Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
371 Cards in this Set
- Front
- Back
|
What makes a hemodynamic arrhythmia clinically important?
|
Ability to compromise cardiac output and oxygen delivery to the body.
|
|
|
What is meant by "60 Hz interference" on an EKG?
|
Electromagnetic interference from surrounding electrical sources (lights, computers, etc) that causes the EKG to look thick and fuzzy.
|
|
|
How is HR presented when multiple rhythms are present?
|
Express the rate of each rhythm
Ex: Atrial and ventricular HR in AV block Ex2: Rate of sinus rhythm, and rate of ventricular foci |
|
|
How can a digoxin-induced arrhythmia be resolved?
|
Remove the digoxin
|
|
|
What information can be gleaned from a thoracic radiograph in a patient with DCM or mitral valve disease?
|
Cardiac silhouette
Pulmonary vasculature Pulmonary parenchymal changes |
|
|
This iagnostic test is required for assessment of cardiac function, valve anatomy, infiltrative myocardial disease, or presence of intracardiac masses.
|
Echocardiogram
|
|
|
What is the goal of arrhythmia treatment in the patient showing signs of weakness, collapse, syncope, and shock?
|
Reduce hemodynamic compromise caused by arrhythmia
Prevent death |
|
|
What is the goal of arrhythmia treatment in the asymptomatic patient?
|
Prevent the arrhythmia from progressing to one which can cause clinical signs or death.
|
|
|
True or false: Many antiarrhythmic drugs are actually quite toxic.
|
True
|
|
|
List two broad mechanisms of arrhythmia formation.
|
Disorders of impulse formation
Disorders of impulse consuction |
|
|
This iagnostic test is required for assessment of cardiac function, valve anatomy, infiltrative myocardial disease, or presence of intracardiac masses.
|
Echocardiogram
|
|
|
What is the goal of arrhythmia treatment in the patient showing signs of weakness, collapse, syncope, and shock?
|
Reduce hemodynamic compromise caused by arrhythmia
Prevent death |
|
|
What is the goal of arrhythmia treatment in the asymptomatic patient?
|
Prevent the arrhythmia from progressing to one which can cause clinical signs or death.
|
|
|
True or false: Many antiarrhythmic drugs are actually quite toxic.
|
True
|
|
|
List two broad mechanisms of arrhythmia formation.
|
Disorders of impulse formation
Disorders of impulse consuction |
|
|
In what way can an EKG differentiate between arrhythmias caused by a defect in impulse formation and defects of impulse conduction?
|
EKG cannot differentiate
|
|
|
In what way can an EKG differentiate between arrhythmias caused by a defect in impulse formation and defects of impulse conduction?
|
EKG cannot differentiate
|
|
|
In what ways can there be defects in the normal automatic depolarization of cardiac cells?
|
Changes in:
-RMP -Slope of repolarization (phase 4) -Threshold potential |
|
|
In what ways can there be defects in the normal automatic depolarization of cardiac cells?
|
Changes in:
-RMP -Slope of repolarization (phase 4) -Threshold potential |
|
|
This kind of cardiac activity relies upon the presence of a previous action potential for its production.
|
Triggered activity
|
|
|
This kind of cardiac activity relies upon the presence of a previous action potential for its production.
|
Triggered activity
|
|
|
This electrical event is the main mechanism of arrhythmia formation.
|
Reentry
|
|
|
This electrical event is the main mechanism of arrhythmia formation.
|
Reentry
|
|
|
What three components determine the timing of the cardiac reentry signal?
|
1. Site of antegrade/forward block
2. Slow conduction retrograde through the block 3. Rapid repolarization of tissue proximal to block, allowing impulse to re-enter the circuit |
|
|
What three components determine the timing of the cardiac reentry signal?
|
1. Site of antegrade/forward block
2. Slow conduction retrograde through the block 3. Rapid repolarization of tissue proximal to block, allowing impulse to re-enter the circuit |
|
|
Atrial and ventricular myocytes (and the Purkinje fibers) have this kind of action potential.
|
Fast response action potential
|
|
|
What occurs during phase 0 of the fast response action potential?
|
Na+ influx and rapid depolarization
|
|
|
What occurs during phases 1 and 2 of the fast response action potential?
|
Early partial repolarization, then Ca++ influx=K+ efflux and positive electrical plateau
|
|
|
What occurs during phase 3 of the fast response action potential?
|
K+ efflux (in excess of Ca++ in) and repolarization to RMP
|
|
|
Atrial and ventricular myocytes (and the Purkinje fibers) have this kind of action potential.
|
Fast response action potential
|
|
|
What occurs during phase 4 of the fast-response action potential?
|
RMP
|
|
|
What occurs during phase 0 of the fast response action potential?
|
Na+ influx and rapid depolarization
|
|
|
What occurs during phases 1 and 2 of the fast response action potential?
