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155 Cards in this Set
- Front
- Back
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#1 priority of the heart
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Maintain normal systemic arterial pressure
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CO
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SV x HR
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MAP
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CO x SVR
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Preload
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Volume > how much blood is coming back to the heart
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Afterload
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Pressure > what heart has to work against to get the blood out
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What can cause jugular pulses
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Increased venous pressure:
1. Rt. sided failure (tricuspid dz, pulmonary hypertension, caval syndrome) 2 Pericardial dz 3. Volume overload 4. Cranial mediastinal mass |
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Systolic crescendo/decrescendo that is high at 3rd rib space on left
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Pulmonic or aortic stenosis
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Grade I murmur
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Very soft, intermittent
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Grade II murmur
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Soft murmur, can hear consistently in a quiet room
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Grade III murmur
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Moderate intensity murmur
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Grade IV murmur
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Loud murmur
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Grade V murmur
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Loud murmur w/ a precordial thrill
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Grade VI murmur
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Very loud murmur, can hear w/ a stethoscope off the body wall
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Really tall "R is consistent with
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LV enlargement
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Really deep "S" is consistent with
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RV enlargement
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Cardiac remodeling: Increased pressure
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Concentric hypertrophy > fibers added in parallel
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Cardiac remodeling: Increased volume
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Eccentric hypertrophy > fibers added in series
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CHF emergency therapy: Diuresis
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Decr. preload > furosemide
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CHF Emergency Therapy: Volume redistribution
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Venodilators > Nitroglycerin ointment, Nitroprusside ICU
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CHF Emergency Therapy: Anxiolytics
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Opiods, diazepam, acepromazine
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CHF Emergency Therapy: Minimize bronchoconstriction
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Aminophylline
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CHF Emergency Therapy: Decrease afterload
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Arteriodilators > hydralzaine, enalapril, amlodipine
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CHF Emergency Therapy: Increase contractility IF myocardial failure
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Pimobendan, dobutamine, amrinone
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CHF Emergency Therapy: HCM cats
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beta blocker, Ca channel blocker
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CHF Chronic Therapy: Diet
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Salt restriction, L-carnitine, Taurine (cats)
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CHF Chronic Therapy: Diuretics
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Furoseminde (lowest dose necessary), Spironolactone (monitor potassium, aldosterone antagonist), Thiazides (not w/ renal dz)
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CHF Chronic therapy: ACE inhibitors
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Enalapril or benazepril; Mainly for neuroendocrine modulating effects; Arterial dilator; Caution in renal failure
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CHF Chronic therapy: Vasodilators
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Hydralazine (arterial effects) and Amlodipine (Ca channel blocker; Peripheral effects; Antihypertensive drug)
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CHF Chronic therapy: Positive ionotropes
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Pimobendan (phosphodiesterase III inhibitor; ionodilator); Digoxin (also anti- and pro- arrhythmic; Na/K ATPase inhibitor; increases Ca; Side effect > can cause arrhythmia)
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CHF Chronic therapy: Beta blockers
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Use early in dz; Caustion w/ myocardial failure; HCM; Arrhythmias (atrial fibrillation; ARVC); Remodeling
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CHF Chronic therapy: Ca channel blockers
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Diltiazem (central effects)
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HCM: What ventricle enlarges?
What type of murmur do you hear? What is the rhythm? Is it systolic or diastlic? |
Idiopathic LV hypertrophy
Systolic murmur (hear on sternum) Gallop rhythm Diastolic failure |
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What type of arrhythmia can you get w/ HCM?
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A. Fib
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What causes the progression of dz in HCM?
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Progressively higher LV filling pressures
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HCM drugs
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Beta blocker (atenolol), Ca channel blocker (diltiazem), ACE inhibitor (benzepril), CHF tx (if already in CHF), +/- aspirin (ultra low dose)
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What is do you want to accomplish with the drugs to tx HCM?
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Enhance:
Ventricular filling Relieve congestion Control arrhythmias Minimize ischemia Prevent TBE |
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Restrictive cardiomyopathy
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Idiopathic
LV endomyocardial fibrosis Middle aged to older cats Systolic murmur Gallop rhythm |
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Peritoneopericardial diaphragmatic hernia
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Defect in septum transversum
Congenital Cats (can present early in life/incidental; DLH, Persians, Himalayans) Dogs (Weimeraners) |
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Acquired degenerative valve disease
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Endocardiosis
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Infective valve disease
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Endocarditis
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What is the most common cause for heart failure in the dog?
