
Q

When can it be hard to distinguish extra heart sounds

A

In high heart rates e.g cats with HR>180

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20
Q

What are the two mechanisms of heart murmurs

A

Turbulence of blood flow
Vibration of a cardiac structure

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21
Q

What causes flow murmurs

A

Low viscosity blood
e.g in immature animals, anaemia

+ increased cardiac outflow velocity can cause it

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22
Q

Murmur grading system

A

I - heard in a quiet room
II – faint but easily heard; disseminated over larger area e.g on both sides
III – same intensity as heart sounds
IV – louder than the heart sounds
V – loud murmur plus palpable thrill
VI – heard when stethoscope removed from the chest wall

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23
Q

What is the loudest and most common type of murmur

A

Systolic

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24
Q

What are the systolic murmurs

A

AV valve regurgitation
Left to right shunting in a ventricular septal defect
Aortic stenosis
Pulmonic stenosis

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25
Q

How can we split up systolic murmurs into two types

A

Plateau murmurs: AV valve regurg, VSD
Ejection murmurs which can be squeaky: aortic stenosis, pulmonic stenosis

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26
Q

What are the types of diastolic murmurs

A

Aortic regurgitation
Pulmonic regurgitation (rarely heard; on right side)
AV valve stenosis

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27
Q

What can cause a continuous murmur

A

Patent ductur arteriosus

Combinations of systolic and diastolic murmurs

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28
Q

What systolic murmur would be heart loudest on left heart base

A

Pulmonic stenosis
Aortic stenosis

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29
Q

What systolic murmur would be heart best on left side over heart apex

A

Mitral valve regurgitation

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30
Q

What heart murmur would be heart best on the right side at the sternal border

A

Ventricular septal defect

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31
Q

What systolic murmur would be heard best on the right side over the mid heart

A

Tricuspid regurgitation
Subvalvular aortic stenosis

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32
Q

What diastolic murmur would be heard best on the left chest wall at the apex

A

Mitral valve stenosis

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33
Q

What diastolic murmur would be heard best on the left side at the heart base

A

Pulmonary valve regurgitation
Aortic valve regurgitation

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34
Q

What diastolic murmur would be heard best on the right side

A

Tricuspid stenosis

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35
Q

What is heart failure

A

State where heart is unable to maintain an adequate circulation in the face of normal filling pressures
- Clinical syndrome involves reducing of cardiac output, increased venous pressures and molecular abnormalities that cause deterioration of heart and myocardial cell death

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36
Q

How do Frank starling curves change in heart failure with increasing preload/afterload

A
  1. Cardiac output can’t increase much with increasing preload
  2. Pressure increases greatly with small increase in preload
  3. Stroke volume falls rapidly with any increase in afterload (arterial resistance against which left ventricle ejects blood)
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37
Q

What consequences are there is preload increases on the right side of the heart

A

Jugular distension + positive hepato-jugular reflux test
Ascites
Odema
Pleural effusion
Enlarged lvier/spleen

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38
Q

What is the hepato-jugular reflux test

A

Where pressure put on the abdomen causes jugular venous distension as blood is forced forward
See this in right sided heart disease; high preload here

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39
Q

What happens if preload increases in the left side of the heart

A

Pulmonary oedema –> hypoxaemia/cyanosis
Can lead to excessive right sided preload

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40
Q

Why do we get arrhythmias when there is a fall in cardiac output

A

Because hypoxia means low perfusion of the heart itself

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41
Q

Signs of fall in CO

A
  • Cool extremities
  • Fall in rectal temperature/shock
  • Weakness/syncope
  • Slow capillary refill time (>2 sec)
  • Arrhythmias
  • Reduced mentation/confusion
  • Congestive failure signs usually coexist with a reduction in cardiac output
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42
Q

What effects does RAAS activation cause following drop in CO

A

Angiotensin II causes vasoconstriction
ADH also causes vasocontriction and water retension
Aldosterone causes sodium and water retention