|
Early partial repolarization, then Ca++ influx=K+ efflux and positive electrical plateau
|
|
|
What occurs during phase 3 of the fast response action potential?
|
K+ efflux (in excess of Ca++ in) and repolarization to RMP
|
|
|
What occurs during phase 4 of the fast-response action potential?
|
RMP
|
|
|
These cardiac cells have a slow-response action potential.
|
SA node, AV node
|
|
|
This type of action potential allows for spontaneous diastolic depolarization of the SA and AV nodes.
|
Slow response action potential
|
|
|
What occurs during phase 0 of the slow response action potential?
|
Ca++ influx and depolarization
|
|
|
What occurs during phase 3 of the slow response action potential?
|
K+ efflux overcomes Ca++ influx and "funny channel" to repolarize the cell
|
|
|
What occurs during phase 4 of the slow response action potential?
|
Slow Na+ influx thru the "funny channel" causes a slow depolarization toward the threshold potential.
|
|
|
What is the "funny channel" of the slow response action potential?
|
Slow Na+ channel that causes RMP to begin becoming less negative as soon as repolarization is complete.
|
|
|
What channel in the automatically depolarizing cardiac cell allows it to spontaneously depolarize?
|
The "funny channel," being a slow Na+ channel
|
|
|
List three factors that may enhance the rate of spontaneous diastolic depolarization (increased HR).
|
Increased body temperature
Sympathetic stimulation Hypoxia |
|
|
List three factors that may depress rate of spontaneous diastolic depolarization (decrease HR).
|
Vagal stimulation
Hyperkalemia Hypothermia |
|
|
Which classes of antiarrhythmic agents are most effective on the fast-response working myocytes?
|
Classes I and III
|
|
|
WHich classes of antiarrhythmic agents are most effective on the slow-response conduction cardiac cells?
|
Classes II and IV
|
|
|
This class of antiarrhythmic drugs acts to block Na+ channels and block Na+ influx.
|
Class I
|
|
|
Quinidine and procainamide belong to this specific antiarrhythmic subclass.
|
Class Ia
|
|
|
Lidocaine and mexiletine belong to this specific subclass of antiarrhythmic drugs.
|
Class Ib
|
|
|
This class of antiarrhythmic drugs is commonly used to treat ventricular tachycardias and atrial fibrillation.
|
Class I
|
|
|
Quinidine is used to treat arrhythmias primarily in what species?
|
Horse (and large animals)
|
|
|
What are the two primary indications for use of quinidine?
|
Control and prevention of VPC and VT
Conversion of atrial fibrillation to sinus rhythm in the absence of myocardial disease in horses. |
|
|
How will quinidine affect serum digoxin concentrations, and why?
|
Increase serum digoxin concentrations b/c higly protein bound
|
|
|
List some toxic effects seen with quinidine.
|
Vasodilation/Hypotension
GI signs in dogs Deafness, ataxia, Sz Pharyngeal edema, laminitis, colic in horses |
|
|
How will quinidine toxicity affect an EKG?
|
Prolongation of all intervals.
|
|
|
When is quinidine contraindicated?
|
3rd degree AV block, hypersensitivity
Relative: 2nd degree AV block, CHF, digoxin toxicity (Quinidine is a weak negative ionotrope) |
|
|
To what antiarrhythmic class does procainamide belong? How does it work?
|
Class Ia, acts to close open Na+ channels.
|
|
|
What are some indications for procainamide?
|
Ventricular arrhythmias
Often used when lidocaine is ineffective |
|
|
What are some of the toxic effects of procainamide?
|
GI signs
Weakness, hypotension, negative ionotropism Nephrotoxic if in renal failure Hypersensitivities |
|
|
When is procainamide use contraindicated?
|
Hypersensitivity reactions
2nd or 3rd degree AV block |
|
|
What antiarrhythmic class does lidocaine belong to? How does it work?
|
Class IB
Keeps closed Na+ channels closed |
|
|
When is lidocaine use as an antiarrhythmic indicated?
|
Acute termination of ventricular arrhythmia
(esp. with myocardial damage) |
|
|
This species is more sensitive to lidocaine toxicity.
|
Cats
|
|
|
List some adverse effects of lidocaine usage.
|
Nausea, vomiting
Ataxia, drowsiness, depression, seizures, muscle tremors |
|
|
When is lidocaine contraindicated as an antiarrhythmic?
|
3rd degree AV block
2nd degree AV block Hepatic disease |
|
|
To what specific antiarrhythmic subclass does mexilitine belong? In which species is it used?
|
Class IB
DOGS |
|
|
This antiarrhythmic drug is used in dogs like an oral lidocaine.
|
Mexiletine
|
|
|
List some signs of mexilitine toxicity.
|
GI: Nausea, vomiting (give with food)
CNS: Ataxia, drowsiness, depression, seizures, muscle tremors |
|
|
What are some contraindications for mexiletine use?
