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SAM 1 > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Do older or younger dogs get congenital conditions? Acquired conditions?

A

Young = congenital (aortic stenosis)

Old = acquired (endocardiosis, DCM)

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2
Q

What is a common condition found in large breed dogs? Small breed dogs?

A

Large = DCM

Small = endocardiosis

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3
Q

Coughing is associated with what condition?

A

LCHF

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4
Q

What are some common causes of dyspnea?

A

Pulmonary edema

Pleural effusion from LCHF

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5
Q

What are common causes of syncope?

A

Heart failure

Arrhythmias

Stenosis

Low BP

Drugs

Hypoglycemia

Vasovagal

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6
Q

What are common causes of ascites?

A

RCHF

Liver disease

Hypoalbuminemia

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7
Q

T/F: Temperature is usually normal or low with cardiac conditions.

A

True

Can be elevated with myocarditis, valvular endocarditis, or hyperthyroid

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8
Q

What are common causes of tachycardia?

A

Heart failure

Fear

Excitement

Exercise

Pain

Elevated temp

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9
Q

What are common causes of bradycardia?

A

Sleep

Excessive parasympathetic tone

Conduction system disease

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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

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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)

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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

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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

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14
Q

What are causes of pale mucous membranes?

A

Fear

LHF

Shock

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15
Q

What are causes of cyanotic mucous membranes?

A

R-L shunt

Severe LHF

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16
Q

What are causes of brick red mucous membranes?

A

Erythrocytosis

R-L shunt

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17
Q

What would cause an increased CRT?

A

Decreased LV output

Peripheral vasoconstriction

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18
Q

Where should you listen for the apical beat?

A

5-6 intercostal space

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19
Q

What would cause the apical beat to be stronger than normal?

A

Anemia

Pyrexia

Excitement

Fear

Pain

Hyperthyroid

Shunts

Enlargement

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20
Q

What would cause the apical beat to be weaker than normal?

A

Shock

Heart failure

Obesity

Emphysema

Lung tumors

Diaphragmatic hernias

Effusions

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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

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22
Q

What causes the S1 heart sound (lub)?

A

Closure of the AV valves

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23
Q

What causes the S2 heart sound (dub)?

A

Closure of the aortic and pulmonic valves

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24
Q

What would cause the S3 heart sound?

A

Rapid passive ventricular filling due to massive LV enlargement

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25
Q

What would cause the S4 heart sound?

A

Contraction of the atria

HCM in cats

Ventricular hypertrophy from aortic stenosis in dogs

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26
Q

What heart sounds do you hear in a protodiastolic gallop?

A

S1, S2, S3

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27
Q

What heart sounds will you hear with a presystolic gallop?

A

S4, S1, S2

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28
Q

What would cause a split S1 heart sound?

A

Left and right AV valves closing at different times due to a conduction issue or a pulmonary arterial pressure issue

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29
Q

What would cause a split S2 heart sound?

A

Aortic and pulmonic valves closing at different times

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30
Q

What is the significance of a systolic click?

A

Early sign of mitral valve degeneration

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31
Q

What would cause you to hear a murmur?

A

Narrowing of vessel

Valve insufficiency

Decreased blood viscosity

Increased blood flow rate

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32
Q

When do you hear a systolic murmur?

A

Between S1 and S2

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33
Q

When do continuous murmurs occur?

A

During systole and diastole

“Washing machine sound”

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34
Q

Grade the murmur:

Soft, one area, heard after long ascultation

A

Grade 1

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35
Q

Grade the murmur:

Soft, small area, heard after a few seconds

A

Grade 2

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36
Q

Grade the murmur:

Louder, woder area, heard immediately

A

Grade 3

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37
Q

Grade the murmur:

Heard on both sides

A

Grade 4

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38
Q

Grade the murmur:

Palpable thrill

A

Grade 5

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39
Q

Grade the murmur:

Loud, dont need stethoscope on chest, heard throughout entire thorax, palpable thrill

A

Grade 6

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40
Q

What is the intensity of a murmur caused by aortic stenosis?

A

Crescendo-decrescendo

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41
Q

What is the intensity of a murmur caused by AV insufficiency?