SO get increase in afterload (from vasoconstriction) AND preload (from increased blood volume via water retention)

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43
Q

What are ANP and BNP and what do they do

A

Stored in myocardium and released when atria and stretched i.e high preload in heart disease

Natriuretics and vasorelaxants so temper RAAS system
Also reduce aldosterone secretion
Inhibit sympathetic system

Act as diagnostic markers

44
Q

What happens to the heart when there is sympathetic upregulation e.g with fall in CO

A

Abolition of sinus arrhythmia in dog
Heart rate increases; this both increases myocardial O2 demand and reduces what it recieves by shortening diastole

45
Q

How does fall in cardiac output change heart itself

A

Causes myocardial hypertrophy

46
Q

What types of cardiomyopathy do dogs vs cats get

A

Dogs get dilated cardiomyopathy = sytolic failure due to failure of contractility

Cats get hypertrophic cardiomyopathy; thick stiffened heart muscle can’t relax so get failure of distole

47
Q

Clinical signs of forward failure

A

Poor muscle perfusion means exercise intolerance
Vasoconstriction means palo
Increased symp tone causes tachycardia
Poor heart contractility gives weak pulses
Poor renal perfusion gives azotaemia
Angiotensin II release causes increased thirts

48
Q

Clinical signs of left sided backwards failure (congestive heart failure)

A

Tachypnoea/dyspnoea due to pleural effusion or pulmonary oedema
+ resp crackles and wheezes or absence of lung noise

Cough may be harsh if from enlarged left atrium or soft if due to pulmonary oedema

49
Q

Signs of right sided backwards failure

A

Jugular distension due to increased RA pressure
Hepatomegaly (increased vena cava pressure)
AScites
Hepatojugular reflex
PLeural effusion (because increased pressure in azygous and bronchial veins)
Peripheral oedema

50
Q

Why does right sided backwards failure cause pleural effusion

A

BEcause it causes increased pressure in azygous and bronchial veins

51
Q

Clinical classification of congestive heart failure*

A

1 = no signs but clinical evidence of heart disease
2 = exercise intolerance or dyspnoea after MARKED exercise
3 = marked exercise intolerance i.e dyspnoea after MILD exercise
4 = dyspnoea at rest, cannot exercise

52
Q

Modified classification of heart failure

A

A Dogs at high risk of heart disease
B1 Murmur but no radiographic heart enlargement
B2 Murmur and chamber enlargement
C Evidence of heart failure
D Heart failure not responding to standard treatment
At B2, it is useful to intervene medically (no evidence that intervening earlier helps)

53
Q

AT what point is it useful to intervene in heart failure

A

Stage B2

54
Q

*What are the 4 phases of diastole

A

1: Isovolumetric relaxation; = time between aortic valve closure and mitral valve opening

2: rapid early mitral inflow

3: Diastasis: little change in ventircular volume or pressure

4: atrial contraction; contributes to ventricular filling

55
Q

What things can delay heart relaxation

A

Ventricular hypertrophy
Abnormal calcium movement

56
Q

What things can cause diastolic dysfunction

A

Ventricular hypertrohy
OBstruction to ventricular filling e.g neoplasia within heart
AV valve stenosis
Pericaridal disease causing tamponade

57
Q

What things can cause ventricular hypertrophy

A
  • Hypertrophic cardiomyopathy
  • Aortic stenosis
  • Pulmonic stenosis
  • Heartworm disease
  • Systemic hypertension
58
Q

What is cardiac tamponade

A

Where pressure from outside the heart affects the filling of the inside of the heart e.g pericardial effusion

Right side is affected first because it is at lower pressure

59
Q

What are the goals of therapy for heart disease and what is the therapy

A

1) Diuretics to control salt and water retention and relieve oedema
2) Inotropic medication to improve pump function e.g piobendane, digoxin
3) Vasodilators to reduce heart workload (afterload)

60
Q

Functions of the pericardium

A

Prevents heart overdilation
Protects heart from infection
Maintains heart in a fixed position
Co-ordinates right and left ventricular funciton

