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Doctor of Veterinary Medicine (Work in progress) > Veterinary Medicine - Cardiology > Flashcards

Veterinary Medicine - Cardiology Flashcards

1
Q

What is the drug of choice for Ventricular Tachyarrhythmia?

A

Lidocaine

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2
Q

What are our 2 main beta-channel blockers?

A

Atenolol

Esmolol

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3
Q

What is the of main advantage of Esmolol? What’s it’s brand name (A hint for the first question)

A

Very short half life

“BreviBlock”

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4
Q

Potassium channel blockers can be used for what type of Tachyarrhythmia?

A

Both SVT & Ventricular!

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5
Q

What is our main Potassium channel blocker (And name the specific preparation for Dogs)?

A

Amiodarone (“Nexterone”)

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6
Q

What are the possible side effectsdisadvantage of Amiodarone

A

Very long half life

Interaction with thyroid gland (can cause hypo hyperthyroidism)

Can cause liver failure

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7
Q

What is our main Calcium-Channel Blocker?

A

Diltiazem

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8
Q

What is the antidote in case of Diltiazem overdose?

A

CaCl

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9
Q

What is the antidote in case of AtenololEsmolol overdose?

A

Glucagon

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10
Q

A patient presents with Ventricular Fibrillation. What are the first 2 counter-measures? (In order)

A

Defibrillator

AAD: Lidocaine or Amiodarone

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11
Q

What are the 2 categories of drugs that treat Bradyarrhythmias?

A

Parasympatholytics

Sympathomimetics

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12
Q

What are 2 Parasympatholytics that we use to treat Bradyarrhythmias?

A

Atropine

Glycopyrrolate

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13
Q

What are 2 Sympathomimetics that we use to treat Bradyarrhythmias?

A

Terbutaline

Theophylline

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14
Q

What are the 3 elements that define Atrial Fibrillation?

A

Irregularly-Irregular rhythm

Tachyarrhythmia

Absence of P-waves

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15
Q

What is the definitive treatment for Bradyarrhythmias?

A

Pacemaker

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16
Q

Atrial Fibrillation - 3 Drugs (of 3 different families) for treatment

A

Atenolol (Beta-blockers)

Diltiazem (Calcium-channel blockers)

Digoxin (Increases parasympathetic input on AVN + Positive Inotrope)

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17
Q

Atrial Fibrillation - What are our 2 avenues of treatment?

A

Drugs

Defibrillation

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18
Q

What is the semi-definitive treatment for AF? Explain the “Semi” Part

A

Defibrillation

Resets the abnormal pacemaker but temporary - Can last for a couple of hours up to a year

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19
Q

What’s the difference between Atrial Fibrillation and Atrial Flutter?

A

Fibrillation - Multiple abnormal atrial pacemakers (F-Waves may or may not be present)

Flutter - Single abnormal atrial pacemaker (F-Waves present)

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20
Q

What is the Systolic & Diastolic pressures of the right atrium?

A

8 / 0(3)

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21
Q

What is the Systolic & Diastolic pressures of the left atrium?

A

8 / 0(5)

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22
Q

What is the Systolic & Diastolic pressures of the right ventricle?

A

25 / 0

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23
Q

What is the Systolic & Diastolic pressures of the main pulmonary artery?

A

25 / 10

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24
Q

What is the Systolic & Diastolic pressures of the left ventricle?

A

120 / 0

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25
Q

What is the Systolic & Diastolic pressures of the aorta?

A

120 / 80

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26
Q

Giving vasodilators will necessarily decrease BP (TF). Explain

A

No

May remain unchanged or even increase! Systemic vascular resistance may decrease, causing cardiac output to increase

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27
Q

S3 & S4 Sounds - What are the physiological meaning if either of them exist?

A

Decreased compliance of the ventricle

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28
Q

S3 - Signifies…?

A

Loss of ventricle compliance in the early & passive stage of the diastole

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29
Q

S4 - Signifies..?

A

Loss of ventricle compliance in the late & active stage of the diastole

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30
Q

Jugular pulse signifies..?

A

Severe tricuspidal regurgitation

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31
Q

Jugular distension signifies…?

A

Dangerously high pressure in the right atrium

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32
Q

Split S2 - Gives clue to the presence of…?

A

Pulmonary hypertension

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33
Q

Jugular distension. What would make you think that the pathology isn’t a life threatening emergency at this very moment?

A

1) Distension goes up only up to distal third of jugular

2) Distension disappears on Inhalation

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34
Q

Positive Hepato-Jugular reflex - Signifies…?