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Valvular endocardiosis
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Which 2 valves are involved in endocardiosis?
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Mitral***
Tricuspid |
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What is the sequellae of endocardiosis?
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Volume overload
Endocardial fibrosis CHF Left bronchial compression Chordae tendinae rupture LA tears and rupture A. Fib |
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What client education do you do for valvular endocardiosis?
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Monitor RR at rest
Earliest sign of pulmonary edema |
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Bacterial endocarditis
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Aortic and mitral
Infective agents: Strep, Staph, E.coli If cx is -ve suspect Bartonella **Concurrent or recent infxn |
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Predisposed breeds for endocardiosis
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Older small-mid breed dogs (poodles, shih tzu, yorkies, Schnauzers, chihuahuas, poms, cockers, pekes, bostons, KCCS)
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Breed for endocarditis
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Often young, large breed dogs
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What could you dx to make you think endocarditis
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Newly dx murmur
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TX for endocarditis
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Supportive care
Abx - IV for at least 1st week Cx based Combo tx: ampi, baytril, azithromycin (bartonella) tx for 6-8 weeks |
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Dilated cardiomyopathy (DCM)
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Idiopathic
Poor contractility, weakness, syncope +/- arrythmias Large and giant breeds |
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Which breed has the highest prevelence for DCM?
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Dobies
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How would a cat get DCM?
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Taurine deficiency (rare)
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How would a dog get a nutritional DCM?
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L-carnitine deficiency (Cockers)
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What arrythmias are a common sequella of DCM?
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A. Fib and VPC's
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DCM causes
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Low CO
Sympathetic activation, hormonal, renal compensatory mechanisms Low output heart failure and CHF |
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What can the first sign of DCM be?
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Sudden death
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What 2 diseases cause a round heart?
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DCM and pericardial effusion
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What drugs would you use for DCM
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ACE inhibitor
Pimobendan Digoxin (A.Fib) +/- Beta blocker (carvedilol, sotalol) +/- Diltizem |
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Pimobendan
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Phosphodiesterase III
Ionodilator: Increases contractility (Increases Ca sensitivity); Peripheral vasodilator Prolongs survival (DCM) |
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Px for DCM
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Always guarded to poor
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Pericardial effusion
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Fluid accumulation (transudate, exudate, hemorrhagic)
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Which type of fluid accumulation is most common in dogs with pericardial effusion?
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Hemorrhagic > torn LA
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Where would HSA go to in the heart?
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Rt Atrium
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What is cor pulmonale
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Heart failure d/t lung dz
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What radiographic signs would you see in cat vs. dog for HWD?
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Cat: Bronchial pattern
Dog: Reverse D |
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C.S. of HWD: Early infxn
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Class I
No Signs |
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C.S. of HWD: Mild dz
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Class 1
Cough |
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C.S. of HWD: Moderate dz
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Class 2
Cough, exercise intolerance, abnormal lung sounds |
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C.S. of HWD: Severe dz
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Cough, exercise intolerance, dyspnea, abnormal heart and lung sounds, enlarged liver, syncope, ascies, death
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C.S. of HWD: Caval syndrome
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Sudden onset of severe lethargy and weakness accompanied by hemoglobinemia and hemoglobinuria
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TX for HWD
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Adulticide:
Melarsomine/Immiticide 2 month protocol |
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Systemic Arterial Hypertension
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CKD, HAC, Hyperthyroidism, Pheochromocytoma, DM, Liver dz, Hyperaldosteronism, Intracranial lx
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What does the doppler evaluate?
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Systolic pressure
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What is the most common cause of systemic arterial hypertension?