A

Plateau

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42
Q

On abdominal palpation, what would cause the liver edges to be rounded?

A

RCHF

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43
Q

What would cause distension of peripheral vessels such as the jug?

A

RCHF

Pericardial effusion

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44
Q

T/F: Radiographs are not necessary with heart conditions?

A

False

They should be taken with all abnormalities

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45
Q

What are some uses of ECG?

A

Measure electrical potentials

Characterizing arrhythmias and conduction issues

Chamber size, hypoxia

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46
Q

What are some common uses of echocardiograms?

A

Size and motion of chambers

Doppler to detect blood flow

Contractility, distensibility, CO

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47
Q

When accessing the left heart by catheterization or angiocardiography, what vessels can you use?

A

Carotid artery

Femoral artery

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48
Q

When accessing the right heart using catheterization or angiocardiography, what vessels can you use?

A

Jugular vein

Femoral vein

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49
Q

What are some uses of catheterization and angiocardiography?

A

Measure pressure and oxygen saturation

Trace blood flow if dye is injected

Endocardial biopsies

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50
Q

What is the advantage of using a phonocardiogram?

A

Get accurate details about murmurs and gallops

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51
Q

What position should the animal be in during an ECG?

A

Right lateral on a rubber mat

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52
Q

How many beats does the rhythm strip record?

A

15-20 beats at 50mm/s

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53
Q

At a paper speed of 25mm/s, how much is each little box worth? At 50mm/s?

A

25mm/s = 0.04s

50mm/s = 0.02s

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54
Q

For the vertical lines of an ECG, how much is each little box worth?

A

0.1mV at 1cm/mV

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55
Q

What is a normal dog heart rate?

A

70-160

Toys = <180

Puppies = <220

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56
Q

What is a normal heart rate for a cat?

A

120-240

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57
Q

What is the normal MEA of a dog?

A

+40 to +100

58
Q

What is the normal MEA for a cat?

A

0 to +160

59
Q

How do you calculate the MEA?

A

Height of the Q wave + height of the R wave

60
Q

What does it mean if the MEA is too high? Too low?

A

Too high = RV enlargement or right bundle branch block

Too los = LV enlargement or left bundle branch block

61
Q

What do you use to determine atrial size?

A

P wave duration and amplitude

62
Q

What does it mean if the P wave is too wide? What is the cut off?

A

LA enlargement

>0.04s

63
Q

What does it mean if the P wave is too high? What is the cut off?

A

RA enlargement

dog = >0.4mV

cat = >0.2mV

64
Q

What does it mean if the P wave it too tall and too wide?

A

Bilateral atrial enlargement

65
Q

What do you use to determine ventricular size?

A

Amplitude and duration of the QRS complex

66
Q

In dogs, what does it mean if the R wave is increased? What is the cut off?

A

LV enlargement

Small dog = >2.5mV

Large dog = >3mV

67
Q

In dogs, what does it mean if the QRS is wider than normal? What is the cut off?

A

LV enlargement

Small dog = >0.05s

Large dog = >0.06s

68
Q

In dogs, what does it mean if the MEA is too low?

A

LV enlargement

69
Q

In cats, what is the only way to diagnose LV enlargement? what is the cut off?

A

R wave too high

>0.9mV

70
Q

How would you diagnose LV enlargement in the dog?

A

Increased R voltage

Increased QRS width

Low MEA

71
Q

How would you diagnose RV enlargement in a dog?

A

S wave higher than 0.35mV

MEA > 100

72
Q

How would you diagnose RV enlargement in a cat?

A

MEA > 160

73
Q

T/F: It is not possible to detect biventricular enlargement

A

True

74
Q

What does it mean if the QRS widens because of a large wide S wave?

A

Right bundle branch block

75
Q

What are your DDx for a right bundle branch block?

A

RV enlargement

VPD

76
Q

If your patient has a left bundle branch block, what would you see on the ECG?

A

Prolonged QRS

77
Q

What are your DDx for a left bundle branch block?

A

LV enlargement

VPC

78
Q

What are some causes of a low voltage QRS complex?

A

Obesity

Effusions

Hypothyroid

Pneumothorax

Diffuse myocardial disease

79
Q

When the S-T segment is either below or above the baseline, what does that tell you?

