Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/155

Click to flip

155 Cards in this Set

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