Vascular diseases Flashcards
1
Q
Why would you measure BP?
A
- Anaesthetic monitoring
- Assessing severity of disease
- Identification of hypertension
- Assessing response to drugs
2
Q
How would you measure BP?
A
- Direct - anaesthetised patient
- Indirect - doppler technique / oscillometric technique
3
Q
What can be consequences of systemic hypertension?
A
- Ocular (retinal haemorrhage, hyphaema, retinal detachment, blindness)
- Central Nervous System (Seizures, Dull & Depressed, Bad-tempered, Overt Neuro. Deficits)
- Renal (Failure, Proteinuria etc)
- Cardiac (Pressure overload causes concentric left ventricular hypertrophy; heart murmurs may be due to LVOTO or MR)
4
Q
What diseases are associated with secondary systemic hypertension?
A
- Chronic renal disease
- Hyperthyroidism (cats)
- Hyperadrenocorticism
- Diabetes mellitus
- Liver diseases
- Hypothyroidism
- Acromegaly
- Phaeochromocytoma
- Hyperaldosteronism
- Chronic anaemia (cats)
- Obesity
- CNS disease
5
Q
How would you treat systemic hypertension?
A
- Amlodipidine - calcium channel antagonist with vasuclar effect
- Protect kidneys -
– reduce glomerular capillary pressure (GCP), so reducing protein loss and also further loss of nephrons
– ACE inhibitors (e.g. Benazepril)
– ACE-I have greater vasodilator effect on efferent than afferent arteriole, so reduce GCP.
– Telmisartan (Semintra) (Angiotensin II
receptor blocker)
6
Q
What are factors of virchows triad?
A
- Circulatory stasis
- Endothelial injury
- Hypercoagulable state
- all may lead to a thrombus
7
Q
Where do cats tend to get feline arterial thrombo-embolism?
A
- Left atrium
- Travel through aorta to external iliacs = saddle thrombus
- V painful + loss of hindlegs
8
Q
What occurs in feline thromboembolism?
A
- Initial embolus
- Further platelet aggregation & adhesion
- Further activation of coagulation cascade
- Vasoconstriction of collateral vessels
= more emboli
9
Q
How would you treat FATE?
A
- Priority = analgesia - Methadone
- Clopidogrel - anti-platelet drug
- ‘clot busting’ drugs - tissue Plasminogen activator
- Heparin - anticoagulant
- Poor prognosis - 50%
10
Q
How do you prevent FATE in at-risk cats?
A
- Aspirin at low dose (every 3 days)
- Clopidogrel
- Treat cardiac disease as appropriate
- Low molecular weight heparin (LMWH) - anti-factor Xa
11
Q
What is arterial thromboembolism associated with in dogs?
A
- Not heart disease
- Endocrinopathy - cushings, hypothyroidism
12
Q
What are different types of pulmonary hypertension?
A
- Type 1 = pulmonary arterial hypertension ( Vascular changes w shunting defects + eisenmengers)
- Type 2 = Associated with left heart failure (High LA pressure)
- Type 3 = Associated with respiratory disease / hypoxia
- Type 4 = pulmonary thromboembolism
- Type 5 = parasitic = dirofilariasis
13
Q
How would you treat pulmonary hypertension?
A
- Treat underlying disease
- Sildenafil (PDE V inhibitor)
- Pimobendan?
- Pulmonary thromboembolism prevention
14
Q
How do you detect dirofilaria?
A
- Direct smear
- Knott’s test
- ELISA test
15
Q
How can you prevent dirofilaria?
A
- Selamectin
- Milbemycin
- Moxidectin