A

Myocardial ischemia

Also seen with wide QRS, tall T, and notched R

80
Q

What does the Q-T interval tell us? What is the normal value in dogs and cats?

A

Tells us calcium and potassium levels

Dogs = 0.15-0.25s

Cats = 0.12-0.18s

81
Q

What does a tall and spiked T wave tell us? What are the normal values for dogs and cats?

A

Hyperkalemia

Dogs = 1/4 R wave

Cats = <0.3mV

82
Q

Define heart failure

A

When cardiac output can’t meet tissue needs

83
Q

What is the compensation mechanism for decreased CO?

A

Decreased BP -> baroreceptors -> SNS activated -> increased inotropy, chronotropy, and constriction

84
Q

Describe the compensation mechanism if there is continuous depression of CO

A

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
Q

What arrhythmia is this?

What abnormalities do you see?

A

Wandering atrial pacemaker

P-R interval decreased/variable

P wave amplitude variable (can go negative)

86
Q

What arrhythmia is this?

What abnormalities do you see?

A

Sinus arrhythmia

R-R interval varies

87
Q

What arrhythmia is this?

What abnormalities do you see?

A

Sinus bradycardia

Long time between beats

Asystole for >6-8s can cause weakness and syncope

88
Q

What arrhythmia is this?

What abnormalities do you see?

A

Sinus arrest

Missing beat(s)

If no beat for >6s can cause weakness, ataxia, and syncope

89
Q

What is the cause of this arrhythmia?

What abnormalities do you see?

A

Hyperkalemia

Bradycardia

Tall, spikey T waves

Smaller P waves

Wide QRS (R wave reduced)

90
Q

What arrhythmia is this?

What abnormalities do you see?

A

First degree AV block

Prolonged P-R

91
Q

What arrhythmia is this?

What abnormalities do you see?

A

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
Q

What arrhythmia is this?

What abnormalities do you see?

A

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
Q

What arrhythmia is this?

What abnormalities do you see?

A

Sick Sinus Syndrome

Sinus bradycardia

Sinus arrest/block

Long periods of asystole

escape beats

Can have tachycardia appear between periods of brady/asystole

94
Q

What arrhythmia is this?

What abnormalities do you see?

A

Supraventricular premature depolarizations (SPD) and atrial tachy

Premature and variable P wave (may be in T wave)

Normal QRS

270 bpm

95
Q

What arrhythmia is this?

What abnormalities do you see?

A

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
Q

What arrhythmia is this?

What abnormalities do you see?

A

Ventricular tachycardia

Runs of 3+ VPDs

>160 bpm

Capture beats

Fusion beats

>30s = sustained VT

97
Q

What arrhythmia is this?

What abnormalities do you see?

A

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
Q

What arrhythmia is this?

What abnormalities do you see?

A

Ventricular fibrillation

Irregular, disorganized

Baseline zigzagged -> flatline

99
Q

What arrhythmia is this?

What abnormalities do you see?

A

Atrial fibrillation

Chaotic heart sounds

No P waves

Normal QRS

Random R-R intervals

100
Q

T/F: Congenital anomalies are more common in cats than dogs?

A

False

More common in dogs than cats

101
Q

When are most congenital anomalies noticed?

A

At first vaccinatino

102
Q

How old does an animal have to be in order to be certified free of congenital heart disease?

A

12 months

103
Q

What are the most common congenital heart diseases in dogs?

A

PDA

Pulmonic stenosis

Aortic stenosis

VSD

104
Q

What are the most common congenital heart diseases in cats?

A

AV valve malformation

VSD

Aortic stenosis

Endocardial fibroelastosis

PDA

Tetralogy of fallot

105
Q

What two vessels does a PDA connect?

A

Aorta and pulmonary artery

106
Q

What is the direction of blood flow in a L-R PDA?

A

Aorta to pulmonary artery

107
Q

In a L-R PDA there is volume overload of the left heart. What does this cause?

A

Eccentric hypertrophy and LCHF

108
Q

What causes a L-R PDA to become a R-L PDA?

