Cardio Exam 1

Front 1

T/F: Almost all cardiac defects in dogs and cats are associated with a cardiac murmur.

Back 1

True
(p 134)

Front 2

Can the clinical signs be directly correlated to the severity of disease associated with CHD?

Back 2

no.

Most are asymptomatic- this is not a prognostic factor.

Front 3

Newfie with a continous murmur has what?

Back 3

PDA

Front 4

What is the major limiting factor to treatment of CHD in animals?

Back 4

lack of Cardiac Bypass

Front 5

What is the mortality rate of untreated CHD?

Back 5

high

Front 6

What direction is blood shunted in PDA?

Back 6

left-> right

Front 7

PDA imposes a volume overload of what side of the heart?

Back 7

LEFT atrium and ventricle

* therefore myocardial dysfunction and mitral valve regurgitation are potential consequences

Front 8

Poodles, Pomeranians and Maltese are highly predisposed to ___, especially females.

Back 8

PDA

Females 3x greater risk than male

Front 9

What are the physical findings associated with PDA?

Back 9

continuous murmur
bounding pulse (hyperkinetic)

Front 10

___ is due to a right ventricular outflow tract obstruction usually results from valvular dysplasia.

Back 10

pulmonic stenosis

Front 11

What CHD causes right ventricular hypertrophy? LV hypertrophy?

Back 11

Right-- pulmonic stenosis (in order to maintain normal pulmonary artery pressures and flow, the RV must generate abnormally high systolic pressure)

Left: Subvalvular aortic stenosis (same mechanism)

Front 12

___ occurs commonly in:

Terriers
English Bulldogs
mini Schnauzers
Samoyeds

Back 12

Pulmonic Stenosis

Front 13

What is the most likely method of correction of pulmonic and subvalvular aortic stenosis?

Back 13

percutaneous balloon valvulplasty

*surgical if that fails
*therapy is only palliative and instituted only after the onset of heart failure

Front 14

Pulmonic stenosis imposes a pressure overload of the ____.

Back 14

RV

Front 15

What breeds are predisposed to Subvalvular Aortic Stenosis?

Back 15

Large breeds
Golden Retrievers
Rottweilers
Boxers
Newfoundlands
German Shepherds

Front 16

What is the most common clinical sign of severe SAS?

Back 16

CS are uncommon in puppies
syncope and sudden death in young adults

Front 17

Outflow tract obstruction results in a (systolic/diastolic) murmur.

Back 17

systolic

*therefore pulse is hypOkinetic

Front 18

T/F: CHF is common in dogs with SAS.

Back 18

False

CHF is UNcommon in SAS

Front 19

Ventricular Septal Defect is a (systolic/diastolic) defect.

Back 19

systolic

Front 20

Clinical importance of a VSD depends on 2 factors:

Back 20

1- size
2- presence of other concurrent defects

Front 21

What species are more commonly affected by VSD?

Back 21

cats and horses

Front 22

What dogs tend to be more commonly affected by VSD?

Back 22

english springer spaniel
English bulldog
bloodhound
shiba inu

Front 23

a VSD results in a ___ murmur due to the pressure difference between the ventricles (Drops to nearly zero during diastole).

Back 23

systolic

Front 24

T/F: Most VSDs in dogs and cats are small and well tolerated.

Back 24

True

*systolic murmur
left to right shunting
volume overload of the LA, LV

Front 25

Unlike VSD which shunts blood through the defect and immediately into the pulmonary circulation during _____, an ASD increases the _____ volume of the right ventricle.

Back 25

VSD -- systole

ASD-- increases RV diastolic volume

Front 26

Is an atrial shunt audible?

Back 26

NO

*there may be relative pulmonic stenosis that creates an audible murmur

Front 27

AV valve dysplasia is a relatively common defect in the ___, that can result in regurgitation (more common) or stenosis. it is UNCOMMON and generally inaudible.

Back 27

CAT

Front 28

Cyanotic heart disease result when there is shunting (due to ASD, VSD, or PDA) + one of the following: (3)

all forms of Cyanotic HD are UNCOMMON

Back 28

severe PS
elevated pulmary vascular resistance
tricuspid stenosis

Front 29

What is the most iportant clinical sequelae of chronic cyanosis?

Back 29

polycythemia

due to systemic hypoxia (stimulates EPO)

Front 30

What is Eisenmenger's Physiology?

Back 30

a reversed PDA, VSD, or ASD

Front 31

What age is does shunt reversal occur in?

Back 31

less than 6 months

Front 32

What has to occur in order for Eisenmenger's Physiology?

Back 32

pulmonary vascular resistance exceeds systemic resistance

Front 33

Tetralogy of Fallot is an uncommon malformation consisting of (4):

Back 33

pulmonic stenosis (MURMUR)
VSD
override of the aorta over the VSD
RV hypertrophy

*clinical signs are related to hypoxemia and polycythemia

Front 34

RA enlargement will show a bulge from __--__ on a VD/DV view.

Back 34

9-11 (right cranial heart border)

Front 35

___ may cause dorsal deviation of the trachea on rads.

Back 35

right atrial enlargement

*this is because elevation is cranial to the birfurcation (different from LA enlargement which is as or behind the carina)

Front 36

What do these have in common?

Pulmonic stenosis
Heartworms
tricuspid insufficiency
tetralogy of fallot
R-->L PDA or VSD
Cardiomyopathy
chronic pulmonary disease

Back 36

can cause Right heart enlargement

Front 37

You look at rads and notice an enlarged heart. There is a bulge from 2-3. What is this likely to be?

Back 37

Left Auricle

Front 38

What heart diseases are associated with Left Heart enlargement?

Back 38

Mitral Valve insufficiency
PDA
Aortic Stenosis
Cardiomyopathy
VSD

Front 39

You are examining rads of a dog with a heart murmur. You see a bulge at 1-2. What is this likely to be?

Back 39

Pulmonary trunk enlargement

Front 40

aortic stenosis results in a ___ (location) dilitation of the ascending aorta. This shows up on Rads as a bulge/widening of the aorta from ____ -____.

Back 40

post-stenotic
11-1

Front 41

What are the differentials for a giant globoid heart on rads?

Back 41

pericardial effusion
peritoneal-pericardial diaphragmatic hernia
biventricular enlargement
CARDIOMEGALY!

Front 42

Why should increased sernal contact NOT be used as a criterion for feline right heart enlargement?

Back 42

it may occur in normal geriatric cats and can be associated with LA and LV enlargement

Front 43

what is the difference between concentric enlargement and eccentric enlargement on radiographs?

Back 43

concentric-- maintains normal apex

eccentric-- rounded apex

Front 44

in the cat LA enlargement may take on the appearance of ___ (lat) or ___ (VD) if the LV is not dilated.

Back 44

ice cream cone (lat)

valentine's heart (VD)

Front 45

What Explain the vertebral heart scale method.

Back 45

measure the heart from the ventral border of the LEFT mainstem bronchus to the most most ventral point of the APEX

+

fattest girth of the heart (upper 1/3)

=

overall size

(canine- 9.7 +/- 0.5, feline- 7.5 +/- 0.3)

Front 46

What drugs would be good to use for animal restraint during a cardiac ultrasound?

Back 46

opioids (butorphanol, buprenophine, hydromorphone)
acepromazine (dogs)
benzodiazepines

p 109 notes

Front 47

The velocity of sound is a function of density and elastic properties of the transmitting medium. In soft tissues and blood this is about __ m/s.

Back 47

1540 m/s

Front 48

explain the relationship of the following transducer properties

resolution: frequency
resolution: penetration

Back 48

resolution increases as frequency increases

resolution decreases as penetration increases

Front 49

___ is the abiliy of some materials o generate an electric field or electric potential in response to applied mechanical stress.

Back 49

piezoelectricity

*how the crystals in the transducer tip work

Front 50

how should the beam be oriented to the interface in order to increase the received reflected sound waves?

Back 50

perpendicular

*except for Doppler velocity interrogations of blood flow-- must be parallel

Front 51

___ is a measure of contractility. It is obtained by (LV end diastolic width- LV end systolic width)/ LV end diastolic width.

Back 51

Fractional shortening

Front 52

the transducer must be ___ to blood flow in order to obtain accurate measurements of velocity.

Back 52

PARALLEL (angle should be less than 20)

*cosine 0 = 1 vs cosine 90 = 0

Front 53

Continuous wave doppler is different from pulsed wave doppler how?

Back 53

continuous: high velocity BF-- exact site of sampling is unknown

pulsed: samples blood velocity at a specific location (does not work for high velocities)

Front 54

What is Bernoulli's equation?

Back 54

delta P = 4(Vsquared)

pressure gradient = 4 times velocity squared

*used to predict a pressure gradient across a valve/stenotic region/ VSD

Front 55

_____ is required to characterize cardiac disease in cats.

Back 55

echochardiograpic evaluation

Front 56

T/F: ALL cases of Congenital heart disease require an echocardiogram and Doppler.

Back 56

true


p 129

Front 57

The ____ propogates as a wave of depolarization through the conduction system and myocardium.

Back 57

action potential

*the wave is the electriccal signal that triggers myocardial contraction

Front 58

What information does an ECG provid?

Back 58

heart rate
rhythym
cardiac size (hypertrophy)

mean vector of ventricular or atrial activation (direction) aka Mean electrical axis

Front 59

What two variables of the ECG can be controlled by th operator?

Back 59

paper speed
sensitivity (units of the Y axis)

Front 60

What general direction does cardiac contraction move in?

Back 60

cranial to caudal
right to left
dorsal to ventral

Front 61

Setting up leads allow for the generation of multiple lines of ECG to read. Waht is the significance of this?

Back 61

allows for different vantage points fromw hic to view the electrical activity of the heart.

Front 62

____ and ___ are superior to the ECG as a means of assessing heart size.

Back 62

echo and rads

Front 63

How is the p-wave different for LA and RA enlargement?

Back 63

RA-- prolonged p wave

LA-- increased amplitude of p wave

Front 64

What do small QRS complexes mean in a dog? in a cat?

Back 64

dog-- pleural or pericardial effusion, obesity

cat-- QRS normally small

Front 65

What is electrical alternans?

Back 65

alternating QRS size

* assocated with pericardial effusion

Front 66

What can you tell from the width of a QRS?

Back 66

narrow: supraventricular origin

wide: ventricular origin (or intraventricular conduction delay-- uncommon)

Front 67

Rhythm analysis:
(3) important steps/questions

Back 67

1. determine HR
2. is the rhythm regular or not
3. association b/t atrial and ventricular activity?

Front 68

T/F: ALL real QRS complexes MUST have an associated T wave.

Back 68

True

Front 69

T/F: T waves can be positive, negative, or biphasic in dogs.

Back 69

true

Front 70

Whats the range for sinus tachycardia?

Back 70

160+ for dogs
240+ for cats

Front 71

Whats the range for sinus bradycardia?

Back 71

below 70 in dogs
below 160 in cats

Front 72

Premature Supraventricular Complexes result in an abrupt decrease in the ___ .

Back 72

RR interval

*p wave is usually superimposed on or even obscured by the T wave

Front 73

Premature supraventricular tachycardias differ from Sinus tachycardia and atrial fib because they arise from ___ which makes them very regular in pattern.

Back 73

a single supraventricular focus

*they are usually rapid (>240bpm)

Front 74

What is the shining characteristic of atrial fib?

Back 74

NO P WAVES!!!!
rapid
irregular

Front 75

_____ must precede the development of AF.

Back 75

marked atrial enlargement

*this is b.c a critical mass of atrial myocardium is required to support the arrhythmia

Front 76

Premature Ventricular Complexes occur early relative to the previous RR. What does the QRS look like?

Back 76

WIDE and bizarre

dump= lub dub

so its like dump dump dump WHOMP dump dump WHOMP dump dump.

(where as Supraventricular Premature complexes would be like dumpdump dumpdump dumpdump)

Front 77

Ventricular tachycardia is defined as more than ____ ectopic ventricular complexes in a row.

Back 77

3

Front 78

Ventricular fibrillation is ____ rhythm.

Back 78

pulseless

Front 79

ventricular fib is a pulseless rhythm that is lethal without prompt _____

Back 79

DC cardioversion

(direct-current-- IE: the toaster!)

Front 80

T/F: Vtac can degenerate to Vfib.

Back 80

true

Front 81

____ is an important cause of sudden arrhythmic death and is the final cardiac rhythm of many dying patients.

Back 81

Ventricular Fib

Front 82

Name some "extracardiac diseases" that might cause ventricular arrhythmias.

Back 82

GDV
road trauma
splenic disease
neurologic disease
sepsis

electrolyte, autonomic, pH imbalances

Front 83

Ventricular Arrhythmias are relatively (fast/slow).

Back 83

slow

Front 84

Describe a second degree AV block and causes.

Back 84

failure of 1 or more atrial depolarizations to conduct to the ventricles

d/t:
high vagal tone (will resolve with atropine admin)
diseased AV node (atropine has no effect

Front 85

T/F: first degree AV block has NO effect on Cardiac output.

Back 85

True

*may hear S4 (gallop)

Front 86

____ is an important cause of syncope-- many patients can be effectively treated with the implantation of a permanent electronic pacemaker.

Back 86

3rd degree AV block

Front 87

What breeds are predisposed to Sick Sinus Syndrome?

Back 87

older, smaller breeds
miniature schnauzers
cockers
terriers

Front 88

How do you differ between physiologic sinus bradycardia and pathological sinus node?

Back 88

atropine will resolve physiologic forms

*diverse appearance on ECG

Front 89

T/F: Hyperkalemia will cause a tachycardia.

Back 89

False

bradycardia
*no p-wave
*wide QRS

Front 90

What causes syncope? ie: define the process not the diseases.

Back 90

transient decrease in cerebral perfusion pressure caused by either a decrease in cardiac output or an inappropriate degree of peripheral vasodilation

Front 91

what arrhythmogenic diseases cause syncope?

Back 91

rapid VTACH
rapid SVT
high grade 2-3 AV block

Front 92

What structural cardiac diseases cause syncope? (think about limiting Cardiac output)

Back 92

aortic stenosis
pulmonic stenosis
pulmonary hypertension
mitral valve regurgitation

Front 93

Whats in the minimum database of syncope diagnosis?

Back 93

CBC
chem
UA
resting EKG

Front 94

What are the Determinants of Cardiac output according to Dr. Abbot?

Back 94

Heart rate
Preload
Afterload
Contractility

Front 95

____ is a potential consequence of practically ANY cardiac disease.

Back 95

Heart failure

Front 96

What is the anatomical classificaiton of heart disease?

Back 96

pericardial disease
myocardial disease
endocardial disease
disease of the conduction system

Front 97

what is the pathophysiologic classifcation of heart disease?

Back 97

volume overload
pressure overload
contractile dysfunction
diastolic dysfunction
arrhytmias
high CO states

Front 98

T/F: a cat with a cough likely has CHF.

Back 98

False.

*cats with heart disease rarely cough

Front 99

____ is the difference between systolic and diastolic pressure.

Back 99

pulse pressure

Front 100

Where can you measure the Central Venous Pressure non-invasively?