|
3rd degree AV block
Renal disease |
|
|
What effect do class I antiarrhythmic drugs have on spontaneously depolarizing cells?
|
Decrease slope of slow-response phase 4 (acts on "funny channel" and Ca channels)
|
|
|
This specific subclass of Class I antiarrhythmics also has undesirable anticholinergic effects.
|
Class Ia
|
|
|
What additional properties do class Ic antiarrhythmic drugs have besides their action on Na+ channels?
|
Beta blocking
Ca++ channel blocking |
|
|
Propafenone belongs to this antiarrhythmic class. What effects does it have?
|
Class IC
Prevents Na+ influx B blocker Ca++ blocker |
|
|
Beta blockers belong to this anti-arrhythmic class.
|
Class II
|
|
|
What effects do class II antiarrhythmics (beta blockers) have?
|
Negative ionotrope
Decreased relaxation (lusitropy) Decreased HR Decreased conduction velocity (dromotropy) Causes mild vasoconstriction as an SE |
|
|
List 3 non-selective Class II antiarrhythmics.
|
Carvedilol
Propanolol Sotalol |
|
|
List two B1 selective Class II antiarrhythmics.
|
Atenolol
Metoprolol |
|
|
Which type of Class II antiarrhythmic should not be administered to asthmatic patients?
|
B1B2 non-specific blockers
Ex: Carvedilol, propanolol, sotalol |
|
|
What side effects are associated with propranolol?
|
Bronchoconstriction (B2 block)
Negative ionotropy Bradycardia Hypotension Diarrhea |
|
|
What are some contraindications of propranolol?
|
3rd degree AV block
ASTHMA 2nd degree AV block Acute CHF Pulmonary disorders Hepatic disease |
|
|
How do Class III antiarrhythmic drugs work?
|
Prolongation of potential duration and refractory period
Blocks K+ channels |
|
|
Sotalol belongs to these two antiarrhythmic groups.
|
Class II (beta blocker)
Class III (K+ block) |
|
|
Amiodarone belongs to these antiarrhythmic classes.
|
Class I (Na+ block)
Class II (B block) Class III (K+ block) Class IV (Ca++ block) |
|
|
What are the indications for sotalol usage?
|
Life threatening ventricular antiarrhythmias
ARVC in Boxer dogs Atrial tachyarrhythmia |
|
|
What is a toxic effect of sotalol?
|
Prolonged QT interval predisposes to dangerous ventricular tachycardia
|
|
|
What are some contraindications for sotalol?
|
CHF (negative ionotrope)
AIrway disease (nonselective B-block) Renal failure (renal excretion) |
|
|
True or false: Amiodarone shortens the action potential of the cardiomyocyte.
|
False. Prolongs AP and delays repolarization
|
|
|
Is amiodarone generally a safe antiarrhythmic drug?
|
No, very toxic-- call cardiologist first if you can.
|
|
|
What are some indications for amiodarone?
|
Life threatening ventricular arrhythmias
Refractory SVT's Conversion of atrial fibrillation to sinus rhythm. |
|
|
What are some of the toxic effects of amiodarone?
|
GI
Neutropenia (high doses) Bradycardia Hepatotoxicity Hypotension Inhibits T4-->T3 Pneumonitis Corneal microdeposits |
|
|
What are some contraindications of amiodarone?
|
Sinus bradycardia
SIck sinus syndrome 3rd degree AV block Hepatic disease |
|
|
How do Class IV antiarrhythmic drugs work?
|
Calcium channel blockers
(slow conduction through AV node and increase AV refractoriness) |
|
|
Diltiazem belongs to which antiarrhythmic class?
|
Class IV (Ca++ blocker)
|
|
|
For what conditions is diltiazem indicated?
|
Ventricular rate response control of atrial fibrillation
SVT |
|
|
List some toxic effects of diltiazem.
|
Bradycardia, sinus arrest, 2nd or 3rd degree AV block
Hypotension (peripheral vasodilation) Aggravation of CHF (negative ionotropy) Vomiting in cats |
|
|
What are some contraindications of diltiazem?
|
3rd degree AV block
Sick sinus syndrome Use of B-blockers concurrently 2nd degree AV block CHF |
|
|
How does digoxin treat arrhythmias? List 3 actions.
|
Inhibits Na+/K+ ATPase
Enhances vagal tone to AV node Positive ionotropy |
|
|
What is the indication of digoxin therapy?
|
Ventricular rate control of atrial fibrillation
|
|
|
What are some signs of digoxin toxicity.
|
GI signs
ECG abnormalities (2nd/3rd degree AV block, ventricular arrhythmias) |
|
|
Serum levels of this antiarrhythmic drug should be measured 6-10 days after initiation of therapy to ensure therapeutic range is maintained.
|
Digoxin
|
|
|
What are some contraindications for digoxin therapy?
|
2nd or 3rd degree AV block.