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Secondary (concurrent w/ clinical dz or drug administration)
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Evidence of target organ damage d/t systemic arterial hypertension:
-Kidneys -Eyes -Brain -Heart and vessels |
Kidneys: Progression of CKD
Eyes: Retinopathy (acute blindness, detachment, vessel tortuosity, perivascular edema, papilledema, hyphema, secondary glaucoma) Brain: Encephalopathy or stroke Heart and vessels: LV hypertrophy or cardiac failure |
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Tx for systemic arterial hypertension
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-Ca channel blockers (*Amlodipine)
-ACE inhibitors (enalapril, benazepril) -Beta blocker (atenolol, propranolol) -Alpha 1 blockers -Hyralazine -Nitroprusside -Ace |
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What 4 things can cause pulmonary hypertension
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-Increased pulmonary blood flow
-Increased blood viscosity -Increased pulmonary vascular resistance -Luminal narrowing |
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Normal pressures:
-RV -PA -LV -Aorta |
-RV: 20/5
-PA: 20/8 -LV: 120/6 -Aorta: 120/80 |
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Mitral stenosis pressures:
-RV -PA -LV -Aorta |
-RV: 130/120
-PA: 130/80 -LV: 110/5 -Aorta: 110/30 |
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Pulmonary hypertension: Continuous wave values
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TR >2.7m/sec
PI >2m/sec |
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Tx for pulmonary hypertension
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Sildenafil/viagra
Tadalifil/Cialis |
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What causes toxic myocardial dz
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Doxorubicin
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What is the murmur for sub-aortic stenosis
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Systolic crescendo/decrescendo (Lub-sh-dub) > musical, loudest over Lt. heart base, can radiate anywhere (on top of head)
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When may you get C.S. w/ SAS
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may not hear murmur or see C.S. until 2 y.o.
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Tx for SAS
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Medical mgmt:
Beta blockers (relaxation, decreasing afterload and arrythmias); Exercise restriction (no bursts) |
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What does SAS predispose dog to
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infective endocarditis**
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What is the murmur for pulmonic stenosis
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Systolic crescendo/decrescendo murmur +/- click
Loudest over Lt. heart base |
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What type of overload happens w/ PS
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Pressure overload > RV hypertrophy w/ secondary dilation and RA enlargement
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What is a severe doppler BP for PS
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>80mmHg
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Tx for PS
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Surgical and balloon procedure
Balloon valvuloplasty |
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What shunt does PDA cause
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Lt to Rt, continuously throughout cardiac cycle
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What type of overload does PDA cause
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Volume overload of pulmonary circulation, LA and LV
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What type of murmur do you hear w/ PDA
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Continuous left basilar murmur
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What is a characteristic CS of PDA
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Hyperkinetic/bounding/water-hammer pulses
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What do you see on a rad of PDA
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Enlarged LV and LA
Overcirculated pulmonary vessels Ductus bump |
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Tx for PDA
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Repair:
transcatheter (coils or ampltz ductal occluder) sx ligation |
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What is the px of PDA w/out tx
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w/out tx 50% will die w/in a year
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Reversed PDA
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Eisenmenge's physiology (not fixable)
RV enlargement Hypoxemia Differential cyanosis (blue butts) |
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Who gets PDA more
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Female dogs > male dogs
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Who gets VSD more
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Cats > dogs
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What type of murmur does VSD cause
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Systolic plateau murmur loudest on Rt. side
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What type of overload does VSD cause
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Volume overload > RVO, pulmonary circulation, LA, LV
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Tx for VSD
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occlusion devices
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Which type of ASD is more common in dogs
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Fossa ovalis
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Which type of ASD is more common in cats
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Ostium primum
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Mitral dysplasia
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Bull terriers
Males > Females Shortened or elongated chordae CS similar to DVD except younger |
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Tricuspid dysplasia
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Labrador Retriever
Males > Females Displaced valve/leaflet (Epstein-like anomaly) Rt. Heart enlargement Rt. CHF Px guarded to poor |
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Tetrology of Fallot (TOF)
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Keeshonds
Exertional weakness Dyspnea Syncope Cyanosis |
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Tetrology
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VSD
PS - Valvular or infundibular Overriding (dextropositioned) aorta RV hypertrophy |
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What a radiograph of TOF look like
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Underperfused lungs/reduced pulmonary vasculature
RV hypertrophy |
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What type of murmur do you hear w/ TOF
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Holosystolic right sternam murmur or
systolic ejection murmur at left base |
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What does chronic hypoxia cause in TOF
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Absolute polycythemia
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Sx options for TOF