A

Increased right atrial pressure

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35
Q

Pulsus Paradoxus - Describe what it means and what it signifies

A

Peripheral pulse strength intensifies on Expiration and weakens on Inspiration.

Cardiac Tamponade

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36
Q

3 DDs for Bounding Pulse

A

PDA

Aortic Insufficiency

3rd Degree AV-Block

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37
Q

What is a common and normal EKG finding regarding P and QRS waves that can be found in Cats?

A

Amplitude of P Wave > R Waves

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38
Q

Wandering pacemakers - Explain the physiology

A

During inspiration, blood has a much easier time entering the atrium, thus causing a reflex that causes an increase in heart rate - leading to Sinus Arrhythmia. At the same time - It causes the right atrium to fill with a larger volume of blood as compared to expiration - causing the atrium to expand - and thus the amplitude of the P-Wave is enlarged on EKG. The opposite happens on expiration - causing a cyclical change in P-Wave amplitude.

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39
Q

Mitral Regurgitation - What are the 2 possible complications of Jet Lesion?

A

1) Pericardial Effusion

2) Atrial septal defect (ASD)

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40
Q

Mitral Regurgitation - Describe the murmur on auscultation?

A

Left Apical - Systolic - Band\Plateau shape Murmur

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41
Q

Mitral Regurgitation - Common signalment. Also, which breed tends to develop the disease the youngest?

A

Middle age - Old, small breed dogs

Cavalier King Charles Spaniel

42
Q

Mitral Regurgitation - History and Clinical signs

A

Exercise intolerance

Nocturnal restlessness

Chronic cough (Enlarged left atrium presses on the atrium)

Tachypnea, Dyspnea, Orthopnea

Pale mucus membranes

Weak peripheral pulse (Lack of perfusion)

Left apical systolic murmur

Syncope, Ascites, Peripheral edema, Jugular distension, Jugular pulsation (2nd Pulmonary hypertension)

Cardiac cachexia

43
Q

Mitral Regurgitation - The quieter the murmur - the lower the severity of the disease (TF)

A

Not necessarily

In chronic disease - Atrial pressure can be so severe that it can barely receive any more blood \ Left ventricle lost ability to contract \ Both

44
Q

Mitral Regurgitation - What are the 3 electrical abnormalities that can arise 2nd to MR?

A

Atrial fibrillation (AF)

Atrial premature complex (APC)

Ventricular premature complex (VPC)

45
Q

Mitral Regurgitation - Vertebral Hearts Score (VHS) - Upper limit in Dogs and Cats?

A

Dogs - 10.5 times the length of T4

Cats - 8.1 times the length of T4

46
Q

Mitral Regurgitation - Name all the possible radiological changes (First on DV, then Lateral)

A

DV:
L.Auricle bulges beyond the cardial silhouette

L.Ventricle enlargement

Increased opacity of the L.atrium

Lateral:
L.Atrial enlargement

Enlargement of the pulmonary veins and later in the disease the pulmonary arteries

Peri-hilar edema (Interstitial -> Alveolar)

Dorsal displacement of the left mainstem bronchi / Trachea

47
Q

3 DDs for chronic cough in old small breed dogs

A

MR Tracheobronchomalacia

Tracheal Collapse

Chronic Bronchitis

48
Q

Mitral Regurgitation - Treatment options

A

Pimobendan

ACE-i

Furosemide

Digoxin

Spironolactone

49
Q

Mitral Regurgitation - According to the EPIC study, in which stage is it recommended to start treatment? Describe the stage and what is the treatment of choice?

A

B2

Moderate cardiomegaly without clinical signs

Pimobendan

50
Q

Dilated Cardiomyopathy - Common etiologies

A

Genetic (Doberman Pinscher)

Taurine deficiency

Grain-free diet

Tachycardia-induced Cardiomyopathy (Large breeds)

51
Q

Dilated Cardiomyopathy - Systolic Diastolic dysfunction

A

Systolic

52
Q

Dilated Cardiomyopathy - Eccentric Concentric Hypertrophy

A

Eccentric Hypertrophy

53
Q

Dilated Cardiomyopathy - Signalment

A

Middle age, Medium Large breed dogs

54
Q

Dilated Cardiomyopathy - Doberman - The failure is on the leftright side

A

L-CHF

55
Q

Dilated Cardiomyopathy - Large breeds - The failure is on the leftright side

A

R-CHF (Giant Dane Dog de Bordeaux)

56
Q

Dilated Cardiomyopathy - Clinical Signs in large breeds

A

Syncope

Sarcopenia

Ascites

Jugular Distension

Positive Hepato-jugular

Tachyarrhythmias (e.g. AF)