Renal disease (excreted by kidneys) Hypokalemia (increased risk of toxicity) |
|
|
List some anticholinergic agents used to treat bradyarrhythmia.
|
Atropine, glycopyrrolate, propantheline bromide, hyoscyamine
|
|
|
How do anticholinergics work to counterract bradyarrhythmia?
|
Increase SA node automoaticity
Improve AV conduction |
|
|
This is a non-selective beta agonist that is used to treat serious life threatening bradyarrhythmia.
|
Isoproteronol
|
|
|
This oral xanthine derivative is used to treat symptomatic sick sinus syndrome.
|
Theophylline
|
|
|
This oral B2 agonist is used in treatment of symptomatic sick sinus syndrome.
|
Terbutaline
|
|
|
How is sick sinus syndrome managed pharmacologically?
|
Anticholinergics (atropine or propantheline)
or sympathomometics (theophylline) |
|
|
How is sick sinus syndrome treated definitively?
|
Artificial pacemaker implantation
|
|
|
A Doberman Pinscher presents with intermittent ventricular tachycardia that is likely the result of DCM. List two drug regimens used to treat the arrhythmia.
|
Mexiletine (Class Ib) with atenolol (Selective class II)
Sotalol (Class II and III) |
|
|
An Irish wolfhound presents in atrial fibrillation and CHF due to DCM. What therapy would be indicated for the arrhythmia? For the CHF?
|
Arrhythmia: Digoxin (ionotrope) and diltiazem (Ca blocker)
CHF: furosemide, pimobendan, enalapril |
|
|
A Boxer dog presents in sustained ventricular tachycardia due to ARVC. What treatment should be given in the hospital? What about at discharge?
|
Initial: Lidocaine
Discharge: Sotalol or mexilitine with atenolol |
|
|
List some possible etiologies of 3rd degree AV block.
|
Idiopathic
Infective endocarditis Myocarditis Neoplasia |
|
|
How is 3rd degree AV block definitively treated?
|
Artificial pacemaker implantation
|
|
|
Describe what it is to do a "vagal maneuver."
|
Action that increased vagal tone, such as pressing gently on a closed eyeball. THis will slow the HR.
|
|
|
A congenital accessory conduction pathway between the atrium and ventricle allows ventriculo-atrial conduction. What arrhythmia pattern could be observed with this?
|
SVT
|
|
|
How is SVT addressed medically when caused by an embryologic remnant of cunductive tissue?
|
Slow conduction through the AV node with CCB
Slow conduction through embrylogic muscular remnant with Class Ia, Ic, or K+/Ca drugs. |
|
|
How is atrial fibrillation addressed in anotherwise normal large animal?
|
Electrocardioversion
Medical/Chemical conversion with quinidine |
|
|
List some signs of quinidine toxicosis.
|
Increased HR b/c vagocytic
Increased QRS interval Ventricular tachycardia |
|
|
True or false: Some normal, old cats have premature atrial and ventricular complexes
|
True
|
|
|
How common is AV block in old cats?
|
Relatively common
|
|
|
Hypothermia is associated with this arrhythmia.
|
Bradycardia
|
|
|
Which species is at more risk for sudden death due to ventricular fibrillation: Cats or dogs?
|
Dogs
|
|
|
The presence of a structural abnormality of the heart.
|
Heart disease
|
|
|
True or false: Heart disease is the precursor to inevitable heart failure.
|
False. The nature and severity of the heart disease determines whether or not heart failure will result.
|
|
|
The end of a progressive cascade of events induced by damage to the heart.
|
Heart failure
|
|
|
The most common heart disease of canines is...
|
Chronic degenerative valvular disease (CDVD)
|
|
|
The most common heart disease of felines is...
|
Hypertrophic cardiomyopathy (HCM)
|
|
|
This condition results when the heart cannot pump enough blood to meet tissue needs at normal venous pressures.
|
Heart failure
|
|
|
How do baroreceptors work with the sympathetic nervous system to respond to cardiac insufficiency?
|
Usually stretch in response to BP. If CO and BP drop, then activates sympathetic nervous system to override vagal tone and increase HR, vasoconstrict.
|
|
|
List three ways in which the RAAS system may be activated.
|
Reduced perfusion pressure in kidney
SIgnal beta receptors in JGA of kidney Decreased NaCl to macula densa of kidney |
|
|
This compound is a potent vasoconstrictor and stimulates ADH release.
|
Angiotensin II
|
|
|
This enzyme converts Angiotensin I to Angiotensin II.
|
Angiotensin Converting Enzyme (ACE)
|
|
|
How are preload, HR, and afterload affected by activation of the RAAS system?
|
All increase
|
|
|
In this class of heart failure, heart disease is present (evidenced by murmurs or other signs) but there are no clinical signs.
|
Class I
|
|
|
In this class of heart failure, clinical signs are seen with strenuous exercise.
|
Class II
|
|
|
In this class of heart failure, clinical signs are seen with everyday activity.
