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23 spring: med surg > Test 1: lecture 11+ 12: congenital > Flashcards

Test 1: lecture 11+ 12: congenital Flashcards

1
Q

pressure overload in heart will cause

A

concentric hypertrophy

thick, smaller volume can fit

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2
Q

what congenital outflow tract obstruction can cause pressure overload in the heart

A

Pulmonic stenosis
sub-arotic stenosis

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3
Q

high afterload can be caused by

A

systemic HTN
pulmonary HTN

leads to increased pressure in LV→ concentric hypertropy

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4
Q

clinical signs of outflow tract obstruction in heart

A

weakness and fainting, arrhythmia and sudden death

reduced ventricular filling from concentric hypertrophy

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5
Q

what types of dogs get pulmonic stenosis

A

small to medium

beagle, bulldog, boxer, spaniel, bullmastiff

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6
Q

Pulmonic stenosis (PS) refers to a dynamic or fixed anatomic obstruction to flow from the — to the — vasculature.

A

right ventricle (RV)
pulmonary arterial

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7
Q

pulmonic stenosis is caused by

A

valve issue

can sometimes be subvalvular or supravalvular obstruction as well

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8
Q

type A pulmonic stenosis

A

fusion of the leaflets

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9
Q

type B pulmonic stenosis

A

hypoplastic valve annulus and thickened leaflets

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10
Q

english bulldogs can have — coronary malformation that leads to pulmonic stenosis

A

aberrant left coronary artery that encircles PA- causes narrowing

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11
Q

clinical signs of mild to moderate Pulmonic stenosis

A

no clinical signs

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12
Q

clinical signs of severe pulmonic stenosis

A

exercise intolerance
syncope
systolic murmur 4-6/6 loudest over left 3rd ICS

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13
Q

what kind of mumur for PS

A

systolic murmur
4-6/6 loudest over left 3rd ICS

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14
Q

physical exam of PS
murmur, pulse, membranes?

A

Systolic murmur 4-6/6 loudest over left 3rd ICS
* Arterial pulses: normal
* Mucous membranes: pink
* Ascites (rare)

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15
Q

xray of PS will show

A

bulge at pulmonic artery (post stenotic bulge)

reverse D: enlargement of the RV

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16
Q

PS will have — velocity

A

high: 6.5 m/s

measured with doppler

bernoulli equation will meaure pressure difference between right ventricle and pulmonary artery

pressure gradient: 4x velocity²
4 x (6.5^2)= 170 mmHg

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17
Q

normal velocity of blood past pulmonic valve

A

1-2 m/s

PS will cause increased velocity

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18
Q

prognosis of mild PS

A

mild (0-50 mmHg)= no intervention,

can treat with beta blocker to decrease HR during exercise and reduce RV hypertrophy

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19
Q

prognosis of moderate PS

A

moderate 50-85 mmHg
+/- valvuloplasty

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20
Q

prognosis of severe PS

A

> 85 mmHg
death in 1 year without intervention
balloon dilation valvuloplasty

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21
Q

english bulldogs and some boxers can have a anamolous — arising from a single — associated with PS

A

left main coronary artery
single right coronary artery

artery can rupture during valvuloplasty

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22
Q

breeding advice for PS

A

do not breed
watch siblings

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23
Q

— is the most common heart defect in dogs

A

subaortic and aortic stenosis

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24
Q

what breeds will get subaortic stenosis and aortic stenosis

A

golden, newfoundland, boxer, german shepherd, rotti, bull terrier, bloodhound

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25
Q

breeding of SAS

A

mild SAS affected parents can produce severely affected pups

Do not recommend breeding

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26
Q

what is subvalvular aortic stenosis

A

ridge below the aortic valve causes narrowing

heart has to work harder to pump, which leads to permanent long term damage

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27
Q

SAS severe clinical signs

A

exercise intolerance, syncope, sudden death

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28
Q

Subvavlular aortic stenosis physical exam

A

systolic murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries

murmur appears/increases until 1 year old

femoral pulses can be weak if severe stenosis

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29
Q

murmur of SAS

A

systolic murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries

can get worse until full grown (1 year old)

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30
Q

why will echo have bright sections with SAS

A

increased pressure causes increased work and increased oxygen requirement

leads to ischemia→ fibrosis which is white on echo

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31
Q

how to measure pressure in LV if peak flow is 5.24m/s

A

4 x (5.24)²
=109 mmHg

109= LV-aorta
assume aortic pressure is 120

LV= 109+120=229 mmHg

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32
Q

prognosis of SAS mild

A

<50 mmHg
good prognosis, no intervention needed

normal life span

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33
Q

prognosis for SAS moderate

A

50-80 mmHg

normal: 10 years+

34
Q

prognosis of sever SAS

A

80-130 mmHg

3 years vs 8 years if graduent less then 133

35
Q

severe SAS over 130 mmHg will have what prognosis

A

70% mortality in 3 years

36
Q

treatment of severe SAS

A

can do surgery or balloon

but does not actually lengthen life span, may improve quality of life

37
Q

complications of SAS

A

sudden death from arrhythmias
infective endocarditis on the aortic valve
CHF

38
Q

Dogs with mild and moderate SAS (— mmHg) have a good long- term prognosis with a normal or near-normal life expectancy.

A

< 80

39
Q

Dogs with severe disease (— mmHg) have a fair prognosis, although cardiac-death remains a possible outcome.

A

80 – 130

40
Q

Dogs with very severe SAS (— mmHg) are more likely to have a poor prognosis and are most likely to benefit from the development
of effective therapeutic interventions.