61
Q

Layers of the pericardium

A

Outer fibrinous layer
Inner serous; patietal and visceral layers

62
Q

What happens in cardiac tamponade

A

Pericardial fluid accumulation means intrapericardial pressure becomes higher than that of the right heart causing collapse and impediment of venous return

This then causes increases systemic venous pressure and can lead to right sided congestive heart failure

63
Q

*What are two congenital diseases of the pericardium

A

Peritoneopericardial diaphragmatic hernia

Benign intrapericardial cyst

64
Q

What is Peritoneopericardial diaphragmatic hernia PPDH:

A

Where pericardial sac does not become independent from the diaphragm and abdominal cavity so abdominal organs can herniate into the pericardial sac

common in weimeraners + persians

Often incidental
Treatment is surgery

65
Q

What are the most common cause of pericardial effusion in dogs

A

Neoplasia
Then idiopathic
Left atrial rupture

66
Q

Which neoplasias can cause pericardial effusion

A

Haemangiosarcoma most common
Chemodectoma
Mesothelioma

67
Q

Signalment of haemangiosarcoma in heart

A

Predilection to right atrial auricle and right atrium
Older large breed dogs e.g GSD, golden retrievers
Hgih metastatic rate

68
Q

What is a chemodectoma and what are the characteristics

A

Heart base tumour; 2nd most common tumour of the heart
Arises from chemoreceptors in pulmonary artery and ascending aorta
Slow growing, low metastatic rate, locally invasive

Treatment = pericardiectomy

69
Q

What breeds are predisposed to chemodectomas

A

Brachycephalics

70
Q

What are mesotheliomas in the heart

A

= diffuse tumours arising from pleura, peritoneum and pericardium
Often large volume of pericardial effusion and rapidly recurs if drained

Treatment = pericardiectomy to relive signs and intracavity chemo

Guarded prognosis

71
Q

Which breeds are predisposed to idiopathic pericardial effusion

A

Younger large breed dogs e.g St Bernard, GOlden Retrievers

72
Q

What is the main differential for idiopathic pericardial effusion

A

Mesothelioma
IPE is a diagnosis of exclusion

73
Q

Which dogs are predisposed to left atrial tear/rupture

A

Older small breed dogs since this is a complication assocaited with advanced mitral valve disease via damage from the jet

74
Q

How can mitral valve disease lead to left atrial tear/rupture

A
  • Severe left atrial enlargement
  • Increased left atrial pressure causes wall over-stretching
  • Mitral regurgiation causes jet lesions in atrial wall
75
Q

What does a left atrial tear look like on echo

A

Pericardial effusion with intrapericardial thrombus inside the pericardial sac
- This clot is attached to where the tear happened and stops the bleeding

Prognosis is fair if they survive first 7 days

76
Q

What is the most common cause of pericardial effusion in cats

A

Congestive heart failure
Presents as mild effusion withOUT cardiac tamponade

77
Q

What is constrictive pericarditis

A

Rare condition of the pericardium where it becomes thickened/fibrotic and non-distensible

Leads to right congestive heart failure with minimal/no pericardial effusion

78
Q

What is the aetiology of constrictive pericarditis + treatment

A

May be idiopathic, neoplastic, inflammatory
Treatment = pericardiectomy (+ do histopath)

79
Q

Key clinical exam findings in a pericardial effusion case

A

Muffled heart sounds **
Weak femoral pulses ***
+ Tachycardia, resp signs, signs of right sided congestive heart failure, tachycardia, pulsus paradoxus

80
Q

What is pulsus paradoxus

A

Where there is a reduction or absence of pulse on inspiration

= because of cardiac interdependence in pericardial effusion i.e only one ventricle can increase in volume at a time;
- During inspiration right side get flow due to change in intrathoracic pressure so less output from L side and weaker pulse

81
Q

Two ket places to look for masses on the heart on echo

A

Right auricle (haemagiosarcoma)
Heart base (chemodectoma)