|
Class III
|
|
|
In this class of heart failure, clinical signs are seen at rest.
|
Class IV
|
|
|
What stage (A-D) of heart failure is present when there is a high risk of heart failure with no known injury and no clinical signs?
|
Stage A
|
|
|
What stage (A-D) of heart failure is present when there is structural injury present but no clinical signs?
|
Stage B
|
|
|
What stage (A-D) of heart failure is present when there is structural injury present , and there are current/past clinical signs.
|
Stage C
|
|
|
What stage (A-D) of heart failure is present when there is significant structural injury and refractory clinical signs?
|
Stage D
|
|
|
A Cavalier King Charles Spaniel in good health would be considered to have this classification of heart disease.
|
Stage A: High risk of developing heart failure, but no apparent structural abnormality at present time
|
|
|
What was the conclusion of the SVEPP enalapril study?
|
No big difference in survivorship when CKCS dogs given enalapril beginning in stage B heart failure than when given placebo.
|
|
|
What was the conclusion of the VETPROOF enalapril study?
|
Enalapril (ACE inhibitor) may increase the survivorship of dogs given the drug beginning with stage B heart failure.
|
|
|
How can beta blockers help delay onset of mitral valve regurgitation?
|
Decrease workload on heart
Decrease myocardial O2 consumption by decreasing HR Inhibit vasoconstriction |
|
|
What are the immediate goals of treatment of acute heart failure?
|
Hemodynamic stabilization
Comfort |
|
|
What are the longer-term goals of treatment of chronic heart failure?
|
Prolonging survival
Improving quality of life |
|
|
What measures can be taken to improve the comfort at rest of a patient in heart failure?
|
Mechanical removal of life-threatening fluid accumulation
Oxygen supplementation Anxiolysis |
|
|
What measures can be taken to provide acute hemodynamic stabilization of a patient in heart failure?
|
Assess and optimize preload, afterload, heart rate and rhythm, contractility
|
|
|
How do loop diuretics work to decrease blood volume?
|
Work on nephric loops at Na/Cl/K cotransporter to induce medullary washout and encourage water to enter the tubules
|
|
|
The most potent type of diuretics
|
Loop diuretics
|
|
|
What kind of drug is furosemide and what does it do to alleviate heart failure?
|
Loop diuretic, decreases blood volume (preload) and ascites.
|
|
|
This venous dilator comes as a paste or a transdermal patch.
|
Nitroglycerine
|
|
|
Afterload reduction is important when treating CHF resulting from...
|
Mitral regurgitation
DCM |
|
|
What kind of cardiac drug is enalapril?
|
ACE inhibitor
|
|
|
What kind of cardiac drug is hydralazine?
|
Direct arteriolar vasodilator
|
|
|
What kind of cardiac drug is amlodipine?
|
Vascular Ca++ channel blocker
|
|
|
What kind of drug is Na Nitroprusside?
|
Mixed vasodilator
|
|
|
How does digoxin address atrial fibrillation?
|
Slows impulses at AV node
|
|
|
List three drugs used to slow the HR in atrial fibrillation.
|
Digoxin
Diltiazem Beta blockers (long term/chronic) |
|
|
List three drugs used to address ventricular tachyarrhythmia.
|
Lidocaine
Mg++ Sotalol |
|
|
Name a drug used to address a sustained SVT.
|
Diltiazem
|
|
|
What actions does pimobendan have on the cardiovascular system?
|
Vasodilation
Positive Ionotropy IL-6 inhibition |
|
|
In what conditions is pimobendan specifically indicated?
|
DCM, late stage MR
|
|
|
How does pimobendan work at the molecular level?
|
Increases the affinity of calcium to myocyte binding sites.
|
|
|
True or false: Dobutamine is a negative ionotrope
|
False. Positive ionotrope.
|
|
|
For what conditions are positive ionotropes like dobutamine indicated?
|
Refractory MR
Refractory HCM |
|
|
For what conditions is nitroprusside IV indicated?
|
Refractory DCM, mitral regurgitation
|
|
|
Caution should be taken when administering nitroprusside to a patient with...
|
Cardiogenic shock (hypotension)
|
|
|
Ventilatory support of a patient in CHF should be initiated when...
|
RR does not fall within 2 hours of therapy
|
|
|
True or false: Furosemide is a safe an effective cardiac drug when given as the sole treatment.
|
False. Activates RAAS.
|
|
|
Why shouldn't furosemide be administered as the sole drug for treatment in heart disease?
|
Activates RAAS--> increased preload and afterload
|
|
|
Furosemide may be combined with the following drugs to treat heart disease.
|
ACE inhibitors
Thiazide Spironolactone |
|
|
What kind of drug is spironolactone?
|
Aldosterone antagonist
|
|
|
Describe the mechanism of action for carvedilol.
