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97 Cards in this Set

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What are the disadvantages of ultrasound imaging?
Poor propagation through gas
Can't examine soft tissues in bone
Choose the echocardiographic mode...
...displays distance on the vertical axis and time on the horizontal.
M-mode echo
Choose the echocardiographic mode...
...can assess ventricular volume.
2-D echo
3-D echo
Choose the echocardiographic mode...
...highest resolution and can detect subtle changes in valvular motion.
M-mode echo
Choose the echocardiographic mode...
...can display the velocity and direction of blood flow.
continuous-wave Doppler flow echocardiography
Choose the echocardiographic mode...
...low velocity blood flow can be measured in a specific heart location.
pulsed-wave Doppler
Choose the echocardiographic mode...
...where the trans-stenotic pressure gradient can be calculated.
pulsed-wave Doppler
What is the formula for the trans-stenotic pressure gradient? This is a modification of which formula?
delta P = 4(v^2)
A modification of the Bernoulli equation
Which of the following can ECG NOT evaluate?
a) myocardial ischemia
b) electrolyte abnormalities
c) stroke volume
d) changes in sympathetic/parasympathetic tone
e) pericardial disease
c) stroke volume
What can ECG be used to evaluate?
Arrthymias
Chamber enlargement
Pericardial disease
Electrolyte abnormalities
Myocardial ischemia/necrosis
Changes in autonomic tone
Presence of drug-mediated changes
What is the RMP of ventricular cells? SA or AV node cells?
Ventricular -90mV
SA or AV node -60mV
What are standard ECG paper speeds for small animals and large animals?
Small 50mm/sec
Large 25mm/sec
What is the standard sensitivity for ECG?
20mm/mV
Which of the following cells show automaticity normally?
a) bundle of His
b) AV node
c) SA node
d) Purkinje fibers
e) Papillary cells
a) bundle of His
b) AV node
c) SA node
d) Purkinje fibers
In which of the following cells is Na current primarily responsible for phase zero of the AP?
a) bundle of His
b) AV node
c) SA node
d) Purkinje fibers
e) Ventricular cells
a) bundle of His
d) Purkinje fibers
e) Ventricular cells
What are normal rates of automaticity for the:
SA node
AV node
Purkinje fibers
SA node (70-140)
AV node (40-60)
Purkinje fibers (15-40)
Which of the following are true regarding the 6 limb lead system?
a) left leg is always negative in bipolar leads
b) lead II runs from LL to RA
c) the combined leads in the augmented system are set as positive
d) lead aVL sets the LA as positive
e) lead I runs from RA to LA
b) lead II runs from LL to RA
d) lead aVL sets the LA as positive
e) lead I runs from RA to LA
Which lead is ALWAYS positive in the bipolar lead system? Which is always negative?
LL is always positive
RA is always negative
T or F:
The summed leads (eg: LA and RA in aVF) are always set as negative in the unipolar lead system.
True!
Which of the following describes atrial depolarization?
a) P wave
b) QRS complex
c) PR interval
d) T wave
a) P wave
Which of the following describes ventricular depolarization?
a) P wave
b) QRS complex
c) PR interval
d) T wave
b) QRS complex
Which of the following describes ventricular repolarization?
a) P wave
b) QRS complex
c) PR interval
d) T wave
d) T wave
Which of the following describes the time spent between the SA impulse and Purkinje fibers?
a) P wave
b) QRS complex
c) PR interval
d) T wave
c) PR interval
Generally, increased P wave amplitude indicates _____________ while increased P wave duration indicates ____________.
Increased amplitude = R atrial enlargement
Increased duration = L atrial enlargement
T or F:
Increased QRS duration is indicative of L heart enlargement.
