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149 Cards in this Set

  • Front
  • Back
T/F: Primary Valvular disease is common in the Cat.

*primary and secondary cardiomyopathies are the most common acquired cardiac disease in the cat
In Hypertrophic Cardiomyopathy, ___ pressures in the ventricle may rise abnormally high.

*even when the diastolic volume is normal or small
HCM refers to ____ or ____ myocardial hypertrophy.
primary or idiopathic
hypertrophy of the myocardium causes __________ to be compromised which further slows myocardial relaxation.
coronary perfusion
T/F: in most cases of HCM, systolic ventricular performance is normal.
What species and gender is most commonly effected by HCM?
Male Cats
_____ is the most common clinical sign associated with feline HCM. It results from ____ or ____.

pleural effusion or pulmonary edema
How do you diagnose HCM?
What is SAM and what is it associated with?
Systolic Anterior Motion of the Mitral Valve

causes dynamic outflow tract obstruction (70% of cats with HCM have this)
Why is the lowest effect dose of furosemide used to treat feline patients with pleural effusion? What else might you use instead?
Feline patients do not tolerate overly aggressive diuretic therapy well.

Therapeutic drugs for patients with diastolic dysfunction has been directed towards the objectives of improving ventricular filling. What specific effect would these drugs have on the heart?
slow heart rate
speed myocardial relaxation

= longer stronger contraction = better ventricular emptying= more space to "fill" with incoming blood flow= increased stroke volume
This drug is sometimes used as an adjunct to diuresis when CHF results from HCM. It is a Calcium channel blocker that has a slowing effect on the sinus node.
These drugs are beta-blockers. They slow heart rate and decrease dynamic outflow tract obstruction.
____ are vasodilators that have far-reaching neuroendocrine effects.
ACE inhibitors
If a cat has subclinical HCM, do you treat it?
if it shows left atrial dilation on echo
Most patients with restrictive cardiomyopathy have normal ventricular wall thickness and normal systolic ventricular performance. So what is abnormal that is causing diastolic dysfunction?
left atrial or biatrial dilation
Why don't cats get DCM much anymore?
We know that taurine is an essential AA for cats-- which was causing the high incidence of DCM along with many other problems.
Cats often develop "flow murmurs" in the absence of structural cardiac disease, but if you hear ____ then the patient likely has myocardial disease.
a gallop
Cats with myocardial disease are predisposed to thromboemboli. Will heparin help treat this complicaiton?
- may be used 24-72 hours post embolization, may prevent the thrombus from enlarging, but does NOT have a thrombolytic effect
Hyperthyroidism is a high cardiac output state that can cause hypertrophy of the heart. Is this reversible?
What is the main difference between hypertrophic cardiomyopathy and restrictive cardiomyopathy?
restrictive-- there is no hypertrophy

both--diastolic dysfunction
Concerning canine dilated cardiomyopathy: Loss of a critical mass of cardiomyoctes and maladaptive hypertrophic responses can result in irreversible _____ myocardial dysfunction.
_____ occurs when the walls of the heart appear thin relative to chamber size, but the absolute heart weight has increased.
eccentric hypertrophy
What breeds of dogs are more commonly diagnosed with DCM?
large-giant breeds
cocker spaniels
Dogs with DCM generally have a ___ sound, related to reduced ventricular compliance and high atrial pressures
gallop (s3)
You are examining a dog's ECG. It has a higher than normal R wave and a wider than normal P wave. What might this indicate?
Tall R--> LV enlargement
wide P--> LA enlargment
What rhythm is most commonly demonstarted in dogs with DCM?
atrial fibrillation
T/F: on Echo, low fractional shortening in the absence of ventricular dilation does NOT constitue a diagnosis of DCM.
Canine DCM:
These breeds usually present with VTAC.

These breeds usually develop ascites and Atrial fibrillation.