|
Nonselective beta block
Alpha-1 block Antioxidant |
|
|
What kind of cardiac drug is atenolol?
|
Selective beta-1 blocker
|
|
|
True or false: Atenolol will not cross the blood-brain barrier.
|
True
|
|
|
What kind of cardiac drug is metoprolol?
|
Selective beta-1 blocker
|
|
|
True or false: Metoprolol will not cross the blood-brain barrier.
|
False
|
|
|
List some contraindications for digoxin use.
|
Renal failure
Noncompliant client |
|
|
This cytokine, blocked by pimobendan, has been linked to myocardial damage.
|
IL-6
|
|
|
List some principles of treatment of refractory heart failure.
|
Diuresis
ACE inhibitors Positive ionotrope HR and rhythm control |
|
|
What effect do beta blockers have on heart rate?
|
Slow it
|
|
|
VPC's in an animal with CHF are likely due to ...
|
Myocardial ischemia due to poor O2 perfusion
|
|
|
True or false: VPC's caused by heart failure may become less frequent or disappear if the heart failure is treated.
|
True
|
|
|
Aldosterone antagonists, such as spironolactone, are "sparing" for this ion.
|
K+
|
|
|
This diuretic class is used in conjucntion with loop diuretics when maximum dose of loop diuretics has been reached.
|
Thiazides
|
|
|
How do amlodipine and hydralazine decrease afterload?
|
Dilate systemic vasculature
|
|
|
What effects do pimobendan have on the RAAS system?
|
Neither attenuares nor adds to RAAS.
|
|
|
True or false: Furosemide may be combined with pimobendan as a complete therapeutic regimen for CHF.
|
False. Need ACE inhibitor to counterract RAAS b/c pimobendan doesn't affect it.
|
|
|
A chronic cough is indicative of...
|
Respiratory disease
|
|
|
A patient presents with decreased appetite, weight loss, a new cough, sinus tachycardia, tachypnea, and exercise intolerance. Is this syndrome more likely to be cardiac or respiratory in nature?
|
Cardiac
|
|
|
A cat presents with a chronic cough, vomiting, and sinus arrhythmia. She is eupneic and maintaining weight. Is her condition more likely cardiac or respiratory in nature?
|
Respiratory
|
|
|
What could be causing VPC's in a dog with DCM?
|
Hypoxic myocardium
|
|
|
Ascites, jugular venous distension, and occasional pleural effusion are indicative of this kind of heart failure.
|
Right heart failure
|
|
|
Describe the therapeutic regimen for acute onset RHF.
|
Mechanical removal of edema fluids
Furosemide Enalapril Pimobendan +/- spironolactone |
|
|
List the three most significant clinical categories of pulmonary hypertension.
|
PH with LH disease
PH due to intrinsic lung disease PH due to thromboembolic disease |
|
|
True or false: Mild pulmonary hypertenson may be seen in conjunction with LH failure.
|
True
|
|
|
This phosphodiesterase specifically works to dilate the pulmonary arterioles.
|
PDE-5
|
|
|
List a drug that specifically targets PDE-5 to alleviate pulmonary hypertension.
|
Sidenifil (Viagra)
|
|
|
List two common LH diseases that may result in pulmonary hypertension.
|
Mitral valve disease
DCM |
|
|
These hypozemic conditions may contribute to pulmonary hypertension.
|
Intrinsic lung disease
Impaired control of breathing Residence at high altitude (Brisket disease in cattle) |
|
|
How large is the normal RV in relation to the LV?
|
1/3 size of LV
|
|
|
In this condition, on an echocardiogram the RV is larger than the LV and there is a bowing of the interventricular septum toward the LV lumen. This is suggestive of...
|
Pulmonary hypertension
|
|
|
List some thrombotic diseases that may cause pulmonary hypertension.
|
Hearworm disease
Hypercoagulable conditions (neoplasm, DIC, IMHA, hyperadrenocorticism, etc) |
|
|
The most common diseases assiciated with pulmonary thromboemboli in cats
|
Neoplasia
Anemia Pancreatitis |
|
|
Do dogs or cats present more often with pulmonary hypertension?
|
Doga
|
|
|
True or false: Pulmonary hypertension may manifest itself at any age.
|
True
|
|
|
The breed predispositions for pulmonary hypertension closely mirror those for which other heart disease?
|
Chronic degenerative valvular disease
|
|
|
Why would furosemide be contraindicated in the event of pulmonary hypertension?
|
LV already has low wnough CO.
|
|
|
What kind of heart murmur may be heard with pulmonary hypertension?
|
L apical systolic murmur, +/- R sided murmur of tricuspid regurgitation
|
|
|
True or false: Oxygen therapy does very little to alleviate the tachypnea seen with pulmonary hypertension.
|
False! Works well because O2 is a vasodilator.
|
|
|
Will the RV hypertrophy seen with pulmonary hypertension be concentric or eccentric?