False! This is only true if there are NO OTHER INDICATIONS of R heart enlargement
Prolonged QT interval is suggestive of which of the following?
a) hypokalemia
b) hypercalcemia
c) digitalis toxicity
d) EG toxicity
e) hypothermia
a) hypokalemia
d) EG toxicity
e) hypothermia
(also hypocalcemia, quinidine toxicity, strenuous exercise, CNS disorders)
Prolonged QT interval is suggestive of which of the following?
a) hypokalemia
b) hypercalcemia
c) digitalis toxicity
d) EG toxicity
e) hypothermia
b) hypercalcemia
c) digitalis toxicity
(also hyperkalemia)
What are the 2 mechanisms of arrhythmia formation?
Disorders of impulse formation
Disorders of impulse conduction
Which of the following describe disorders of impulse formation?
a) ectopic pacemaker
b) depressed/enhanced automaticity
c) reentry loop
d) early or delayed after-depolarization
a) ectopic pacemaker
b) depressed/enhanced automaticity
d) early or delayed after-depolarization
What are the two modes of impulse conduction abnormalities?
blockage
rerouting (eg: reentry loop)
Which of the following describe escape beats?
a) ectopic beats
b) R-R interval from preceding normal beat is shorter than prevailing R-R interval
c) due to SA node impulse or conduction issue
d) can be treated if needed
a) ectopic beats
c) due to SA node impulse or conduction issue
(R-R interval is LONGER; DON'T TREAT THESE)
Which of the following describe premature beats?
a) ectopic beats
b) R-R interval from preceding normal beat is shorter than prevailing R-R interval
c) due to SA node impulse or conduction issue
d) can be treated if needed
a) ectopic beats
b) R-R interval from preceding normal beat is shorter than prevailing R-R interval
d) can be treated if needed
What are the 3 methods of altering automaticity?
Lower RMP
Increase threshold potential
Decreasing the slope of phase 4
What are the mechanisms by which reentry circuits can be interrupted?
Remove unidirectional block
Convert unidirectional block into bidirectional block
Altering conduction velocity of abnormal tissue
Altering repolarization time of normal tissue
What are the Vaughan-Williams classifications for the following?
Ca blockers
Na blockers
Beta blockers
K blockers
Ca blockers - Class 4
Na blockers - Class 1
Beta blockers - Class 2
K blockers - Class 3
Which of the following causes a decrease in phase 0 slope?
a) class 1c
b) lidocaine
c) procainamide
d) mexiletine
a) class 1c
c) procainamide
(also quinidine)
What are some examples of class 1a antiarrhythmia drugs?
Quinidine
Procainamide
(Na channel blockers; decrease phase 0 and 4 slope)
What are some examples of class 1b antiarrhythmia drugs?
Lidocaine
Mexiletine
(Na channel blockers; decrease phase 4 slope of DISEASED cells)
What are some examples of class II antiarrhythmia drugs?
Propanolol
Atenolol
Esmolol
Metoprolol
(Beta blockers)
Which type II drugs are selective for beta 1 and what is their effect?
Atenolol
Esmolol
Metoprolol
(all act only on the heart to reduce sympathetic effects)
Which cardiac drugs are not selective for beta 1 and what are their beta-blocking effects?
Sotalol (Type III)
Propanolol (type II)
(Both decrease sympathetic stim to heart; also broncho/vasoconstriction)
What are the general effects of beta blockers on the heart?
Reduce HR
Reduce contractility
What are examples of class III drugs and what are their effects?
Sotalol; amiodarone
(K-blockers; prolong AP duration)
What are examples of class IV drugs and what is their action?
Diltiazem, Verapamil
(Ca channel blockers; causes vasodilation; slows conduction and decreases contractility in the heart; prolongs phase 4 and 0)
Which drugs are used to treat supraventricular tachycardias?
a) quinidine
b) atenolol
c) verapamil
d) mexiletine
a) quinidine (yup)
b) atenolol (good for atrial tach)
c) verapamil (slows AV node conduction)
d) mexiletine (NOOOOO)
GI side effects are usually noted with which drug or drug class?
Class Ia (Quinidine)
Also class IV and digoxin
Which drug or drug class is only active on ventricular cells?
Class Ib (Lidocaine, Mexiletine)
Cats are very sensitive to:
a) Mexiletine
b) Quinidine
c) Propanolol
d) Lidocaine
d) Lidocaine
Which beta blocker is ULTRA SHORT ACTING?
