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85 Cards in this Set
- Front
- Back
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cat hw ag test?
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no just use it to confirm a positive ab test
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DCM
-dogs or cats? -etiology -breeds |
both!
taurine in cats, genetic in dogs medium/large breeds |
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4 DCM dog breeds
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dobie
cocker danes newfie |
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DCM definition
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cardiac enlargement with dilation of the ventricles and impaired systolic function
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DCM begins as disease of what?
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the sarcomeres. leads to Na and H2O retention
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what is the breaking point of DCM?
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when increased intracardiac volume stops leading to increased stretch. increased end-diastolic pressure goes up and then pulmonary edema and ascites
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DCM PE signs?
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soft systolic murmur or gallop (S3)
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history of slow progressive weight loss, exercise intolerance, cough/dyspnea. PE soft systolic murmur/gallop (S3). eh?
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DCM
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want to confirm DCM. diagnostics?
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chest rads, blood pressure (low), taurine level if cat or cocker
ECG (atrial fib/VT) |
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DCM 3 chest rad findings
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any chamber enlargement
pulm venous distension Pulm edema |
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what's the test of choice for DCM. results?
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echo!
LESS MOVEMENT! decr fractional shortening, increased EDV, mitral regurge |
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echo results can look the same for DCM and AV valve disease. how can you tell
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large/giant breeds DCM
small breeds AV dz |
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DCM treatment goals (4)
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inc contractility
decr afterload decr Na/H2O retention treat arrhythmias |
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2 ways to increase contractility in treating DCM
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digoxin
pimobendan (PDE inhibitors) |
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2 ways to decrease afterload in treating DCM
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ACE inhibitors
Ca channel blockers |
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2 ways to decrease Na and H2O retention in treating DCM
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furosemide
spironolactone |
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what drug is good for patients with CHF secondary to valvular endocardiosis and DCM? how?
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pimobendan!
inotropic and vasodilates, reducing preload and afterload) |
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what about pimobendan for HCM?
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NO because you don't want to contract against an obstruction
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HCM in cats or dogs and what is it?
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CATS, rarely dogs
concentric hypertrophy of IVS and LV free wall |
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HCM pathophysiology
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increased EDP so outflow velocity goes up, large pap muscles obstruct LV outflow tract, anterior leaflet of mitral valve is pulled into the LVOT during systole = HCM. that leads to mitral regurge.
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which heart problem is notorious for causing aortic TE (saddle thrombus)?
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HCM
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what 2 diseases MUST you rule out before diagnosing HCM in a cat? 3 tests to do it?
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hyperthyroid
hypertension T4 level doppler renal panel |
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chest rads HCM action? 3 things.
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pleural effusion
pulm edema enlarged LA |
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HCM 4 no-no's if no clinical signs
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low stress
NO ketamine fluids/anesthesia no roids |
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what drug should you never never never never never use in a cat with HF?
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beta blockers
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so you can't EVER give an HCM cat beta blockers?
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you can but only if they ARENT in heart failure yet
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4 tx for HCM cats in heart failure
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oxygen
diuretics thoracentesis ACEis |
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what is RCM?
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looks like HCM but ventricle isn't thick it's just stiff
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what is ARVC? what causes it?
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genetic
boxer cardiomyopathy. fibrous fatty infiltrate of the RV free wall. causes LBBB. |
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syncope, exercise intolerance and sudden death in a boxer. eh?
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ARVC!
arrhythmogenic right ventricular cardiomyopathy |
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best dx for ARVC boxer cardiomyopathy?
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24 hours holter
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2 tx for boxer cardiomyopathy
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sotalol
mexiletine/atenolol combo |
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most common valve for endocardiosis?
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mitral!
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what is endocardiosis/myxomatous valvular disease?
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degenerative change in the surface of the valve leading to denuding of the endothelium, fibrosis and nodular rolling of the valve edges
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what does endocardiosis lead to?
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regurge, cordae stretching
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what is increased with endocardiosis and why?
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preload!
valve doesn't seal so blood from LV goes back up into the LA |
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so what chamber is increased in size with endocardiosis?
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left atrium
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endocardiosis
who? |
small pocket dogs!!!!! older dogs too.
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endocardiosis signs early, middle and late and also an acute representation
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early - none
middle - cough, exercise intolerance late - dyspnea, cough, cyanosis, CHF acute - cordae rupture or LA rupture |
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treatment for early, middle and late endocardiosis
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early - nothing, monitor
middle - limit exercise or furosemide late emergent - FON chronic - FAP |
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what are FON and FAP
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for emerging late and chronic late endocardiosis
emergent = FON = furosemide/oxygen/nitrates chronic = FAP = forusemide/ACEi/pimobendan |
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should you treat an endocardiosis dog without signs?
