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Cardiology and Respiratory SA Med > Systolic Dysfunction > Flashcards

Systolic Dysfunction Flashcards

1
Q

Rule #1 of the heart

A
  • Know normal circulation and oxygenated vs deoxygenated blood
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2
Q

Rule #2 of the heart

A
  • Heart is a muscle

- Heart will hypertrophy if it has to work harder

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3
Q

Rule #3 of the heart: What are the three main functions?

A
  1. ) Conduct electricity
  2. ) Systole (contract)
  3. ) Diastole (dilate)
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4
Q

Rule #4 of the heart about blood flow

A
  • Water is LAZY!

- Flows from high to low pressure

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5
Q

Systemic venous pressure value

A
  • 5 mmHg
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6
Q

Right atrial pressure

A
  • 5 mm Hg
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7
Q

Right ventricular pressure

A
  • 5 mmHg in diastole

- 20 mmHg in systole

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8
Q

Pulmonary artery pressure

A
  • 8 mmHg in diastole

- 20 mmHg in systole

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9
Q

Pulmonary circulation pressure

A
  • 6 mmHg
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10
Q

Pulmonary vein pressure

A
  • 6 mmHg
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11
Q

Left atrial pressure

A
  • 6 mmhg
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12
Q

Left ventricular pressure

A
  • 6 mmHg in diastole

120 mmHg in systole

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13
Q

Why is the left ventricle so high pressure during systole?

A
  • Has to pump against gravity
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14
Q

Aortic pressure

A
  • 80 mmHg diastole

- 120 mmHg systole

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15
Q

What is the calculation for Blood pressure? Cardiac output?

A
  • BP = CO * Systemic vascular resistance

- Cardiac output = Stroke volume * heart rate

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16
Q

What three things impact stroke volume?

A
  • Preload
  • Afterload
  • Contractility
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17
Q

What are the two morphologic responses to disease for the heart?

A
  • Concentric hypertrophy

- Eccentric hypertrophy

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18
Q

What diseases lead to concentric hypertrophy?

A
  • Diastolic dysfunction

- Pressure overload

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19
Q

What diseases lead to eccentric hypertrophy?

A
  • Systolic dysfunction

- Volume overload

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20
Q

What diseases in the heart do not usually lead to hypertrophy?

A
  • Arrhythmias
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21
Q

What happens during concentric hypertrophy?

A
  • Heart muscle becomes too thick

- Lumen is smaller, and walls get thicker

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22
Q

What happens during eccentric hypertrophy?

A
  • Walls stay the same, but the lumen gets bigger

- Systolic dysfunction occurs first, and then you get eccentric hypertrophy secondary to that

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23
Q

Systolic dysfunction and volume overload

A
  • Not as much blood leaving the heart
  • Next time you go into diastole, it’s filled more already
  • Volume overload secondary to systolic dysfunction
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24
Q

What is point of maximal intensity of systolic dysfunction murmur?

A
  • on left side below costochondral junction (mitral valve)

- Left apical murmur

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25
Q

What is timing of systolic dysfunction murmur?

A
  • Systole
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26
Q

What is quality of systolic dysfunction murmur?

A
  • Regurgitant
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27
Q

Femoral pulses for systolic dysfunction quality

A
  • Potentially weak

- May have pulse deficits too if arrhythmias

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28
Q

Primary causes of systolic dysfunction

A
  1. Dilated cardiomyopathy

2. Arrhythmogenic Right Ventricular Cardiomyopathy

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29
Q

Secondary causes of systolic dysfunction

A
  • Toxin/drug
  • Dietary deficiency
  • Tachycardia-induced cardiomyopathy
  • Hypothyroidism
  • Inflammation
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30
Q

What non-infectious diseases can lead to myocarditis and secondary systolic dysfunction?

A
  • Trauma (HBC)
  • Heat stroke
  • Systemic inflammatory disorders (septicemia, immune-mediated diseases)
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31
Q

What infectious diseases can lead to myocarditis and secondary systolic dysfunction?

A
  • Viral (Parvo, distemper)
  • Bacterial (Bartonella, Borrelia)
  • Protozoal (Trypanosoma or Chagas; Toxoplasma)
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32
Q

Treatment for myocarditis and secondary systolic dysfunction secondary to systemic inflammation?

A
  • Treat underlying disease
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33
Q

Prognosis for myocarditis and secondary systolic dysfunction secondary to systemic inflammation?

A
  • Depends on underlying disease

- Heat stroke is okay if you don’t have MODS

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34
Q

How can hypothyroidism lead to systolic dysfunction?

A
  • Dysfunction of Hypothalamic-pituitary-thyroid axis (see notes)
  • Decreased production of T4 and T3
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35
Q

Etiology of hypothyroidism

A
  • Thyroiditis
  • Idiopathic atrophy
  • Bilateral neoplasia
36
Q

Indirect effects of thyroid hormones on the heart

A
  • Increase metabolic rate

- Think about what hypothyroidism would do

37
Q

Direct effects of thyroid hormones on the heart

A
    • Inotropy and + chronotropy

- Think about what hypothyroidism

38
Q

Ultimate impact of hypothyroidism on the heart due to direct and indirect effects

A
  • Decreased contractility and decreased heart rate
39
Q

Treatment for hypothyroid induced systolic dysfunction

A
  • Treat the hypothyroidism

- Levothyroxine

40
Q

Prognosis for hypothyroid induced systolic dysfunction

A
  • Good with treatment

- RARELY a cause of myocardial failure

41
Q

Treatment for tachycardia-induced cardiomyopathy and systolic dysfunction

A
  • Stop the tachycardia

- Anti-arrhythmic medications: Digoxin, Diltiazem, Beta-blockers, Sotalol

42
Q

Prognosis for tachycardia-induced cardiomyopathy and systolic dysfunction

A
  • Guarded to good

- Potentially curable

43
Q

Function of taurine

A
  • Amino acid
  • Diverse function
  • Concentrates in the heart and retina
  • Essential amino acid in cats!!!
44
Q

What impact can taurine deficiency have on an animal?

A
  • Central retinal degeneration

- Cardiac systole dysfunction

45
Q

Who gets taurine deficiency systolic dysfunction?

A
  • Cats
  • American Cocker Spaniels
  • MAY be a link with grain free and high legume diets
46
Q

Diagnosing systolic dysfunction secondary to taurine deficiency

A
  • Diet history

- Taurine blood levels

47
Q

Treatment for systolic dysfunction secondary to taurine deficiency

A
  • Treat CHF: Furosemide, pimobendan, ACE inhibitor

- Taurine supplementation

48
Q

Prognosis for systolic dysfunction secondary to taurine deficiency

A
  • Guarded to good

- Potentially curable

49
Q

L-carnitine role

A
  • Fatty acid metabolism and energy production

- Concentrated in skeletal and cardiac muscles

50
Q

What happens with L-carnitine deficiency potentially?

A
  • Cardiac systolic dysfunction
51
Q

Who gets L-carnitine deficiency?

A
  • American Cocker Spaniels
  • Golden Retrievers
  • Boxers
52
Q

Diagnosis of systolic dysfunction secondary to L-carnitine deficiency?

A
  • Diet history
  • Myocardial levels (myocardial biopsy)
  • Response to supplementation
53
Q

Treatment for systolic dysfunction secondary to L-carnitine deficiency?

A
  • Treat CHF: Furosemide, pimobendan, ACE-inhibitor

- L-carnitine supplementation

54
Q

Prognosis for systolic dysfunction secondary to L-carnitine deficiency?

A
  • Guarded to good

- May be curable

55
Q

What nutritional deficiency can lead to systolic dysfunction in large animals or food animals?

A
  • Selenium and Vitamin E
56
Q

What is Vitamin E/Selenium deficiency called in horses/cows vs pigs?

A
  • White muscle disease
57
Q

Which drug is most commonly implicated for causing systolic dysfunction?

A
  • Doxorubicin (Adriamycin)

- Chemotherapeutic agent

58
Q

Doxorubicin cardiotoxicity

A
  • Dose dependent (will happen with a higher dose)
  • Arrhythmias
  • Severe systolic dysfunction
59
Q

Treatment for doxorubicin induced systolic dysfunction

A
  • No direct treatment
60
Q

Prognosis for for doxorubicin induced systolic dysfunction

A
  • Poor

- Severe systolic dysfunction is irreversible

61
Q

Primary dilated cardiomyopathy how to diagnose?

A
  • Diagnosis of exclusion

- Rule out toxin/drug, dietary deficiency, tachycardia, hypothyroidism, and inflammation

62
Q

Etiology of primary DCM

A
  • Idiopathic

- Suspected genetic disorder

63
Q

Who gets DCM: Age?

A
  • Adults
64
Q

Who gets DCM: Breed?

A
  • Two-handed dogs!
  • Irish Wolfhounds, Great Danes, Boxers
  • American Cocker Spaniels
  • Dobermans!
65
Q

Treatment for Stage B1 (mild) DCM

A
  • No treatment

- Monitor

66
Q

Treatment for Stage B2 (moderate/severe) DCM

A
  • Pimobendan

- +/- ACE Inhibitor

67
Q

Treatment for Stage C (post-CHF) DCM

A
  • Furosemide
  • Pimobendan
  • ACE inhibitor
  • +/- Spironolactone
  • +/- Anti-arrhythmics
68
Q

What happens to blood flow with DCM?

A
  • Not enough blood going forward (systolic dysfunction)
  • Most often a disease of the left side of the heart
  • Blood will go back to the lungs (left sided CHF)
69
Q

Prognosis for B1 DCM

A
  • Year to never

- Can take a VERY long time to get to stage C

70
Q

Prognosis for B2 DCM

A
  • Months to year to never depending on age at diagnosis
71
Q

Prognosis for Stage C DCM Dobermans

A
  • 3-6 months

- Less with atrial fibrillation

72
Q

Prognosis for Stage C DCM Breeds besides Dobermans

A
  • 6-12 months
73
Q

Monitoring for DCM

A
  • Ideally monitor with echocardiogram

- Ideally at least yearly, possibly more if very severe (up to 6 months)

74
Q

Arrhythmogenic right ventricular cardiomyopathy breed

A
  • Boxers
75
Q

Arrhythmogenic right ventricular cardiomyopathy - which side of the heart is most often impacted?

A
  • Right sided disease
76
Q

Arrhythmogenic right ventricular cardiomyopathy - features of dsisease

A
  • Arrhythmias (most often ventricular)

- Syncope and/or sudden death

77
Q

Etiology of Arrhythmogenic right ventricular cardiomyopathy

A
  • Idiopathic, suspect genetic
78
Q

Histologic characterization of Arrhythmogenic right ventricular cardiomyopathy

A
  • Fibro-fatty replacement of myocytes
79
Q

Pathophysiologic effects of Arrhythmogenic right ventricular cardiomyopathy

A
  • Systolic and diastolic dysfunction
  • Cannot conduct electricity as well
  • Likely due to fat replacement of myoctes
80
Q

Diagnosis of Arrhythmogenic right ventricular cardiomyopathy

A
  • Holter monitor

- Echocardiogram

81
Q

Normal amount of VPCs in 24 hours for regular dogs and Boxer dogs

A
  • <50 VPCs in 24 hours

- Boxer should have <100 VPCs

82
Q

Treatment for Arrhythmogenic right ventricular cardiomyopathy if just arrhythmias

A
  • Mexiletine

- Sotalol

83
Q

Arrhythmogenic right ventricular cardiomyopathy Treatment if just CHF/Systolic dysfunction

A
  • Furosemide
  • Pimobendan
  • ACE inhibitor
  • +/- Spironolactone
84
Q

Arrhythmogenic right ventricular cardiomyopathy Treatment if CHF and arrhythmias

A
  • Mexiletine
  • Sotalol
  • Furosemide
  • Pimobendan
  • ACE inhibitor
  • +/- spironolactone
85
Q

Prognosis for Arrhythmogenic right ventricular cardiomyopathy if just arrhythmias

A
  • Guarded

- Syncope and sudden death

86
Q

Prognosis for Arrhythmogenic right ventricular cardiomyopathy if systolic dysfunction and CHF

A
  • Guarded
  • 3-6 months
  • Often will get ascites

Cardiology and Respiratory SA Med (15 decks)

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