Back 100

external jugular... should pulsate 5-8cm (1/3) above the thoracic inlet ie: the level of the RA

Front 101

What occurs during S1?

Back 101

closure of the AV valves

LA-> mitral-> LV

RA-> tricuspid -> RV

(also begins atrial diastole)

Front 102

What occurs during S2?

Back 102

closure of the semilunar valves

L- aortic
R- pulmonic

(also begins ventricular diastole: remember T wave follow QRS which is S2)

Front 103

What occurs during the p-wave?

Back 103

S4: atrial systole/ late ventricular diastole

Front 104

What is the difference between a gallop and a click?

Back 104

gallop is an actual heart sound-- S4-- that is generally not audible

click is the splitting of S1 into 2 audible components (generally occurs so close that we cannot differentiate)

Front 105

___ is a prolonged series of vibrations that originate from the cardiovascular system and is audible with a stethoscope.

Back 105

Murmur

Front 106

What are the 3 determinants of blood flow character?

Back 106

velocity-- acceleration explains almost all murmurs

viscosity-- anemia may explain murmurs when HCT<17

vessel diameter

Front 107

How are murmurs characterized?

Back 107

intensity, location, timing

Front 108

Explain the grading system for Murmur intensity.... generally.

Back 108

1-2 soft, require expert
3,4 - intermediate, loud
5,6- precordial thrill

Front 109

Significant weight loss is common in ___ with CHF but not ___.

Back 109

weight loss is common in dogs

not cats

Front 110

___ is often the first clinical sign of heart disease in cats.

Back 110

Dyspnea

Front 111

Mid-systolic clicks are common in what breed?

Back 111

Cavalier King Charles Spaniel

Front 112

diminished heart sounds may be appreciated with ____ where as diminished lung sounds may be a result of ___, ___, and ___.

Back 112

heart: pericardial effusions

lung: pleural effusion, pneumothorax, atelectasis, masses

Front 113

Louder than norma lung sounds are indicative of ___.

Back 113

pulmonary edema

Front 114

What heart disease are males more predisposed to than females?

Back 114

Dilated cardiomyopathy

Front 115

What breeds are predisposed to dilateive cardiomyopathy?

Back 115

Dobies, Boxers

giants: Danes, Irish Wolfhounds, Newfies, Borzois...

Front 116

what breeds tend to get 3rd degree AV block?

Back 116

labrador retrievers
chow chows

Front 117

What diagnostic test would you do to determine why a patient is coughing?

Back 117

Rads

Front 118

What diagnostic test would you do to determine why a patient has an irregular heart beat?

Back 118

ECG

Front 119

What diagnostic test would you do to determine why a patien has a murmur?

Back 119

Echo

Front 120

What diagnostic test would you do to determine why a patient has pleural effusion?

Back 120

echo, cytology, minimum.

Front 121

What is Holter monitoring?

Back 121

24 hour ambulatory ECG monitoring

Front 122

What information can an echo provide?

Back 122

cardiac anatomy and function

diastolic and sytolic pulmonary arterial pressure in the presence of pulmonic and tricuspid valve insufficiency, respectively

Front 123

What is Central venous pressure? where is is measured?

Back 123

CVP is a reflecction of RA pressure and therefore RV EDP.

it is measured in the great veins just before they enter the RA

Front 124

What cardiac leakage biomarkers show up on a chem profile of a cardiac disease patient?

Back 124

cardiac troponin I
cardiac troponin T
creatine kinase isoenzyme MB

functional biomarkers include: brain natriuretic peptide, atrial natriuretic peptide

Front 125

___ and ___ are myofibrillar proteins in the cardiac muscle cells that regulate the calcium mediated action between actin and myosin filaments in cardiac muscle.

Back 125

Cardiac troponin I and T

Front 126

___ and ___ generally oppose the physiologic action of the renin-angiotensin-aldosterone system.

Back 126

atrial natriuretic peptide
brain natriuretic peptide