Bryan - Sa Med Ii - Cardiology Test 2A - Winter 3Rd Year

Front 1

What are the functions of the pericardium?

Back 1

Lubrication
Stabilization
Infection barrier

Front 2

T or F:
PPDH is usually due to traumatic injury.

Back 2

False!
it is ALWAYS a congenital defect

Front 3

What organs are generally found in a PPDH? When is it an emergency? What breed is predisposed?

Back 3

Liver and omentum
If stomach is in there, EMERGENCY;
Weimaraners are predisposed

Front 4

Which pericardial congenital defect always requires surgery?
a) pericardial cysts
b) PPDH
c) pericardial defects
d) none of the above!

Back 4

a) pericardial cysts (they trap stuff and compress the heart)

Front 5

Constrictive pericarditis in small animals is generally due to..

Back 5

...coccidiodomycosis

Front 6

What is the breakdown of pericardial effusions in terms of cause?

Back 6

75% neoplastic
20% idiopathic
5% other

Front 7

What are the common tumors involving the pericardium?

Back 7

Hemangioma/sarcoma
Mesothilioma
Heartbase tumors (chemodectoma; ectopic thyroid/parathyroid)

Front 8

T or F:
Whenever you find HSA on the spleen, there is a 25% chance of mets to the right atrium/auricle.

Back 8

False!
The heart HSA is CONCURRENT, PRIMARY AND NOT METASTATIC

Front 9

Chemodectomas are usually found in which breeds?

Back 9

Brachycephalicq

Front 10

If you find a pericardial effusion but cannot find any tumors, what is your next step?

Back 10

TAP THAT BITCH! Pericardiocentesis is generally curable in idiopathic causes!

Front 11

What are the 3 cardinal signs of pericardial effusion (Beck's Triad)?

Back 11

Muffled heart sounds
Venous congestion/Jugular pulses
Weak femoral pulses

Front 12

Describe the pathogenesis of cardiac tamponade.

Back 12

Pericardial vol/pressure increase, thus reducing compliance (esp in R heart); SV declines which activates RAAS; HR increases and CO reduces

Front 13

What two things will be seen on a radiograph of cardiac tamponade?

Back 13

Globoid heart
enlarged CVC

Front 14

How do you perform a pericardiocentesis? How often is it curative?

Back 14

Clean/perp per usual
Tap on the right side and aim for the center of the heart!
(50% of the time it works all of the time)

Front 15

When performing a subtotal pericardiectomy, what structure should you leave intact?

Back 15

The heart! Oh yeah, and the phrenic nerves...

Front 16

What are causes of pericardial effusion in cats?

Back 16

Cardiomyopathy
LSA
FIP

Front 17

What are the three main classes of congenital heart disease in dogs?

Back 17

Acyanotic with no shunt
Acyanotic with L to R shunt
Cyanotic with R to L shunt

Front 18

Which of the following are NOT acyanotic L to R shunts?
a) PDA
b) Tetralogy of Fallatio
c) VSD
d) ASD
e) subaortic stenosis

Back 18

a) PDA (can SOMETIMES be cyanotic R to L with pulmonary hypertension)
b) Tetralogy of Fallot is a R to L cyanotic shunt

Front 19

What are the top 4 congenital heart defects in dogs?

Back 19

1. PDA
2. Subvalvular aortic stenosis
3. Valvular pulmonic stenosis
4. VSD

Front 20

Predict patterns of enlargement in...
...PDA

Back 20

Enlarged pulmonary vasculature
Enlarged aortic arch proximally
Enlarged LA and LV

Front 21

Predict patterns of enlargement in...
...VSD

Back 21

LV enlargement
Pulmonary vasculature
(maybe RV eccentric enlargement)

Front 22

Predict patterns of enlargement in...
...ASD

Back 22

RA
RV
Pulmonary vasculature

Front 23

T or F:
PDA has female predisposition in dogs.

Back 23

TURD!

um that was supposed to say true

Front 24

What is the pathogenesis of PDA?
a) lack of maternal signaling to the ductus
b) lack of placental signaling to the ductus
c) lack of ductus recognition of increased oxygen tension
d) congenital reduction in ductus smooth muscle
e) all of the above

Back 24

d) congenital reduction in ductus smooth muscle (can't constrict)

Front 25

How will a PDA commonly present?

Back 25

Young animal, continuous murmur, bounding femoral pulse

Front 26

What other congenital anomaly is commonly associated with PDA?