This is the only SMALL breed that commonly gets DCM.
VTac: dobies, boxers

Ascites + AF: Giants

Small: cocker
measurement of N-terminal pro-B-type natriuretic peptide may aid in identifying dogs with ____.
occult DCM
What is the conventional therapy for congestive heart failure due to SYSTOLIC dysfunction?
1- furosemide
2- ACE inhibitor
3- Pimobendan
What is Pimobendan?
phospodiesterase inhibitor
positive ionotrope
What can you manage VTac with?
elevated HR?
refractory edema?
IV lidocaine
How long does it take to see a response to taurine supplementation?
3-4 months
This is an inherited disorder that is characterized by fatty or fibrofatty replacement of the right and sometimes left ventricular myocardium.
Arrhythmogenic right ventricular cardiomyopathy

(boxer dog cardiomyopathy)
How do you diagnose ARVC?
DNA swab test to WSU

- genetic history
- left apical systolic murmur
- VTac
- syncope
-PM: fibrofatty infiltrated myocardium
>100 PVCs over 24 hours in an Adult Boxer is strongly suggestive of ____.
Arrhythmogenic Right Ventricular Cardiomyopathy
If you treat syncope that you think is due to VTac (and is really due to neurocardiogenic bradycardia) what will happen?
syncope gets worse

Fish Oil Omega-3s
mexiletine + atenolol

are all treatment options for ARVC.
English Springer Spaniels and Old English Sheepdogs are commonly affected by ____, noted on the ECG as an escape complex with no P wave.
Atrioventricular myopathy
(silent atria, persistent atrial standstill)
You do a necropsy on an Old English Sheepdog that had progressive severe muscle atrophy. You examine the heart and find dilated, thin, almost transparent atria with no visible muscle. What is your tentative diagnosis?
Atrioventricular myopathy
Chagas, Parvo, and Lyme can cause what myocardial disease?

*also distemper, systemic fungal infections, bartonella
_____ is, by far, the most commonly encountered acquired cardiac disease in adult dogs, and the condition is caused by a progressive myxomatous degeneration of AV valves.
Degenerative mitral valve disease
What breed commonly gets Chronic Degenerative Valvular disease?
Cavalier King Charles Spaniels

*Male- slightly more common
What are the 6 structures of the mitral valve apparatus?
valve leaflets
annulus fibrosus
chordae tendinae
papillary muscles
left atrium
left ventricular muscle
What 2 factors determine the severity and volume of regurgitation of the mitral valve?
Regurgitation orifice area

Left ventricular or left atrial pressure gradient
What physical findings can be directly correlated to the severity of the regurgitation/ NYHA classes of heart failure?
murmur intensity
heart size
In dogs, determining whether the main underlying problem is cardiac or respiratory in origin can be difficult. What are some differences?
BCS thin,
HR rapid,
Rhythm regular,
Murmur loud

BCS obese,
HR normal,
Rhythm respiratory arrhythmia,
Murmur soft
Diagnostic evaluation of Mitral regurgitation can be done with Radiographs. What are some of the signs you might see?
enlarged left auricle: bulge from 1-3
enlarged cardiac silhouette
obtuse angle/ dorsal deviation of the mainstem bronchi
LA: dense mass superimposed
T/F: Echo is essential to diagnosis of Chronic Degenerative Valvular Disease in Dogs.

*thoracic rads are essential, echo can be helpful if radiographic signs are not obvious
T/F: ECG of dogs with Mitral valve regurgitation is generally Normal.
What does FONSE stand for and when is it used?

standard of care of ACUTE heart failure management
Why is the aggressive use of furosemide in the presence of cardiac tamponage but absence of pulmonary edema contraindicated?
patients with LA rupture resulting in cardiac tamponade often require IV fluid therapy due to circulatory collapse
____ is the most common degenerative valve abnormality identified in older horses.
aortic valve insufficiency
What is the difference between endocarditis, vegetative endocarditis, and infective endocarditis?
endocarditis: inflammation of hte endocardial surface

vegetative:platelets, fibrin, microorganisms, inflammatory cells adhere to heart valves, septal defects, chordae tendinae, mural endocardium

infective:microbial infection of the endocardial surface
What are the most common reported isolates from infective endocarditis?
Staphy, Strep, E. coli, Corynebact, Bartonella, (others: AB resistant: Pseudomonas, proteus)
As wall stress___ there is a ___ in myocardial oxygen demand.
stress increases
O2 demand increases
Law of Laplace explains _____. This is represented by the equation:

____ = P x r/h
wall stress
T/F: embolization of the spleen can be catastrophic.

clinically silent
* kidneys, CNS are catastrophic
You have a critically ill puppy you are treating for parvo. He has been receiving IV fluids for 3 days, and just as his fever has diminished and you think you can send puppy home-- he presents with a sudden fever spike and a new cardiac murmur. What do you think is going on?
Acute infective endocarditis-- get the catheter Ouuuuut
What do you expect the pulse to feel like in Aortic valve insufficiency?
bounding/ hyperkinetic
Of the tests listed, which is absolutely diagnostic for acute infective endocarditis:

thoracic rads
Blood culture
blood cultures
What is the "modified Duke Criteria"?
major and minor criteria used to diagnose infective endocarditis

Major: 2 + blood cultures, Echo evidence of oscillating mass
What is different about the development of endocarditis in ruminants versus other species?
Ruminants tend to develop lesions of the RIGHT side of the heart (tricuspid and pulmonary) whereas other species always develop lesions on the left.

*corynebact is the most common
What are the 2 forms of pericardial disease and which is most common?
effusive* common
Most pericaridal effusinos in cats are due to ____ where as in dogs they are primary resulting from the presence of neoplasia or idiopathic pericarditis.
____ is present when intrapericardial pressures and diastolic pressures of the ventricles are equal
What are the clinical signs of tamponade resulting from?
low cardiac output and systmic (right) congestion
What is the rhythm of tamponade usually?

*may be muffled by the pericardial effusion
What are the characteristic changes in the pulse associated with tamponade?
weakening of the arterial pulse with respiration--> pulsus paradoxus

jugular distension
Physical findings of tachycardia, muffled heart sounds, jugular vein distension, and ascites are HIGHLY suggestive of ____.
cardiac tamponade
T/F: pulmonary edema usualy accompanies cardiac tamponade.
___ is the diagnostic test for cases of cardiac tamponade for its prognostic and diagnostic information.
almost all Pericardial effusions in dogs are ___.
Treatment of pericardial effusion with diuretics is ineffective and potentially harmful. What should you do instead?
Normal pulmonary circulation is ___-flow, ___-resistance circuit capable of accomodating the entire right ventricular output at ____ the pressure of systemic circulation.
high flow
low resistance

1/5 systemic pressure
Secondary Pulmonary Hypertension develops as a result of: (3 things)
impedance of pulmonary venous drainage
pulmonary overcirculation
increased pulmonary vascular resistance
Pulmonary Hypertension imposes a ____ load on the ____ ventricle which hypertrophies with ______ hypertrophy.
pressure load
right ventricle
concentric hypertrophy
You are presented with a dog that has respiratory distress and right apical murmur. What should you suspect?
Pulmonary Hypertension
How could you determine the velocity of a tricuspid regurgitant jet?
modified Bernoulli equation

delta P = 4Vsquared

where delta p is the change in pressure from the right atrium to the right ventricle
What are Phosphodiesterase-V inhibitors used to treat?
Pulmonary Arterial Hypertension

- great distribution of PDE-V in the lung tissue
In pulmonary hypertensive cases that also have left heart disease, what are your treatment options?
reduce afterload, increase contractility
reduce afterload:

positive ionotrope:
Pulmonary hypertension due to lung disease or hypoxemia can be treated with...
ambulatory oxygen
What is the general pathogenesis of Cor Pulmonale in Ruminants?
high altitude hypoxia leads to pulmonary vasoconstriction which causes Right Heart hypertrophy, dilation and eventually CHF
What would cause Cor pulmonale in the horse?
Chronic COPD
T/F: The # of circulating microfilaria in the peripheral blood correlate well with the number of adult heartworms and therefore can be used to determine the severity of infection.
What does the ELISA Heartworm test detect?
circulating heartworm antigen shed form the cuticle of female worms (therefore infections with all male worms may produce a false negative)

*high sensitivity and specificity
What view is best view to evaluate the caudal lobar pulmonary vessels for heartworms?
If you suspect the caval syndrome what diagnostics should you run?
PCV- anemia
UA- HGBuria

* do NOT treat with Melarsomine: a HW extraction is required
What are the differences in:
circulatory failure
heart failure
myocardial failure
Congestive heart failure
Circulatory Failure- delivery of O2 is insufficient ( can be d/t many different things)

Heart Failure- injured heart = inability to pump enough blood for metabolic needs and BV pressures

Myocardial failure=defect in contractility

Congestive Heart Failure= abnormal heart function results in congestion and edema
*increased blood volume
*hyponatremia w/ severe CHF

these are systemic alterations that may be associated with ___.
heart failure
What is the difference in the presentation of patients with acute versus chronic heart failure?
acute: CS associated with Low Cardiac output

chronic: CS associated with Congestion
What are the determinants of Cardiac Output?
Heart rate
Increased diastolic wall stress stimulates ____ hypertrophy while increased systolic wall stress stimulates _____ hypertrophy.
diastolic: eccentric

systolic: concentric
the rate of myocardial relaxation is an active, energy requireing rocess that depends on the rate at which systolic ______ ions are re-sequestered by the ____.
ca++ : sarcoplasmic reticulum
in chronic heart conditions such as volume overload, the heart cannot keep up with the demands. hypoxia signals a neurohormonal reponse causing ______________ and __________ which increases afterload and preoload. However this only exacerbates the condition.
peripheral vasoconstriction and fluid retention
concerning chronic pressure overloads: If concentric hypertrophy returns wall stress and end systolic volume to normal, why is there still a problem?
capilarry density and myocardial perfusion does not increase in proportion to the increase in muscle mass. = myocardial hypoxia = arrhythmias and sudden death
What is the relationship between backward failure, forward failure, and the modern concept of heart failure?
the modern concept of heart failure incorporates both concepts of backward and forward failure.

forward: inadequate tissue perfursion = RAAS

backward: ventricular failure causes back up of blood
Frank-Starling Mechanism operates mainly to equalize outputs betwen _____.
the ventricles
Cardiac Response to the SNS results in increasd ___ and ___.
heart rate and contractility
What is ANP? Where does it come from and what does it do?
Atrial Natriuretic Peptide

Released from the atria when there is distension results in increased Na+ and water excretion by the kidney and vasodilates.
Plasma ___ levles often correlate well with the severity of heart failure because the SNS is activated when CO is depressed.
drugs to treat diastolic heart failure aime to improve____ while drugs that treate systolic heart failure aim to improve ____ and decrease ____.
diastolic--- improve ventricular filling

systolic-- improve contractiliy and decrease congestion
Digitalis is a positive ionotrope. How does it work?
makes more Ca++ available

*narrow MOS, toxicity = GI, arrhythmias
What drug is known as an "Inodilator"?
Pimobendan is particularly effective for use in what breed of dogs?

* often used in conjunction with furosemide, ACE inhibitors (and possibly even digoxin, spironolactone, or beta blockers)
Name 2 bipyridines. How do they work?
Amrinone, Milrinone

* increase Ca++ availability by increasing cAMP by phosphodiesterase inhibition and other mechanisms
What kind of diuretic is furosemide?
how do thiazide diuretics (hydrochlorothiiazide, chlorothiazide) work?
inhibit the reabsorption of sodium and chloride in the distal tubule
What kind of diuretic is spironolactone?
potassium sparing
systemic arterial vasodilators are used to reduce _____ and increase ____.
reduce myocardial oxygen consumption (decreasing the volume load decreases the wall stress)

increase cardiac output

*they also reduce regurgitant volume and increase forward output
Whats the main difference between nitroprussied and nitroglycerin?
nitroprusside-- arteriolar vasodilator

nitroglycerine-- venous vasodilator
Name 3 drugs that counter the neurohormonal dysfunction associated with CHF.
Beta-blockers (sometimes)
Digoxin (increases PS tone and decreases adrenergic tone)
spironolactone (aldosterone antagonist)
Ohm's Law:

BP = ___ x ___
blood pressure = cardiac output x systemic vascular resistance
Enalapril has proven efficacy in dogs with heart failure resulting from ____ or ____.
degenerative mitral valve disease

dilated cardiomyopathy
The cardiotoxic effects of digitalis are related to the serum _____ concentration. What is usually the first sign of digoxin toxicosis?