|
Concentric
|
|
|
This valve will often become "leaky" in the event of pulmonary hypertension.
|
Tricuspid valve
|
|
|
Scientific name for heartworm.
|
Dirofilaria immitis
|
|
|
What stage of the heartworm life cycle takes place in the mosquito?
|
L1-L3
|
|
|
What conditions must be present in order for heartworm microfilariae to mature in the mosquito?
|
Average daily temp of at least 57 deg F
|
|
|
Natural hosts for Dirofilaria immitis
|
Dog
|
|
|
Where in the mammalian host body do Dirofilaria immitis congregate?
|
Pulmonary artery
|
|
|
How long can L5 of heartworm live in the dog? In the cat?
|
7 years in dog
2-3 years in cats |
|
|
How long may the L1 of Dirofilaria immitis persist as such in the dog?
|
2.5 years
|
|
|
Describe the vascular lesions seen with heartworm disease.
|
Inflammatory arteritis--> increased vascular resistance--> pulmonary hypertension
|
|
|
What pathologic changes may be seen in the lung of an animal with heartworm disease?
|
Congestion
Hemorrage Pneumonitis Pulmonary infarction |
|
|
Heartworm disease will cause hypertrophy and failure of which ventricle?
|
Right
|
|
|
This type of hypersensitivity reaction may occur in heartworm disease, contributing to secondary clomerulonephritis.
|
Type III, immune complex
|
|
|
Is aberrant migration of immature Dirofilaria immitis more commonly seen in cats or dogs?
|
Cats
|
|
|
This syndrome is characterized by hemolytic anemia and hemoglobinuria that result from large masses of heartworms in the pulmonary artery, right ventricle, tricuspid valve, and right atrium.
|
Caval syndrome
|
|
|
How does a dog with heartworm disease typically present?
|
Asymptomatic usually
Wt loss Cough/hemoptysis/tachypnea Exercise intolerance/syncope Ascites |
|
|
Why would a dog with heartworm disease be febrile?
|
Massive release of cytokines in response to pulmonary thromboembolism--> Stimulates hypothalamic febrile response
|
|
|
This test detects antibodies to the cuticle of the female adult heartworm.
|
ELISA
|
|
|
If a patient has never recieved a macrolide for prevention of heartworm disease, this test should be done to screen for the precence of microfilaria in the dog.
|
Microfilaria Knotts or filter test
|
|
|
List some reasons that a heartworm SNAP test may yield a false negative result.
|
Prepatent infection
Low worm burden Immature females All male infection Kit not warmed to room temperature |
|
|
List some reasons that a heartworm SNAP test may yield a false positive result.
|
RARELY inadequate washing or delay in reading the test results
|
|
|
This diagnostic test will help to predict the possible complications of adulticide therapy in heartworm disease.
|
Thoracic radiographs
|
|
|
What benefit is there to doing an echocardiogram in a suspected case of heartworm disease
|
Evaluae suspect caval syndrome
RHF Murmur Assists in adult worm extraction by transesophageal visualization |
|
|
List three factors affecting the probability of post adulticide thromboembolic complication.
|
Extent of pulmonary vascular disease
Severity of infection Activity level of the dog (Should be CAGE REST) |
|
|
Drug used to treat adult heartworm infections.
|
Immiticide
|
|
|
List some possible complications of adulticidal treatment of heartworms.
|
Pain/swelling at injection site
Anorexia Lethargy Neurologic signs Fever, cough, hemoptysis |
|
|
How is heartworm treatment addressed in the event of caval syndrome?
|
Most dogs will die within 1 week of diagnosis if worms are not extracted
Then follow with adulticide once patient is stable. |
|
|
What are the goals of monthly macrolide therapy for preventing heartorm>
|
Prevent further infection
Eliminate microfilariae Destroy developing L4 larvae |
|
|
True or false: Developing L4 hearworm larvae are not susceptible to monthly heartworm adulticide therapy.
|
True
|
|
|
Why in the event of heartworm diseare treatment, is microfilaricide therapy initated 3 months before the arsenical?
|
Due to susceptibility gap between when microfilariae are affected by treatment, and when adult worms become susceptable to immiticide,
|
|
|
In a dog with microfilaremia due to hearworms, when is the first dose of macrolide administered?
|
Before patient leaves the hospital.
|
|
|
For how long after the initial macrolide dose for a microfilaremic patient is given should he be monitored in the hospital? Why?
|
8-12 hours
Watch for adverse reactions like lethargy, inappetance, salivation, retching, hypotension, tachycardia, and collapse |
|
|
List an alternative treatment protocol for heartworm patients in which arsenicals are contraindicated.
|
Ivermectin/doxycycline
Ivermectin monthly Doxy BID for 4 weeks every 3 minths until infection resolves |
|
|
How long can it take to eliminate an adult heartworm infection?
|
Over 2 years
|
|
|
True or false: Cats are less resistant to heartworm infection than are dogs.