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NONONONONO
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what breed is kind of big with endocardiosis?
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king charles spaniel.
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how does blood get from the VC to the aorta
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VC - RA - tricuspid - RV - pulmonic - lungs - LA - mitral - LV - aorta
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purkinje rate in dogs?
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20-40 bpm (cats faster)
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review L3 beginning.
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OK.
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what are the 4 heart sounds and which are normal?
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S1 - AVs close, ventricular ejection
S2 - aortic/pulmonics close, ventricles relax S3 - ventricular gallop (LV dilation and failure (DCM) S4 - atrial gallop (stiff LV, HCM) |
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preload:
-another term -how it's used |
EDV
what the LV starts with for ejection |
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what does starling's law say?
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optimal stretch to maximize contraction
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what is afterload and what does contractility depend on?
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the force the V has to overcome to eject blood
Calcium |
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what happens with increased afterload?
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increased pressure - stretch - sarcomeres added but NOT new capillaries so myocardium prone to ischemia
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what are 2 causes of increaed pressure in the LV?
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SAS
systemic hypertension |
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2 causes of RV increased pressure
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heartworm dz
any pulmonary problem |
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4 clinical examples of increased volume
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DCM
valvular dz PDA septal sefect |
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volume, contractility and afterload effects on SV?
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incr volume, contractility = incr SV
decr afterload = increased SV |
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what can very high HR do to CO and what's the result?
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decreased CO! this can lead to decreased perfusion of tissues!
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when deciding to treat arrhythmias, what heart value really matters?
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perfusion! so is CO affected?
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what's a higher HR, compensation or primary cardiac abnormality?
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primary! (like 230-300)
compensation (ie hemoabdomen) will be around 180. |
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what is orthopneic stance?
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elbows abducted, neck stretched.
it means extreme respiratory distress. |
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cardio PE thingies
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long CRT
pale MMs cyanotic jug pulse/distension thyroid nodules in cats |
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4 causes of a jug pulse
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RHF
pericardial effusion DCM heartworm caval syndrome |
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2 signs of pericardial effusion
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pulsus paradoxicus (stronger pulse on expiration)
alternating R waves |
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3 cardio abdominal signs
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palp - hepatomegaly
ballottement -ascites hepatojugular reflex - gentle pressure on abdomen looking for elevation of jug vein |
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what's a pulse deficit?
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when pulse is less than HR. contracture is premature and ventricles no filly.
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extremities weak vs bounding pulse
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weak - venous occlusion.
weak on inspiration - pleural eff. bounding - anemia, AI, PDA |
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you auscult a cardio dog and hear nothing. eh?
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pleural effusion!
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S1
-where you hear it -split? |
left apical region
split maybe normal in large dogs or IV conduction block |
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S2
-where you hear it -split OK? |
left base!
no pulmonic valve closure delayed b/c prolonged RV ejection |
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4 causes of a split S2?
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pulm hypertension
atrial/septal defect pulm stenosis RBBB |
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S3
-what -how to best hear it? -3 main causes |
rapid term of ventricular fillin'
with bell! DCM, AV insufficiency, L->R shunts |
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S4
-what -best heard by? -main cause |
augmented atrial contraction required to fill
bell! HCM in cats. |
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what kind of murmer can be innocent up to 6 months old?
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left basilar systolic
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2 big causes of left basilar systolic murmurs
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subaortic stenosis (cong heart defect)
pulmonic stenosis (dogs) |
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what's the most common murmur in middle aged small dogs? where is it and what causes it?
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left apical systolic murmur which is MITRAL insufficiency. caused by chronic degenerative valve disease
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besides mitral insufficiency, what other 3 things can cause left apical systolic murmurs?
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DCM
L to R PDA VSD |
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relate size of VSD to murmur volume
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smaller is louder!
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2 types/causes of right sided systolic murmurs?
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tricuspid insufficiency
VSD |
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3 causes of tricuspid insufficiency causing R systolic murmur
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CDVD
DCM pulm hypertension |
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what's the best place to hear a murmur in a cat?
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right over ventral sternum!
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2 types of diastolic murmurs?
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aortic insufficiency (bacT endocarditis)
mitral stenosis (no way) |
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3 types of continuous murmurs
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PDA
pulmonary AV fistula coronary AV fistula |
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2 causes of left sided congestion?
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pulm edema, arrhythmias
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4 causes of right sided congestion?
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pleural
ascites, hepatic congestion |
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coughing in heart disease?
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cats NO
dogs YES! |
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cardio exam if not stable?
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NO
put in oxygen and observe |
