Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RUSVM SAM 1 > Systemic and Pulmonary Hypertension > Flashcards

Systemic and Pulmonary Hypertension Flashcards

1
Q

T/F: systemic hypertension usually occurs secondary to another condition in cats and dogs

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the basic pathophysiology causing systemic hypertension?

A

Arterial/arteriolar walls are disease and vessel lumen is narrowed - > reduced blood flow to tissues and/or hemorrhage due to vessel/capillary fragility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who should we test for systemic hypertension?

A

Patients with ..
-target organ damage (eyes, kidney, CNS, or CVS)

-associated conditons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Renal damage can be associated with systemic hypertension. What are the potential clinical signs?

A

Isosthenuria
Azotemia
Proteinuria
Structural abnormalities (eg atrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of renal damage can systemic hypertension cause?

A

Glomerular and/or tubulointersitial

Ischemia, necrosis, and atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are potential clinical signs associated with ophthalmic damage due to systemic hypertension?

A

Vision loss
Retinal hemorrhage/edema
Retinal detachment
Intraocular hemorrhage (hyphema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are potential clinical signs associated with neurological damage due to systemic hypertension?

A 
Seizure 
Vestibular signs 
Disorientation 
Mentation or behavior change 
Signs may be transient or persistent

-“hypertensive encephalopathy” good prognosis with normalization of BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What cardiovascular changes can you see due to systemic hypertension?

A

LV concentric hypertrophy
—> pressure

Diastolic dysfunction
Mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are potential clinical findings associated with CV damage due to systemic hypertension?

A 
L sided CHF signs
Epistaxis 
Mitral murmur 
Cardiac gallop 
Arrhythmia 
L- Sided cardiomegaly and proximal aortic dilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a common condition in cats and dogs causing systemic hypertenion?

A

Renal disease

Diabetes mellitus
Obesity
Hyperaldosteronism
Pheochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What medication do dogs often receive for urinary problems that may make them hypertensive ?

A

Phenylpropanolamine (A agonist) —> tighten urethral sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the differentials for systemic hypertension?

A

True/pathologic hypertenion

  • secondary (most common)
  • idiopathic/primary

Stress-induced hypertenion (“white coat”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you avoid stress-induced hypertension?

A

Ensure good technique
Rule out/treat co-morbidities that could cause high BP

Measure BP with owner present
Change room/personnel
Verify abnormal readings at other sites

Proper equipment
Verify correct cuff size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the steps in making a diagnosis of systemic hypertension ?

A

PE to evaluate for TOD
Obtain multiple reliable BP readings
Testing for associated conditions (eg renal disease)

If TOD is present or if BP >180 —> treat for hypertension
If not —> reassess in a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you do to investigate an underlying cause of systemic hypertension?

A

Minimum database: CBC, Biochem, UA

Additional diagnostics in select patients: endocrine testing, UPC, urogenital ultrasound, thoracic radiographs, echo, Catecholamines levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What patients with systemic hypertension are usually admitted as inpatients? What are the usual drugs used?

A

Those with ocular and/or neuro signs

Nitroprusside CRI
Hydralazine
Acepromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first choice treatment for systemic hypertension in doggos?

A

Angiotensin-converting enzyme inhibitor (ACEi)

—> indirect vasodilator blocking angiotensin II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When are ACE inhibitors contraindicated ?

A

Dehydrated and hypovolemic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the MOA of amlodipine ?

A

Dihydropyridine-type Ca channel blocker

—> inhibit Ca influx across vascular smooth muscle cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the first choice treatment for systemic hypertension in cats?

A

Amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What combo of drugs do you use in cats with systemic hypertension that do not respond to a single drug?

A

Amlodipine and ACEi

22
Q

What technique can be used to reduce stress-induced hypertension?

A

Environment

  • quiet and comfortable
  • with our without owners
  • 5-10mins to acclimate
  • minimal distractions
  • minimal restraint
  • co-morbidities?

Personnel

  • skilled
  • informed
  • gentle

Equipment (calibrate)

  • Doppler vs oscillometric
  • several cuff sizes
  • ultrasound gel- Doppler
  • alcohol

Lateral or sternal recumbency (artery at level of the heart)

23
Q

What is the normal systolic pulmonary arterial pressure?

A

30mmHg

24
Q

What is the calculation for pulmonary arterial pressure?

A

PAP = (cardiac output x pulmonary vascular resistance) + pulmonary venous pressure

25
Q

What are the mechanisms of pulmonary hypertension?

A

Increased cardiac output

Increased pulmonary vascular resistance/radius
-increased vasoconstriction or decreased vasodilation

Increased pulmonary venous pressure

26
Q

pulmonary hypertension is classified based on underlying disease processes. What are these classifications?

A
  1. due to pulmonary vascular disease
  2. Due to left-sided heart disease
  3. Due to chronic pulmonary disease /hypoxia
  4. Due to thrombotic/embolic disease
  5. Misc (compression of vessels -neoplasia or granuloma)
27
Q

What are causes of pulmonary vascular disease leading to pulmonary hypertension ?