82
Q

In which case of pericardial effusion would we not drain the fluid (pericardiocentesis)

A

Left atrial tear

83
Q

When is pericardiectomy indicated

A

Recurrent pericardial effusion
Constrictive pericarditis
Palliate surgery in neoplastic effusion cases

84
Q

When is pericardiocentesis essential

A

Cardiac tamponade cases

85
Q

Which X ray views do we take of the heart by convention*

A

Right lateral
Dorsoventral (to avoid distorsion)

86
Q

What heart phase will most X rays be taken in and what effect does this have

A

Diastole since this lasts longest
Makes heart bigger than if taken in systole

87
Q

Normal cardiac size parameters in dogs

A
  • Heart width <2/3 width of thorax
  • Height of heart < 2/3 height of thorax
  • Width of heart 2.5-3.5 IC spaces
    Vertebral heart score 9.7 +/- 0.5
88
Q

Cardiac size parameters in cats

A

Width < 2/3 width of thorax and 2-3 intercostal spaces

89
Q

What does the heart look like in canine generalised cardiomegaly

A

Globoid with enlargement in all chambers
Signs of congestive heart failure e.g pulmonary oedema, hepatomegaly, ascites

90
Q

What does heart look like in feline generalised cardiomegaly

A

More valentine shaped
Heart displaced to the right

91
Q

What does cardiac X ray look like with left atrial enlargement

A

Increased heart height
Enlargement of pulmonary veins
Dorsal deviation of mainstem bronchi

Rounded soft tissue opacity visible in dorsocaudal part of lung

92
Q

Radiographic signs with left ventricular enlargement

A

Tracheal elevation
Straight caudal border of the heart
Longer cardiac silhouette with rounding of apex on DV

93
Q

Radiographic signs of right ventricular enlargement

A

NB = overdiagnosed; actually rare
Elevation of apex on left lateral view, elevation of trachea
Rare in isolation; often concurrent with left ventircular dilation in DCM

94
Q

Radiographic signs of right atrial enlargement

A

Rare in isolation
Focal bulge on cranial aspect of cardiac silhouette
Deviation of trachea at focal bulge

95
Q

X ray signs with pericardial effusion

A

Globoid shape
Sharp borders
Evidence of right sided CHD often present

96
Q

Where do pericardial cysts occur

A

At costophrenic angles; related to trapped omentum or abnormal mesenchymal development
Presents similarly to pericardial effusino

97
Q

What do peritoneo-pericardial diaphragmatic hernias look like on X ray

A
  • Globoid or abnormally shaped cardiac silhouette
  • Gas filled structures overlying cardiac silhouette
  • Cardiac silhouette not of homogenous opacity
  • “Empty abdomen”
  • Sternebral abnormalities
  • Most common in Weimaraners
98
Q

What should we consider as possible causes of microcardia

A

Addison’s
Hypovolaemic shock

99
Q

Where are artery and vein in relation to each other on DV ad lateral

A

DV view: artery = lateral to vein
Lateral: artery = dorsal to vein

Should be < diameter or 9th rib

100
Q

What does pulmonary under-circulation look like

A

LUng fields more lucent
Pulmonary arteries small than normal and than the corresponding vein

101
Q

Differentials for pulmonary under circulation

A
  • Hypovolaemia e.g shock, dehydration
  • R-L shunting
  • Severe pulmonic stenosis
  • Pulmonary thrombo-embolism

[Could also be emphysema, overinflation, overexposure]

102
Q

What does pulmonary over circulation look like on x ray

A

Increased vascular pattern, arteries and veins larger than

103
Q

Differentials for pulmonary over-circulation

A
  • Left to right shunting
  • Congestive heart failure
  • Heartworm disease
  • Iatrogenic fluid overload
    Also could be: underexposure, expiratory radiograph
104
Q

Modified bernouli equation

A

Pressure gradient = 4 X (maximum velocity)^2

105
Q
A
106
Q
A

Cardiology (6 decks)

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