Esmolol
Which of the following slow conduction through the AV node?
a) Sotalol
b) Verapamil
c) Digoxin
d) Atenolol
e) Quinidine
b) Verapamil
c) Digoxin
(also Diltiazem)
Which drug slows the heart rate while increasing contractility?
Digoxin
What are some treatment options for bradyarrthymias? Sick sinus syndrome?
Sympathomimetics, Anticholinergics, and Pacemakers for both
T or F:
The only permanent treatment for 3rd degree AV block is pacemaker implantation.
True!
Isoproterenol will work for 24 hours though
Which drugs can be used to convert a supraventricular tachycardia to a sinus rhythm?
Class 1a; Class III
Digoxin or Class II if re-entry
How can atrial fibrillation be treated?
Slow the ventricles (digoxin, class IV, Class II)
Convert to sinus rhythm (Class I)
Electrocardioversion
EMERGENCY TACHYCARDIA! What do you do?
2mg/kg lidocaine over 1-2 minutes should do the trick!
What are the reliable signs of heart disease?
Certain murmurs & thrills
Abnormal transient sounds
Cardiac arrhythmias
Marked cardiomegaly
Pericardial effusion/friction rubs
Generalized venous engorgement
What are the categories of heart failure?
Right vs. Left
Acute vs. Chronic
Low vs. High Output
What are the major signs of heart failure?
Low output signs (exercise intolerance, weakness, collapse, syncope)
Congestive signs (jug pulse, ascites, anorexia, diarrhea, wt loss)
Ascites develops when ________ pressure rises above _________mm Hg.
Right atrial pressure >15mmHg
Pulmonary edema develops when ________ pressure rises above _________mm Hg.
pulmonary wedge pressure >25mmHg
What are some causes of high output failure?
Anemia
Hyperthyroidism
What is the formula for fractional shortening? Ejection fraction?
(ESD-EDD)/EDD * 100% = FS
(ESV - EDV)/EDV * 100% = EF
In which of the 4 classes of heart disease do signs occur with minimal exercise?
Class 3
Which of the following are involved in CARDIAC mechanisms of compensation?
a) Myocardial hypertrophy
b) RAAS activation
c) Natriuretic Peptides
d) Fred-Sparrow Mechanism
e) Sympathetic activation
a) Myocardial hypertrophy
c) Natriuretic Peptides
e) Sympathetic activation
(Also Frank-Starling Mechanism)
Which of the following are involved in SYSTEMIC mechanisms of compensation?
a) Myocardial hypertrophy
b) RAAS activation
c) Natriuretic Peptides
d) Fred-Sparrow Mechanism
e) Sympathetic activation
b) RAAS activation
e) Sympathetic activation
(Also kidney response and increase in 2,3-DPG)
Volume overload leads to ____________ hypertrophy while pressure overload leads to __________hypertrophy.
Volume = eccentric
Pressure = concentric
How does increased diastolic pressure affect collagen and myocardial hypertrophy? Increased systolic pressure?
Diastolic (replication in series and decreased collagen)
Systolic (replication in parallel and increased collagen)
T or F:
Wall thickness decreases while chamber size increases in volume overload.
False! Only in acute volume overload does this occur; in chronic conditions, chamber size enlarges proportionally to wall thickening.
What is the effect of ANP and BNP?
Vasodilation
Decreased aldosterone
Increased Na excretion
Decreased renin
T or F:
In the backwards failure hypothesis, edema is due to capillary congestion while edema is due to Na retention in the forward failure hypothesis.
Yup this is pretty much true.
Describe the modern concept of heart failure.
Cardiac injury leads to...
Decreased CO and perfusion leads to...
compensatory responses lead to...
Na/H2O retention, vasoconstriction, remodeling leads to...
Congestion, increased afterload, myocyte death leads to...
cardiac injury!
What are the 4 pressor molecules that affect vasoconstriction?