57
Q

Dilated Cardiomyopathy - Clinical Signs

A

Chronic cough

Dyspnea, Orthopnea

Exercise Intolerance

Low-grade Murmur

Cyanosis

Pulse Deficit

58
Q

Dilated Cardiomyopathy - Possible X-ray findings

A

L.V. Enlargement

+- L.A Enlargement

Pulmonary Edema

Enlarged pulmonary vasculature

Ascites, Hepatomegaly (R-CHF)

59
Q

Dilated Cardiomyopathy - Possible EKG findings

A

QRS Amplitude Increase (L.V. Enlargement)

APCs /AF (Large Breeds - Doge De Bordeaux)

VPCs \ VT

60
Q

Dilated Cardiomyopathy - Treatment tenets + Specific drugs

A

Decrease AL : Pimobendan \ ACE-i \ Nitroprusside \ Hydralazine \ Amlodipine

Positive Inotropes: Pimobendan \ Dobutamine \ Digoxin

Decrease PL: ACE-i \ Furosemide

AAD: Digoxin \ Beta Blockers \ Calcium Channel Blockers

61
Q

Dilated Cardiomyopathy - Prognosis

A

75% of Clinical dogs - 6 months MST

62
Q

Hypertrophic Cardiomyopathy - Signalment

A

Cats - >1 year, any age

Predisposed breeds: Maine-coon, Ragdoll, British shorthair, Sphynx, Persian

63
Q

Hypertrophic Cardiomyopathy - Systolic Diastolic Dysfunction

A

Diastolic

64
Q

Hypertrophic Cardiomyopathy - Eccentric Concentric Hypertrophy

A

Concentric Hypertrophy

65
Q

Hypertrophic Cardiomyopathy - Possible Clinical Signs

A

Open-mouth breathing

Tachypnea \ Orthopnea \ Dyspnea \ Abdominal expiratory effort

Acute hind limb\s paresis \ Plegia

Syncope

66
Q

Hypertrophic Cardiomyopathy - Classic Radiological Findings

A

L.Atrial + R.Atrial enlargement (“Valentine-shaped heart”)

67
Q

Hypertrophic Cardiomyopathy - Diagnosis

A

Pro-NT BNP

US: LA Enlargement + Hypertrophy of LV Aorta\LA ratio > 1.5

EKG

68
Q

Hypertrophic Cardiomyopathy - Treatment

A

Pimobendan (If HOCM is ruled out)

ACE-i \Furosemide

Clopidogrel \Heparin \Rivaroxaban (Prevent thrombus formation)

69
Q

Pulmonic \ Sub-Aortic Stenosis - Which is easier to identify on X-ray? What are the common findings of it?

A

Pulmonic stenosis

R.Ventricular enlargement

Main pulmonary artery trunk bulge

70
Q

Pulmonic \ Sub-Aortic Stenosis - Treatment options

A

Beta \Calcium Channel Blockers

ACE-i +- Furosemide - In case of danger of CHF

Surgery /Catherization (only for Pulmonic stenosis)

71
Q

Pulmonic \ Sub-Aortic Stenosis - Which can be catheterized?

A

Pulmonic Stenosis

72
Q

Pulmonic \ Sub-Aortic Stenosis - How to differentiate? (Physical exam)

A

Weak Femoral Pulse - SAS

Normal Femoral Pulse - PS

Murmur radiating to the right side of the thorax as well - SAS

73
Q

Pulmonic \ Stenosis / Sub-Aortic Stenosis- Classic EKG findings

A

Pulmonic stenosis:
Lead 1 - Negative QRS
AVF - Negative QRS

Sub-Aortic Stenosis:
Lead 2 - Increased QRS amplitude

74
Q

Patent Ductus Arteriosus (PDA) - Auscultatory Finding

A

Left Basilar - Systolic + Diastolic - Band Shape Murmur

75
Q

Patent Ductus Arteriosus (PDA) - X-ray finding

A

On DV:
Bulging of (From right to left):
Main pulmonary artery + Aorta + Left auricle enlargement (“Triad”)

L.V Enlargement +- L.A Enlargement

76
Q

Patent Ductus Arteriosus (PDA) - EKG Finding

A

Increased QRS amplitude on lead 2

77
Q

Patent Ductus Arteriosus (PDA) - Which side of the heart is affected most?