Back 26

Persistent Left Cranial Vena Cava

Front 27

What drug needs to be given perioperatively during a PDA surgical correction?

Back 27

Dobutamine (keeps the heart pumpin' strong)

Front 28

How does a R to L PDA present?

Back 28

Lame, split S2, differential cyanosis
R heart enlargement (reverse D)

Front 29

How are R to L PDAs corrected?

Back 29

NOT SURGICALLY CORRECTED - BLEED THEM WITH LEEECHES!!!
Medical management with hydroxyurea to prevent polycythemia

Front 30

T or F:
The RV is NOT enlarged in a VSD.

Back 30

False! This describes the Right Atrium!

Front 31

How are VSDs diagnosed?

Back 31

Echo is the best!
Rads also help...
PE should find the murmur on the RIGHT
ECG is pretty worthless

Front 32

VSD murmurs are loudest on the __________ side (just like ______________ murmurs).

Back 32

loudest on the RIGHT (like tricuspid insufficiency)

Front 33

How are VSDs managed?

Back 33

most require no intervention; big ones might be surgically treated by banding the pulmonary artery (mild stenosis to decrease the severity of the shunt)

Front 34

How are ASDs diagnosed?

Back 34

ECG shows R heart enlargement
Rads show R heart enlargement
PE finds ejection murmur at heart base
Echo finds the defect!

Front 35

What is the most common cyanosis producing defect?

Back 35

Tetralogy of Fallot

Front 36

What are the 2 things necessary in producing a R to L shunt?

Back 36

Hole from R to L
Something elevating pressures on the R

Front 37

What are clinical signs of R to L shunts?

Back 37

Cyanosis
Polycythemia
Low PaO2
Small pulmonary vasculature (on rads)

Front 38

What is the most sensitive test for R to L shunt?

Back 38

Contrast echocardiograph

Front 39

What 4 thingys comprise the Tetralogy of Fallot?

Back 39

Pulmonic stenosis
VSD
Dextropositioned Aorta
RV hypertrophy

Front 40

What are physical exam findings in at Tetralogy of Fallot?

Back 40

Systolic murmur @ left heart base
Normal arterial pule
Cyanotic at rest or with exercise

Front 41

How can Tetralogy of Fallot be treated?

Back 41

Pretty much like a R to L PDA - treat the polycythemia w/hydroxyurea

Front 42

What are the major secondary changes in subvalvular aortic stenosis?

Back 42

LV hypertrophy (concentric)
Post stenotic dilation of aorta

Front 43

What would physical exam findings be in a dog with subvalvular aortic stenosis?

Back 43

Diamond shaped ejection murmur at left heart base
Weak femoral pulse

Front 44

If abnormal, what are some possible ECG findings in subvalvular aortic stenosis?

Back 44

Tall R waves w/wide QRS
ST depression/elevation

Front 45

Which are appropriate treatments for significant subvalvular aortic stenosis in dogs?
a) Exercise restriction
b) Beta blockade
c) balloon valvuloplasty
d) digoxin

Back 45

a) Exercise restriction
b) Beta blockade
(note: valvuloplasty does work but it tends to re-stenose)

Front 46

Where does pulmonic stenosis typically occur?
a) subvalvular
b) valvular
c) supravalvular
d) wherever it friggin' wants to!

Back 46

b) valvular
Valvular>subvalvular>supravalvular

Front 47

When performing cardiac auscultation in puppies, where should you spend a lot of time and why? In old dogs?

Back 47

Puppies (left base d/t pulmonic and aortic stenosis, PDA)
Old dogs (base d/t AV degeneration)

Front 48

What heart defect do 20-25% of dogs with pulmonic stenosis have?

Back 48

Tricuspid insufficiency

Front 49

In which breeds is pulmonic stenosis more commonly seen?

Back 49

Terriers, Schnauzers, Bulldogs

Front 50

What abnormality is commonly concurrent with pulmonic stenosis in bulldogs and why is this bad?

Back 50

aberrant left coronary; it can pop with balloon valvuloplasty

Front 51

What dictates treatment with pulmonic stenosis?

Back 51

Pressure gradient over the stenotic region.
If >80-85 definitely treat. If <50 not treatment. If between the two, maybe treat.

Front 52

How is pulmonic stenosis treated?

Back 52

Most (valvular) treated with balloon valvuloplasty