What drugs are standard management for Systolic failure? diastolic failure?
systolic: furosemide, Ace inhibitor, pimobendan, +/- digoxin

diastolic: furosemide, enalapril?
T/F: most dogs with HF are tachycardic.
Large dogs usually get ____ while small elderly breeds usually get ___.
large-- DCM

small-- degenerative mitral valve disease
If mitral valve disease is severe enough to cause HF, what will you hear on auscultation?
loud murmur
What is the urgent therapy protocol for Cats in Acute CHF?
+/- nitroglycerine

When herat failure is the cuase of dyspnea, the response to diuretic therapy is usually ___ and ____. Failure to respond to empirical therapy for HF should prompt reevaluation of the diagnosis.
rapid and dramatic
Arrhythmias resulting from disorders of impulse formation include: (4)
depressed normal automatacity
enhanced normal automatacity
abnormal automatacity (ectopic tac)
triggered activity (preceded by normal cardiac depolarization)
concerning arrhythmias due to disorders of impulse conduction: blockages of impulse conduction commonly result in ____ while rerouting of impulses usually results in _____.
block: bradycardia

reroute: tachycardia
Successful treatment of arrhythmias requires:
ACCURATE ECG diagnosis

*consideration of underlying mechanisms, heart disease, prevent progression
T/F: administration of antiarrhythmics has the possibility to induce more dangerous arrhythmias.
To be successful, antiarrhythmics must selectively target the abnormal cells without supressing normal cardiac pacemaker cells in the sinus node. How do they do this?
- suppress abnormal automatacity
- lower RMP
- raising the threshold potential of diseased cells
Increases in adrenergic stimulation, temperature and hypoxia have what effect on diastolic depolarization?
What is the manifestation of Triggered activity arrhthmias?
abnormal calcium fluxes or imbalanced autonomic tone =

Premature beats or ectopic tachycardias
__________ is one of the most common and importatn causes of tachyarrhythmias.
What classes of antiarrhythmics primarily affect working myocytes?
conduction system?
working myocytes: I & III

conduction: II & IV
arrhythmias arrising from ectopic myocardial locations should be treated with what class of antiarrhythmics?
class 1 or 3
Class 1 Antiarrhytmics are ____ blockers. They act to decrease the __________________.
1: Sodium Channel Blockers

decrease slope of phase 4
Class 1a are _____. (general class)
Class 1c are_____.
1a: anticholinergic

1c: beta-blockers
Propranolol, Atenolol, and esmolol are class II antiarrhythmics. Their mechanism of action is____.
What class of antiarrhythmic is sotalol?
Class III: potassium channel blockers

*also has class 2 properties
What is unique about amiodarone? Does this add to or distract from its toxicity potential?
it is an antiarrhythmic that has class 1,2,3 and 4 properties.

Lots of Toxicities-- indicated for use in life threatening ventricular arrhytmias
T/F: potassium channel blockers (class 3 antiarrhytmics) have little effect on ABNORMAL automaticity.
Calcium channel blockers are class ___ antiarrhythmics. They interrupt reentry pathways by increasing ____ refractoriness.
CCB: Class 4

increase AV node refractoriness
If you could choose between quinidine or procainamide, which would you use in a small animal setting if there were no specific indications for the use of one over the other?
procainamide has less side effects

All of these have something in common.
negative ionotropes
What would you use to treat bradyarrhythmia?
atropine, glycopyrrolate (PSM)

isoproterenol, theophylline (SM)
When APCs are observed in patients with CHF, ____ treatment is indicated as APCs may be a precursor for ____.

atrial fibrillation
What is a vagal maneuver?
When is it used?
ocular or carotid sinus compression can intiate a reflex that results in vagal discharge

may terminate an SVT or induce AV block in pathologic SVT
describe an ideal candidate for DC cardioversion.
AF with structurally normal hearts

*generally occurs in giant breeds
Equine hearts have many weird but normal variations. Name 2
Sinus arrhytmia
wandering pacemaker
first degree AV block
sinus arrest
SA block
What population of horses tends to develop idiopathic atrial fibrillation?
young horses-- sudden unexplained loss of stamina

-- if no heart disease: conversion of AF to sinus rhythm is attempted with quinidine
T/F: Most arrhythmias in ruminants are due to GI disturbances (bloat, vagal indigestion, DA) electrolyte disorder, acid base disturbances.
Hypocalcemia in cows results in a ________ QT interval, where as hypercalcemia is characterized by a ____ QT interval.
hypocalcemia: prolonged QT
(initial bradycardia followed by an INCREASED HR)

hypercalcemia: shortened QT (bradycardia)