A

Left side of the heart

78
Q

Pulmonic Sub-Aortic Stenosis - Auscultatory findings

A

Left Basilar - Systolic - Diamond shape (“crescendo-decrescendo”)

79
Q

Patent Ductus Arteriosus (PDA) - Femoral pulse is? (Bounding Normal Weak)

A

Bounding

80
Q

Patent Ductus Arteriosus (PDA) - Treatment modalities

A

Pimobendan + ACE-i \Furosemide

Surgery

Stenting

81
Q

Ventricular septal defect (VSD) - Auscultatory finding

A

Right Apical - Systolic - Band \ Diamond Shape Murmur (Depending on the size of the defect: Band - big, Diamond - small)

82
Q

Ventricular septal defect (VSD) - Treatment

A

Pimobendan

ACE-i \ Furosemide

83
Q

Ventricular septal defect (VSD) - Which murmur is worse - Band/Diamond Shape?

A

Band shape (Bigger defect)

84
Q

Explain Differential Cyanosis

A

When R-L shunt occurs - Mucosa of the caudal region (i.e. Genital mucosa) will suffer more from hypoxia and demonstrate worse cyanosis

85
Q

Young dog with a right apical systolic murmur - DDs

A

Tricuspidal-valve dysplasia

Ventricular septal defect

86
Q

Medium, large breed dog (young) presents with a Left Basilar - Systolic - Diamond-shape Murmur, followed by a Left Basilar - Diastolic - Decrescendo Murmur. What is the most probable diagnosis?

A

Aortic semi-lunar valve bacterial infection (Endocarditis) and acquired Aortic Insufficiency following congenital Sub-Aortic Stenosis

87
Q

Spectral Doppler - What is the normal Ratio between the 2 diastolic phases?

A

E > A (1-1.7)

88
Q

Spectral Doppler - What is the meaning of a severe increase in E/A ratio?

A

Severe decrease in ventricular compliance

89
Q

Spectral Doppler - What is the use of E/E’?

A

Best evaluator of the diastolic function of the ventricles

90
Q

M-Mode US - Equation of FS (Fractional Shortening)

A

FS = [ EDV - ESV / EDV ] x 100

91
Q

FS (Fractional Shortening) - As the BW of the animal decreases - the FS…?

A

Increases

Large Breeds ~ 30%
Small Breeds Cats ~50-60%

92
Q

Left-side - Volume overload - 4 DDs

A

Mitral valve dysplasia \ MMVD

VSD

Aortic Insufficiency

PDA

93
Q

What is a disease that you should particularly worry about before anesthesia?

A

DCM

Add positive inotropes

*Other cardiac diseases of course also warrant consideration specifically be conservative with IV fluids

94
Q

Pulmonic Stenosis - On auscultation can be easily confused with…? Why? (Not Sub Aortic stenosis)

A

ASD

Because it creates a “Pulmonic Stenosis-like” Murmur (Relative Pulmonic Stenosis due to excess blood flowing through the tricuspid valve)

95
Q

Right side - Volume overload - 3 DDs

A

Tricuspidal valve dysplasia \ TR

ASD

Pulmonic Insufficiency

96
Q

Left side - Pressure overload - 2 DDs

A

Sub Aortic Stenosis

HOCM

97
Q

What are the 4 elements of Tetralogy of Fallot

A

1) VSD

2) Pulmonic Stenosis

3) RV Hypertrophy

4) “Overriding” Aorta

98
Q

Right Side Pressure Overload - 3 DDs

A

Pulmonic Stenosis

Tetralogy of Fallot

R-L Shunting PDA

99
Q

What are the characteristics of an Innocent Murmur?

A

Situational (Position / Stress..)

Short

Soft ( < III / VI )

Single

Small (Focal)

Systolic (Only)

Disappears until 4 months of age

Weakens over time

Typically left basilar

No associated clinical signs

100
Q

MMVD Monitoring - What can we tell the owners to monitor at home to monitor deterioration/efficacy of treatment?

A

Sleeping Respiratory Rate

101
Q

MMVD Treatment - By Stages

A

Stage A - No treatment needed. Monitor once a year

Stage B1 - (Murmur) - Enalapril

Stage B2 - (Cardiomegaly\Atrial Enlargement) - Pimobendan + Enalapril

Stage C - O2 \ Furosemide/ ACE-i \ Pimobendan \ Sedation. If indicated: Anti-tussives \ Anti-arrhythmic \ Bronchodilators

Stage D - Afterload Reduction => Amlodipine \ Nitroprusside. If indicated: Thiazides \ Sildenafil \ Anti-tussives \ Bronchodilators

102
Q

When should you treat VPCs?

A

High number of VPCs per minute

Pairs\Triplets of VPCs

Multi-Focal \ Polymorphic

R on T Phenomenon

Clinical signs ( Lethargy, Syncope, Pulse deficits, Decreased BP)

Doctor of Veterinary Medicine (Work in progress) (17 decks)

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