A

Parasitic -eg heartworm

Congenital systemic-to-pulmonary shunt (PDA or VSD)

Idiopathic

28
Q

What are causes of left-sided heart failure leading to pulmonary hypertension?

A

Degenerative mitral valve disease

Dilated cardiomyopathy

—> increased pulmonary venous pressure

29
Q

What are causes of chronic pulmonary disease leading to pulmonary hypertension?

A

Tracheobronchial disease (chronic bronchitis)

Interstitial lung disease (idiopathic pulmonary fibrosis)

Upper airway obstruction (brachycephalic airway syndrome)

Low inspired PO2 (high altitude)

30
Q

What are usually the causes of of thrombin/embolic disease leading to pulmonary hypertension?

A

Thrombus or thromboembolism due to hypercoagulable state (hyperadrenocortisim, pancreatitis, protein losing disease, IMHA)

Cardiac (endocarditis)

Non-thrombic emboli (heartworm/neoplasia)

31
Q

What is the signalment of pulmonary hypertension?

A

Dogs&raquo_space; cats
Middle age-older
Small breed

32
Q

What are the clinical signs of pulmonary hypertension and what cardiac disease has a similar presentation and signalment?

A 
Exercise intolerance 
Cough 
Tachypnea
Dyspnea 
Syncope or pre-syncope 
Ascities if R CHF is present

Mitral valve disease

33
Q

T/F: pulmonary systolic pressures greater than 30mmHg is abnormal but you usually dont see symptoms until pressures are significantly increased (greater than 80mmHg)

A

True

34
Q

T/F: patients with severe pulmonary hypertension may have systemic HYPOtension

A

True

35
Q

In mild/moderate PH, there may not be exam findings due to the PH, but there may be abnormalities due to the underlying dz. What might you find?

A

Dyspnea/tachypnea

Abnormal lung sounds (crackles, wheezes, and increased BV sounds)

HR normal to increased

Temperature is usually normal

Cyanosis

Murmur due to tricuspid regurgitation (PMI right apex)

36
Q

What diagnostics do you do to evaluate an underlyyting cause of PH?

A

Minimum database

Heart-worm test

Thoracic radiographs

Echo is the gold standard for diagnosis of PH in small animals

37
Q

What would you see on radiographs of an animal with pulmonary hypertension ??

A

Pulmonary infiltrates

Sternal contract due to right ventricular enlargement

Dilated pulmonary artery

38
Q

What is the treatment of pulmonary hypertension?

A

Underlying cause

Vasodilator drugs
-sildenafil -> phosphodiesterase V inhibitor is most common in small animals

-supplemental oxygen also dilates pulmonary arteries, PO2<70mmHg

  • pimobendan—>vasodilator effects
  • antithrombic therapy in cats
39
Q

What is the prognosis of PH?

A

Fair- good: if underlying cause can be treated

Poor: severe cases

Sudden death can occur in severe PH
Can also develop R-CHF and low output HF

40
Q

What is a pulmonary thromboembolism ?

A

Obstruction of the pulmonary artery by a thrombus that originated in systemic venous circulation

41
Q

What is Virchow’s triad for thrombus formation?

A

Hypercoagulability
Endothelial injury
Blood stasis

42
Q

What conditions are associated with PTE?

A

Immune melted hemolytic anemia

Protein losing nephropathy/enteropathy (loss of antithrombin III)

Neoplasia
Pancreatitis 
Diabetes mellitus 
Hyperadrenocortisim 
Sepsis 
R-sided cardiac disease 
HWD 
Surgery 
Trauma
43
Q

What clinical signs are seen due to PTE?

A

ACUTE

Dyspnea/tachypnea 
Lethargy 
Cyanosis 
Syncope, cough
TR murmur if severe PH has developed

Symptoms related due to co-morbidities

44
Q

Definitive diagnosis of PTE requires ??

A

CT, angiography, or radionuclide ventilation/perfusion scan

45
Q

T/F: thoracic radiographs, or prothrombin (PT) time cannot definitively diagnose PTE but provide supporting evidence to the diagnosis

A

True

46
Q

Thoracic radiographs can often appear normal in PTE, but what signs might be seen due to PTE?

A

Focal interstitial/alveolar infiltrates

Lung lobe consolidation

  • a hypovascular area/lobe would be fairly specific for PTE
47
Q

What are the goals of treatment of PTE?

A

Prevent growth of existing thrombi and prevent formation of new thrombi

Support respiratory and cardiovascular system

48
Q

What are the initial/acute treatments for PTE?

A

Anticoagulant therapy with unfractionated heparin or low molecular weight heparin (LMWH)

Supplemental oxygen

IV fluid therapy to optimize tissue perfusion

49
Q

What is the therapy for chronic PTE?

A

Minimize antithrombic drugs

Minimize endothelial injury

Minimize blood stasis

50
Q

What are the anticoagulant drugs?

A

Unfractionated heparin

LMWH (SC)

51
Q

What are the antiplatelet drugs?

A

Clopidogrel

Aspirin

RUSVM SAM 1 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions