Test 1 Flashcards
1
Q
Do older or younger dogs get congenital conditions? Acquired conditions?
A
Young = congenital (aortic stenosis)
Old = acquired (endocardiosis, DCM)
2
Q
What is a common condition found in large breed dogs? Small breed dogs?
A
Large = DCM
Small = endocardiosis
3
Q
Coughing is associated with what condition?
A
LCHF
4
Q
What are some common causes of dyspnea?
A
Pulmonary edema
Pleural effusion from LCHF
5
Q
What are common causes of syncope?
A
Heart failure
Arrhythmias
Stenosis
Low BP
Drugs
Hypoglycemia
Vasovagal
6
Q
What are common causes of ascites?
A
RCHF
Liver disease
Hypoalbuminemia
7
Q
T/F: Temperature is usually normal or low with cardiac conditions.
A
True
Can be elevated with myocarditis, valvular endocarditis, or hyperthyroid
8
Q
What are common causes of tachycardia?
A
Heart failure
Fear
Excitement
Exercise
Pain
Elevated temp
9
Q
What are common causes of bradycardia?
A
Sleep
Excessive parasympathetic tone
Conduction system disease
10
Q
What is it called when the pulse is large, strong, and the artery is distended?
A
Hyperkinetic pulse
Can be caused by exerceise or anemia
11
Q
What is it called when the pulse is small, weak, short, and easily blocked with your finger?
A
Hypokinetic pulse
Can be caused by decreased LV stroke volume (DCM, shock, aortic stenosis, pericardial effusion)
12
Q
What is it called when there is a big difference between systolic and diastolic pressure?
A
Waterhammer pulse
Can be caused by AV shunt or severe anemia
13
Q
What is it called when there is a difference in pulse pressure from pulse to pulse?
A
Alternating pulse
Can be caused by atrial fib
14
Q
What are causes of pale mucous membranes?
A
Fear
LHF
Shock
15
Q
What are causes of cyanotic mucous membranes?
A
R-L shunt
Severe LHF
16
Q
What are causes of brick red mucous membranes?
A
Erythrocytosis
R-L shunt
17
Q
What would cause an increased CRT?
A
Decreased LV output
Peripheral vasoconstriction
18
Q
Where should you listen for the apical beat?
A
5-6 intercostal space
19
Q
What would cause the apical beat to be stronger than normal?
A
Anemia
Pyrexia
Excitement
Fear
Pain
Hyperthyroid
Shunts
Enlargement
20
Q
What would cause the apical beat to be weaker than normal?
A
Shock
Heart failure
Obesity
Emphysema
Lung tumors
Diaphragmatic hernias
Effusions
21
Q
T/F: The bell of the stethoscope picks up high frequencies?
A
False
It picks up low frequencies and the diaphragm picks up high frequencies
22
Q
What causes the S1 heart sound (lub)?
A
Closure of the AV valves
23
Q
What causes the S2 heart sound (dub)?
A
Closure of the aortic and pulmonic valves
24
Q
What would cause the S3 heart sound?
A
Rapid passive ventricular filling due to massive LV enlargement
25
What would cause the S4 heart sound?
Contraction of the atria
HCM in cats
Ventricular hypertrophy from aortic stenosis in dogs
26
What heart sounds do you hear in a protodiastolic gallop?
S1, S2, S3
27
What heart sounds will you hear with a presystolic gallop?
S4, S1, S2
28
What would cause a split S1 heart sound?
Left and right AV valves closing at different times due to a conduction issue or a pulmonary arterial pressure issue
29
What would cause a split S2 heart sound?
Aortic and pulmonic valves closing at different times
30
What is the significance of a systolic click?
Early sign of mitral valve degeneration
31
What would cause you to hear a murmur?
Narrowing of vessel
Valve insufficiency
Decreased blood viscosity
Increased blood flow rate
32
When do you hear a systolic murmur?
Between S1 and S2
33
When do continuous murmurs occur?
During systole and diastole
"Washing machine sound"
34
Grade the murmur:
Soft, one area, heard after long ascultation
Grade 1
35
Grade the murmur:
Soft, small area, heard after a few seconds
Grade 2
36
Grade the murmur:
Louder, woder area, heard immediately
Grade 3
37
Grade the murmur:
Heard on both sides
Grade 4
38
Grade the murmur:
Palpable thrill
Grade 5
39
Grade the murmur:
Loud, dont need stethoscope on chest, heard throughout entire thorax, palpable thrill
Grade 6
40
What is the intensity of a murmur caused by aortic stenosis?
Crescendo-decrescendo
41
What is the intensity of a murmur caused by AV insufficiency?
Plateau
42
On abdominal palpation, what would cause the liver edges to be rounded?
RCHF
43
What would cause distension of peripheral vessels such as the jug?
RCHF
Pericardial effusion
44
T/F: Radiographs are not necessary with heart conditions?
False
They should be taken with all abnormalities
45
What are some uses of ECG?
Measure electrical potentials
Characterizing arrhythmias and conduction issues
Chamber size, hypoxia
46
What are some common uses of echocardiograms?
Size and motion of chambers
Doppler to detect blood flow
Contractility, distensibility, CO
47
When accessing the left heart by catheterization or angiocardiography, what vessels can you use?
Carotid artery
Femoral artery
48
When accessing the right heart using catheterization or angiocardiography, what vessels can you use?
Jugular vein
Femoral vein
49
What are some uses of catheterization and angiocardiography?
Measure pressure and oxygen saturation
Trace blood flow if dye is injected
Endocardial biopsies
50
What is the advantage of using a phonocardiogram?
Get accurate details about murmurs and gallops
51
What position should the animal be in during an ECG?
Right lateral on a rubber mat
52
How many beats does the rhythm strip record?
15-20 beats at 50mm/s
53
At a paper speed of 25mm/s, how much is each little box worth? At 50mm/s?
25mm/s = 0.04s
50mm/s = 0.02s
54
For the vertical lines of an ECG, how much is each little box worth?
0.1mV at 1cm/mV
55
What is a normal dog heart rate?
70-160
Toys = \<180
Puppies = \<220
56
What is a normal heart rate for a cat?
120-240
57
What is the normal MEA of a dog?
+40 to +100
58
What is the normal MEA for a cat?
0 to +160
59
How do you calculate the MEA?
Height of the Q wave + height of the R wave
60
What does it mean if the MEA is too high? Too low?
Too high = RV enlargement or right bundle branch block
Too los = LV enlargement or left bundle branch block
61
What do you use to determine atrial size?
P wave duration and amplitude
62
What does it mean if the P wave is too wide? What is the cut off?
LA enlargement
\>0.04s
63
What does it mean if the P wave is too high? What is the cut off?
RA enlargement
dog = \>0.4mV
cat = \>0.2mV
64
What does it mean if the P wave it too tall and too wide?
Bilateral atrial enlargement
65
What do you use to determine ventricular size?
Amplitude and duration of the QRS complex
66
In dogs, what does it mean if the R wave is increased? What is the cut off?
LV enlargement
Small dog = \>2.5mV
Large dog = \>3mV
67
In dogs, what does it mean if the QRS is wider than normal? What is the cut off?
LV enlargement
Small dog = \>0.05s
Large dog = \>0.06s
68
In dogs, what does it mean if the MEA is too low?
LV enlargement
69
In cats, what is the only way to diagnose LV enlargement? what is the cut off?
R wave too high
\>0.9mV
70
How would you diagnose LV enlargement in the dog?
Increased R voltage
Increased QRS width
Low MEA
71
How would you diagnose RV enlargement in a dog?
S wave higher than 0.35mV
MEA \> 100
72
How would you diagnose RV enlargement in a cat?
MEA \> 160
73
T/F: It is not possible to detect biventricular enlargement
True
74
What does it mean if the QRS widens because of a large wide S wave?
Right bundle branch block
75
What are your DDx for a right bundle branch block?
RV enlargement
VPD
76
If your patient has a left bundle branch block, what would you see on the ECG?
Prolonged QRS
77
What are your DDx for a left bundle branch block?
LV enlargement
VPC
78
What are some causes of a low voltage QRS complex?
Obesity
Effusions
Hypothyroid
Pneumothorax
Diffuse myocardial disease
79
When the S-T segment is either below or above the baseline, what does that tell you?
Myocardial ischemia
Also seen with wide QRS, tall T, and notched R
80
What does the Q-T interval tell us? What is the normal value in dogs and cats?
Tells us calcium and potassium levels
Dogs = 0.15-0.25s
Cats = 0.12-0.18s
81
What does a tall and spiked T wave tell us? What are the normal values for dogs and cats?
Hyperkalemia
Dogs = 1/4 R wave
Cats = \<0.3mV
82
Define heart failure
When cardiac output can't meet tissue needs
83
What is the compensation mechanism for decreased CO?
Decreased BP -\> baroreceptors -\> SNS activated -\> increased inotropy, chronotropy, and constriction
84
Describe the compensation mechanism if there is continuous depression of CO
Continuous depression of CO -\> decreased renal blood flow -\> RAAS stimulation -\> angiotensin 2 -\> vasoconstriction -\> aldosterone -\> sodium and water retention -\> increased blood volume -\> increased venous return
85
What arrhythmia is this?
What abnormalities do you see?
Wandering atrial pacemaker
P-R interval decreased/variable
P wave amplitude variable (can go negative)
86
What arrhythmia is this?
What abnormalities do you see?
Sinus arrhythmia
R-R interval varies
87
What arrhythmia is this?
What abnormalities do you see?
Sinus bradycardia
Long time between beats
Asystole for \>6-8s can cause weakness and syncope
88
What arrhythmia is this?
What abnormalities do you see?
Sinus arrest
Missing beat(s)
If no beat for \>6s can cause weakness, ataxia, and syncope
89
What is the cause of this arrhythmia?
What abnormalities do you see?
Hyperkalemia
Bradycardia
Tall, spikey T waves
Smaller P waves
Wide QRS (R wave reduced)
90
What arrhythmia is this?
What abnormalities do you see?
First degree AV block
Prolonged P-R
91
What arrhythmia is this?
What abnormalities do you see?
2° AV block
Mobitz 1 = PR widens with each beat and eventually the QRS will be dropped
Mobitz 2 = no change in PR and the QRS drops suddenly
High grade = 2:1 or 3:1 P:R ratio, cant tell if PR is prolonged
92
What arrhythmia is this?
What abnormalities do you see?
3° AV block
P wave normal
QRS are escape beats from junctional or ventricular pacemakers
Junctional = normal QRS, 40-60 bpm
Ventricular = weird QRS, \<40 bmp
93
What arrhythmia is this?
What abnormalities do you see?
Sick Sinus Syndrome
Sinus bradycardia
Sinus arrest/block
Long periods of asystole
escape beats
Can have tachycardia appear between periods of brady/asystole
94
What arrhythmia is this?
What abnormalities do you see?
Supraventricular premature depolarizations (SPD) and atrial tachy
Premature and variable P wave (may be in T wave)
Normal QRS
270 bpm
95
What arrhythmia is this?
What abnormalities do you see?
Ventricular premature depolarization (VPD/VPC)
Premature QRS, wide and bizarre
RV VPD = positive QRS
LV VPD = negative QRS
No P wave
Bigeminy - every second beat is a VPD
Dropped S2
R on T phenomenon and runs of VPDs increase chance of death
96
What arrhythmia is this?
What abnormalities do you see?
Ventricular tachycardia
Runs of 3+ VPDs
\>160 bpm
Capture beats
Fusion beats
\>30s = sustained VT
97
What arrhythmia is this?
What abnormalities do you see?
Accelerated idioventricular rhythm/idioventricular tachycardia
Spontaneous ventricular depolarization at 160-180 bpm
Capture and fusion beats
P waves sometimes really close to QRS or sometimes really early - capture/fusion beats
QRS normal or wide and bizarre
98
What arrhythmia is this?
What abnormalities do you see?
Ventricular fibrillation
Irregular, disorganized
Baseline zigzagged -\> flatline
99
What arrhythmia is this?
What abnormalities do you see?
Atrial fibrillation
Chaotic heart sounds
No P waves
Normal QRS
Random R-R intervals
100
T/F: Congenital anomalies are more common in cats than dogs?
False
More common in dogs than cats
101
When are most congenital anomalies noticed?
At first vaccinatino
102
How old does an animal have to be in order to be certified free of congenital heart disease?
12 months
103
What are the most common congenital heart diseases in dogs?
PDA
Pulmonic stenosis
Aortic stenosis
VSD
104
What are the most common congenital heart diseases in cats?
AV valve malformation
VSD
Aortic stenosis
Endocardial fibroelastosis
PDA
Tetralogy of fallot
105
What two vessels does a PDA connect?
Aorta and pulmonary artery
106
What is the direction of blood flow in a L-R PDA?
Aorta to pulmonary artery
107
In a L-R PDA there is volume overload of the left heart. What does this cause?
Eccentric hypertrophy and LCHF
108
What causes a L-R PDA to become a R-L PDA?