A

PG ≥ 130

41
Q

pulses for PS vs SAS

A

PS: normal

SAS: weak (takes longer to leave aortic valve)

42
Q

PDA is

A

patent ductus arteriosis

connection between PA and aorta did not close at birth

allows for left to right shunt

43
Q

what breeds get PDA

A

bichon, german shepherds, maltese, yorki

females > males

44
Q

clinical signs of PDA

A

75% no symptoms

coughing, exercise intolerance (CHF)

continuous murmur (loudest over left heart base)

bounding femoral pulse

45
Q

PDA will have — murmur

A

continuous

loudest over left heart base

46
Q

femoral pulse for PDA

A

bounding

higher pulse pressure gradient (120/40) from blood shunting back through PDA to Pulmonary artery

47
Q

Xray of PDA

A

cardiomegaly: LA and LV

pulmonary over-circulation (increased size of lobar vessels (arteries and veins) and increased vascularity )

triple bump (big aorta, PA, Left side)

48
Q

amplatz device is used for

A

close PDA

minimally invasive (through catheter)

used for medium duct

49
Q

how to repair PDA

A

small dogs: coil embolization

medium: amplatz canine duct occluder (ACDO)

german shepherd or toy breed: surgical ligation

50
Q

VSD

A

ventricular septal defect

shunt from one side of the heart to the other side

51
Q

VSD is the — most common congential defect in cats and dogs

A

cats: #1
dogs: 4th or 5th

52
Q

what breeds get VSD

A

Engl. Springer Sp., WHWT, Cocker, Engl. Bulldog, Basset Hound, Akita, Shih tzu, Husky

53
Q

what kind of murmur for VSD

A

systolic murmur loudest over the RIGHT 3rd intercostal space

54
Q

VSD will have blood flow

A

from left to right

high to low pressure

55
Q

VSD can causes

A

pulmonary overcirculation

eccentric LV hypertrophy from volume overload

+/- eccentric RV hypertrophy

dilated left atrium

56
Q

Xray of VSD

A

left sided (LV,LA) enlargement
RV enlargement
pulmonary over circulation → CHF

57
Q

echo of VSD will show

A

high velocity get from left to right

small hole may be hard to see

58
Q

treatment for VSD

A

usually no treatment

can do surgery invasive or catheter(amplatzer duct occluder ADO) if severe

59
Q

ASD

A

atrial septal defect
left to right shunting

60
Q

what kind of murmur for atrial septal defect

A

no murmur

because pressure between right and left atrium are similar

61
Q

how to treat atrial septal defects

A

small= no treatment

large: can cause volume overload and CHF:
Transcatheter occlusion for PFO and secundum defects with AMPLATZER®
Atrial Septal Occluder

open heart surgery very rare in animals

62
Q

what is complete AV canal defect

A

opening to all 4 chambers

very bad: need to fix with open heart

rarely done: high mortality

can do bubble test: will look like snow

63
Q

what can cause right to left shunt

A

reverse PDA
tetralogy of fallot
malposition of great arteries

64
Q

clinical signs of a right to left shunt

A

exercise intolerance, weakness, fainting
cyanosis

reverse PDA, tetralogy of fallot, malposition of great arteries

65
Q

reverse PDA will cause

A

right to left shunt

exercise intolerance, hind limb weakness, seizures, polycythemia

differential cyanosis (mouth pink, prepuce blue)

66
Q

how to treat reverse PDA

A

closure is not recommended

would cause right heart failure and death

phlebotomy to decrease hematocrit keep PVC > 75%

chemo to try to decrease production of RBC

low oxygen in lower half, body trys to compensate by making more RBC, can make too many and cause problems

67
Q

reverse PDA will have what murmur

A

no murmur: pressure similar

right to left shunting

68
Q

echo of reverse PDA

A

right to left

right wall will be very thick from increased pulmonary pressure

bubble test: will see airbubbles in abdominal vena cava: this means blood skipped the lungs

69
Q

tetralogy of fallot will have what 4 things

A

VSD
pulmonic stenosis/hypoplasia
overriding aorta
RV hypertrophy

70
Q

what breeds get tetralogy of fallot

A

keeshond and english bulldog

71
Q

what kind of shunt for tetralogy of fallot

A

right to left across VSD

72
Q

treatment of tetraology of fallot

A

ballon valvuloplasty for the PS

beta blockers to decrease RV hypertrophy

Phlebotomy to decrease hematocrit (PVC 70-75%)

open heart surgery

73
Q

tricuspid valve dysplasia is common in

A

labs, shepherd, great danes

74
Q

mitral valve dysplasia is common in

A

bull terrier, great dane, weimaraner

75
Q

what kind of murmur for tricuspid valve dysplasia

A

systolic murmur 2-6/6
loudest over right 3rd ICS

76
Q

symptoms of tricuspid valve dysplasia

A

systolic murmur 2-6/6 loudest over right 3rd ICS
ascites

puppy usually asymptomatic

77
Q

treatment of tricuspid valve dysplasia

A

will cause right heart failure leading to ascites

treat with diuretics, ACE-I, pimobendan, venodilators

can do open heart surgery- valve repair or replacement

78
Q

grossly tricuspid valve dysplasia will look

A

thickened, short or elongated valve with wierd chordae tendineae and papillary muscles

valve may be tethered to septum (unable to open or close)

79
Q

mitral valve dysplasia symptoms

A

CHF
cough in dogs
dyspnea in cats

80
Q

mitral valve dysplasia will cause — murmur

A

systolic and diastolic murmur over left 5-6th ICS

81
Q

mitral valve dysplasia prognosis

A

poor

causes huge LA pressure that leads to CHF very early in life

can try to manage on drugs or repair surgically

cats and dogs

23 spring: med surg (60 decks)

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