A

Pulmonary resistance gets too high

109
Q

At what age will a L-R PDA become a R-L PDA?

A

6-8 weeks

110
Q

With a R-L PDA there is overcirculation of the right heart. What does this cause?

A

Hypertrophy of the RV and RCHF

111
Q

In which PDA is deoxygenated blood pumped to the body? What is the body’s mechanism to overcome this?

A

R-L PDA

Kidneys release EPO -> erythrocytosis and hyper viscosity

112
Q

What breeds most commonly have PDA?

A

Toy and mini poodles, GSD

Polygenic trait in poodles

113
Q

T/F: PDA is more common in females than males

A

True

3:1 female:male

114
Q

What will the heart sound like during PE for a dog with PDA?

A

Machinery murmur loudest forward of heart base

Can feel a thrill

115
Q

Describe the pulse in a dog with PDA

A

Water hammer femoral pulse due to wide pulse pressure

(Systolic pressure high from volume overload)

116
Q

With which PDA can you see cyanosis caudally but not cranially?

A

R-L

117
Q

What is the difference in the blood gas levels between a L-R and a R-L PDA?

A

Normal for L-R

Low for R-L (causes erythrocytosis)

118
Q

What will you see on a radiograph of a dog with L-R PDA?

A

Left heart enlargement

Lung vessels prominent

119
Q

What will you see on a radiograph of a dog with R-L PDA?

A

Right heart enlargement

Lungs appear under perfused

120
Q

When doing an echo on a dog with PDA, what will you see on the doppler?

A

Turbulence in pulmonary artery just distal to the pulmonic valve

121
Q

What will you see on an EKG of a dog with PDA?

A

Enlargement of ventricles

Arrhythmias with severe cases

122
Q

How do you treat a L-R PDA?

A

Surgery

Close with umbilical tape, embolization coil, or amplatz canine duct occluders

123
Q

How do you treat a dog with a R-L PDA?

A

Can only treat with medical management

Control erythrocytosis by removing blood and adding saline

124
Q

What is the prognosis of a dog with L-R PDA?

A

Die within 1 year/heart failure by 16 months with no treatment

If they survive surgery = excellent

125
Q

What is the prognosis of a dog with R-L PDA?

A

Maintained medically for 3-5 years

126
Q

With aortic stenosis, when will you see fibrocartilagenous CT?

A

3-8 weeks

127
Q

Which type of aortic stenosis is most common in dogs? Cats?

A

Subvalvular in dogs

Supravalvular in cats

128
Q

Describe the pathophysiology of aortic stenosis

A

Increased afterload -> LV concentric hypertrophy -> reduced distensibility -> decreased filling and CO -> decreased coronary bloof flow despite increased MVO2

129
Q

What are the common clinical signs of aortic stenosis?

A

Exertional syncope

Sudden death from arrhythmias

Signs are rare for LCHF

130
Q

Describe the heart sounds heard for aortic stenosis

A

Systolic murmur loudest over the left heart base

Murmur all the way through carotids and right hemithorax

131
Q

Describe the femoral pulse with aortic stenosis

A

Hypokinetic

Hyperkinetic if aortic insufficiency and regurg

132
Q

What will the radiograph look like of a dog with aortic stenosis

A

Normal

+/- dilation of ascending aorta w/ LV and LA enlargement

133
Q

What will you see on Angiography of a dog with aortic stenosis?

A

Small LV cavity

Subvalvular obstruction

Post stenotic dilation

134
Q

What will you see on an echo of a dog with aortic stenosis?

What velocities on the doppler indicate mild/moderate/severe disease?

A

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
Q

What wil you see on an ECG of a dog with aortic stenosis?

A

Normal

LV enlargement

ST depression

VPDs

136
Q

How would you treat aortic stenosis?

A

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
Q

T/F: In regards to pulmonic stenosis, valvular is the most common

A

True

138
Q

What changes in the heart are commonly see in dogs with pulmonic stenosis?

A

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
Q

What breeds most commonly get pulmonic stenosis?

A

English Bulldog, Scottish Terriers, Mini Schnauzers, Wire-haired Fox Terriers

Polygenic in Beagles

140
Q
A

SAM 1 (4 decks)

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