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Open heart
Anastamoses (subclavian artery to make a window between aorta and pulmonary artery) |
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What ECG change occurs with hyperkalemia
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Tall tented T waves, No P's, and Bradycardia (widdened QRS)
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What does the sympathetic nervous system do to beta 1 vs 2
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Beta 1 > turns it up
Beta 2 > slows it down |
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Adrenergic receptor actions:
Alpha 1 |
Via increased phospholipase C, constricts arteries, constricts bronchioles, increases mucous in saliva
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Adrenergic receptor actions:
Alpha 2 |
Via decreased cAMP, inhibits digestion, inhibits insulin secretion
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Adrenergic receptor actions:
Beta 1 |
Via increased cAMP, increases heart rate, increases contractility, increases relaation time, increases conduction velocity
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Adrenergic receptor actions:
Beta 2 |
Via decreased cAMP, dilates veins, inhibits digestion, dilates bronchioles
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Adrenergic receptor actions:
Beta 3 |
Via increased cAMP, fat breakdown
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What ECG change occurs with hyperkalemia
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Tall tented T waves, No P's, and Bradycardia (widdened QRS)
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A. fib rhythm
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Fast irregular and irregularly irregular
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What does the sympathetic nervous system do to beta 1 vs 2
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Beta 1 > turns it up
Beta 2 > slows it down |
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Adrenergic receptor actions:
Alpha 1 |
Via increased phospholipase C, constricts arteries, constricts bronchioles, increases mucous in saliva
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What arrhythmia is normal
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sinus tachycarida
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Adrenergic receptor actions:
Alpha 2 |
Via decreased cAMP, inhibits digestion, inhibits insulin secretion
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Drug options for supraventricular tachycardias
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Digoxin (increase contractility, Decrease speed of nodal conduction)
Diltiazem (Ca channel blocker) Beta blocker Cobinations |
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Adrenergic receptor actions:
Beta 1 |
Via increased cAMP, increases heart rate, increases contractility, increases relaation time, increases conduction velocity
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Adrenergic receptor actions:
Beta 2 |
Via decreased cAMP, dilates veins, inhibits digestion, dilates bronchioles
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Adrenergic receptor actions:
Beta 3 |
Via increased cAMP, fat breakdown
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A. fib rhythm
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Fast irregular and irregularly irregular
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What arrhythmia is normal
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sinus tachycarida
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Drug options for supraventricular tachycardias
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Digoxin (increase contractility, Decrease speed of nodal conduction)
Diltiazem (Ca channel blocker) Beta blocker Combinations |
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What recumbancy should patient be in for a precordial thump
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Right lateral
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Tx for tachyarrhythmia
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Damaged section:
- Creating a shock -Shortening the refractory period Normal section: -Improving conduction -Increasing the refractory period |
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Mechanism for class Ia
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Fast Na channel block, membrane stabilizers, depress conduction in normal and abnormal muscle, prolong repolarization
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Mechanism for class IB
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Na channel block, profoundly effect abnormal muscle conduction, increase refractory period
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Mechanism for class Ic
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Na channel block, slow conduction
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Mechanism for class II
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Beta blockers, increase conduction time
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Mechanism for class III
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Prolong AP and refractory period
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Mechanism for class IV
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Ca channel blockers, slow (L-type) channel inhibitors, slow sinoatrial and junctional AP's prolong refractory period
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Example of IB
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Lidocaine
Mexiletine |
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Example for class II
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Atenolol
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Example for class Ib
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Lidocaine
Mexiletine |
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Example for class II
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Atenolol
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Example for class III
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Sotalol
Amiodarone |
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Example for class IV
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Diltiazem
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V Tac therapy for cats
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Beta blocker
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TX for ARVC
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Sotalol
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What increases with bradyarrhythmias
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**Increased vagal tone (vom and defecation)
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2nd degree AV block
Mobitz type 1 |
Wenckenback
Expressed as a ratio of conducted to non-conducted beats |
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2nd degree AV block
Mobitz type 2 |
P-R interval is steady
More suggestive of nodal dz than type 1 Tx > pacemaker |
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3rd degree AV block
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NO relationship b/tw P's and QRS
Often ventricular escape beats or AV nodal beats TX > pacemaker |
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Common breed to get sick sinus syndrome
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Older female mini schnauzers
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