Norepinephrine
Angiotensin II
Endothelin I
ADH
Which are results of sympathetic activation in heart failure?
a) vasoconstriction
b) RAAS activation
c) ADH release
d) ANP/BNP release
e) positive inotropy
a) vasoconstriction
b) RAAS activation
c) ADH release
e) positive inotropy
What are functions of ATII?
Vasoconstriction
Increased sympathetic activity
Increase aldosterone
Increase vascular remodeling
Increase myocardial hypertrophy
What causes renin release?
Decreased renal perfusion
Increased sympathetic activity
(also hyponatremia but not a big deal)
Which of the following is the most pro-fibrotic?
a) ANP
b) ADH
c) ATII
d) Aldosterone
e) Endothelin I
d) Aldosterone
Which of the following is the most vasoconstrictive?
a) ANP
b) ADH
c) ATII
d) Aldosterone
e) Endothelin I
b) ADH
Which of the following is locally vasodilative and systemically vasoconstrictive?
a) ANP
b) ADH
c) ATII
d) Aldosterone
e) Endothelin I
e) Endothelin I
Which of the following are involved with myocardial remodeling?
a) ANP
b) ADH
c) ATII
d) Aldosterone
e) Endothelin I
b) ADH
c) ATII
e) Endothelin I
(also NE)
What factor is probably the most important to manage in Right heart failure?
Edema, Na, and water retention
What are the 3 classes of diuretics commonly used in heart disease and what does each do?
Loop diuretic (inhibit Na resorption from PCT)
Aldosterone antagonist (block aldosterone)
Thiazide (inhibit NaCl resorption from DCT)
What are the principles of diastolic heart failure treatment?
Relieve congestion
Avoid tachycardia
Maintain synchronicity
Improve relaxation
Restore compliance
What are 2 main pharmaceutical classes used to treat congestion in diastolic failure?
Diuretics
Nitrates (venodilators)
What drugs are commonly used to treat tachycardias in diastolic heart failure? What are specific indications for each?
Beta blockers (Atenolol) good for outflow obstructions
Ca channel blockers (Diltiazem) good for everything else
How can normal compliance be restored pharmaceutically?
ACE inhibitors
Neuroendrocrine blockade
What is a good treatment protocol for a patient in acute heart failure with good systolic pressure and no azotemia?
FON
Furosemide
Oxygen
Nitroprusside
Which drug provides arterial and venous vasodilation?
Nitroprusside!
What is a good treatment protocol for a patient in acute heart failure with hypotension and azotemia?
FOND
Furosemide, Oxygen, Nitroprusside, Dobutamine (or dopamine)
If you don't want to use dopamine or dobutamine in acute heart failure protocol, what are good alternative protocols?
FOAM
(Furosamide, Oxygen, Amrinone OR Milrinone)
FOP
(Furosamide, Oxygen, Pimobendan)
Which drug inhibits phosphodiesterase and is a Ca sensitizer? What is the effect of these functions?
Pimobendan
Causes vasodilation with positive inotropy
Which of the following is good to treat v-tach acutely? For maintenance treatments?
a) lidocaine
b) procainamide
c) sotalol
d) amiodarone
e) digoxin
ACUTE
a) lidocaine
b) procainamide
MAINTENANCE
c) sotalol
d) amiodarone
Which aspect is the treatment focus for congestive heart failure?
a) control edema
b) reduce tachyarrthymias
c) improve pump function
d) antagonize neurohormonal alterations
d) antagonize neurohormonal alterations
What clinical effects do ACE inhibitors have? What is the major effect?
Reduce vascular remodeling (main)
Reduce preload
Increase survival/quality
Mild hemodynamic/diuretic/vasodilation effects
What are the mainstays of current CHF therapy?
LA-PD protocol
Diuretics (furosemide & etc)
ACE inhibitor ('prils)
Positive inotrope (Pimobendan)
Maybe Digoxin
What conditions is digoxin commonly used to treat in dogs?
A-fib or supraventricular tach
How do you know that a patient is experiencing digoxin toxicity?
GI signs
Measure serum digoxin levels