Pulmonary resistance gets too high
109
At what age will a L-R PDA become a R-L PDA?
6-8 weeks
110
With a R-L PDA there is overcirculation of the right heart. What does this cause?
Hypertrophy of the RV and RCHF
111
In which PDA is deoxygenated blood pumped to the body? What is the body's mechanism to overcome this?
R-L PDA
Kidneys release EPO -\> erythrocytosis and hyper viscosity
112
What breeds most commonly have PDA?
Toy and mini poodles, GSD
Polygenic trait in poodles
113
T/F: PDA is more common in females than males
True
3:1 female:male
114
What will the heart sound like during PE for a dog with PDA?
Machinery murmur loudest forward of heart base
Can feel a thrill
115
Describe the pulse in a dog with PDA
Water hammer femoral pulse due to wide pulse pressure
(Systolic pressure high from volume overload)
116
With which PDA can you see cyanosis caudally but not cranially?
R-L
117
What is the difference in the blood gas levels between a L-R and a R-L PDA?
Normal for L-R
Low for R-L (causes erythrocytosis)
118
What will you see on a radiograph of a dog with L-R PDA?
Left heart enlargement
Lung vessels prominent
119
What will you see on a radiograph of a dog with R-L PDA?
Right heart enlargement
Lungs appear under perfused
120
When doing an echo on a dog with PDA, what will you see on the doppler?
Turbulence in pulmonary artery just distal to the pulmonic valve
121
What will you see on an EKG of a dog with PDA?
Enlargement of ventricles
Arrhythmias with severe cases
122
How do you treat a L-R PDA?
Surgery
Close with umbilical tape, embolization coil, or amplatz canine duct occluders
123
How do you treat a dog with a R-L PDA?
Can only treat with medical management
Control erythrocytosis by removing blood and adding saline
124
What is the prognosis of a dog with L-R PDA?
Die within 1 year/heart failure by 16 months with no treatment
If they survive surgery = excellent
125
What is the prognosis of a dog with R-L PDA?
Maintained medically for 3-5 years
126
With aortic stenosis, when will you see fibrocartilagenous CT?
3-8 weeks
127
Which type of aortic stenosis is most common in dogs? Cats?
Subvalvular in dogs
Supravalvular in cats
128
Describe the pathophysiology of aortic stenosis
Increased afterload -\> LV concentric hypertrophy -\> reduced distensibility -\> decreased filling and CO -\> decreased coronary bloof flow despite increased MVO2
129
What are the common clinical signs of aortic stenosis?
Exertional syncope
Sudden death from arrhythmias
Signs are rare for LCHF
130
Describe the heart sounds heard for aortic stenosis
Systolic murmur loudest over the left heart base
Murmur all the way through carotids and right hemithorax
131
Describe the femoral pulse with aortic stenosis
Hypokinetic
Hyperkinetic if aortic insufficiency and regurg
132
What will the radiograph look like of a dog with aortic stenosis
Normal
+/- dilation of ascending aorta w/ LV and LA enlargement
133
What will you see on Angiography of a dog with aortic stenosis?
Small LV cavity
Subvalvular obstruction
Post stenotic dilation
134
What will you see on an echo of a dog with aortic stenosis?
What velocities on the doppler indicate mild/moderate/severe disease?
Concentric LV hypertrophy
Subvalvular echogenic ridge or band -\> narrowing of outclow tract
Doppler - increased velocity across aortic valve w/ regurg
1.5-3m/s = mild
\>3 = moderate
\>4.5 = severe
135
What wil you see on an ECG of a dog with aortic stenosis?
Normal
LV enlargement
ST depression
VPDs
136
How would you treat aortic stenosis?
Beta blockers for moderate/severe gradient (4m/s) or arrhythmias
Class 1 antiarrhythmics (lidocaine)
Sotalol is best choice for treatment of arrhythmias
Surgery - myectomy or balloon valvuloplasty
if CHF - diuretics, vasodilators
137
T/F: In regards to pulmonic stenosis, valvular is the most common
True
138
What changes in the heart are commonly see in dogs with pulmonic stenosis?
RV concentric hypertrophy
Ventricle can also contract causing dynamic outflow obstruction
Post-stenotic dilation
RA enlarged due to increased ventricular filling pressure
Predisposed to arrhythmias
139
What breeds most commonly get pulmonic stenosis?
English Bulldog, Scottish Terriers, Mini Schnauzers, Wire-haired Fox Terriers
Polygenic in Beagles
140