|
False. More susceptible.
|
|
|
How common are circulating microfilariae in HW infected cats?
|
Seldom found, persist only about 30 days
|
|
|
What are some common clinical signs of feline heartworm disease?
|
Asymptomatic
Asthma-like signs Pulmonary inflammationm Fatal, acute lung injury Rarely caval syndrome |
|
|
How is feline heartworm disease treated in asymptomatic cats?
|
No Tx for asymptomatic cats
|
|
|
How is feline heartworm disease treated in cats with pulmonary signs?
|
Prednisolone
|
|
|
True or false: Adulticide therapy is a key component of heartworm disease treatment in both dogs and cats.
|
False. Not cats.
|
|
|
Mitral regurgitation may result from damage of structure or function of any of the following cardiac structures.
|
Valve leaflets
Annulus fibrosus Chordae tendinae Papillary muscles Left atrium Left ventricular muscle |
|
|
Endocardiosis is also known by these names...
|
Chronic degenerative valvular disease
Canine valular heart disease Mitral valve disease Myxomatous degenerative heart disease |
|
|
True or false: CDVD may account for as many as 75% of all dogs with signs of CHF.
|
True!
|
|
|
What % of Cavalier King Charles Spaniels over 10 years old experience mitral valve degeneration?
|
Nearly 100%
|
|
|
What symptoms may be caused by a ruptured chordae tendinae?
|
May cause signs of abrupt, fulminant heart failure.
|
|
|
Early signs of this heart condition include enlongated chordae tendinae and enlarged thickened mitral valve leaflets with areas showing bulging/ballooning/prolapse toward the atrial side.
|
CDVD
|
|
|
Can mitral valve regurgitation lead to LA hypertrophy?
|
Yes
|
|
|
What kind of hypertrophy is seen in the LV with chronic CDVD?
|
Eccentric
|
|
|
A sterile, degenerative disease that, contrary to myth, has no relationship to endocarditis.
|
CDVD, aka endocardiosis
|
|
|
True or false: CDVD is a sequelum to prior cardiac infection and/or poor dental health.
|
False
|
|
|
Mitral regurgitation may result from damage of structure or function of any of the following cardiac structures.
|
Valve leaflets
Annulus fibrosus Chordae tendinae Papillary muscles Left atrium Left ventricular muscle |
|
|
Endocardiosis is also known by these names...
|
Chronic degenerative valvular disease
Canine valular heart disease Mitral valve disease Myxomatous degenerative heart disease |
|
|
True or false: CDVD may account for as many as 75% of all dogs with signs of CHF.
|
True!
|
|
|
What % of Cavalier King Charles Spaniels over 10 years old experience mitral valve degeneration?
|
Nearly 100%
|
|
|
What symptoms may be caused by a ruptured chordae tendinae?
|
May cause signs of abrupt, fulminant heart failure.
|
|
|
In this kind of cardiac hypertrophy, the heart is bigger and has more mass but does not necessarily appear thicker.
|
Eccentric hypertrophy
|
|
|
A high regurgitant orifice area in the mitrav valve, and a large trans-mitral pressure gradient will likely lead to this lung problem.
|
Pulmonary congestion/edema
|
|
|
How does mitral regurgitation affect L ventricular pressure during early systole?
|
Lowers it due to regurgitation into LA
|
|
|
How does cardiomyopathy of volume overloas affect cardiac contractility?
|
Maladptation of cellular signaling pathways due to chronic volume overload
|
|
|
What is the typical signalment of a dog presenting with CDVD?
|
Many small and toy breed dogs
Over 10 years usually |
|
|
Where will a mitral valve murmur be located on ascultation?
|
Left apex
|
|
|
How is most CDVD first detected?
|
Incidental finding of a murmur at PE
|
|
|
What is usually the first clinical sign to be observed in dogs affected with CDVD?
|
Cough
|
|
|
List three CDVD factors that are strongly associated with the likelihood of developing CHF.
|
Murmur intensity
Heart size Severity of regurgitiation |
|
|
A thin, tachycardic dog presents witha cough. The heart rhythm is regular, aside from a loud systolic murmur. Is this cough likely respiratory or cardiac in origin?
|
Cardiac
|
|
|
An obsese, bradycardic dog presents with a cough. There is an exaggerated sinus arrhythmia and a soft systolic murmur. Is the cough most likely respiratory or cardiac in origin?
|
Respiratory
|
|
|
True or false: Cachexia is a common CS of CHF in cats.
|
False
|
|
|
How will a heart affected by CDVD appear radiographically?
|
LA enlargement
Larger vertebral heart score Pulmonary vein distension Pulmonary edema |
|
|
True or false: A mitral valve murmur may be present for years prior to the onset of clinical signs of CDVD .
|
True
|
|
|
Current studies suggest that ACE inhibitors may extend survival time for dogs with CDVD, except for those of this breed.
|
Cavalier King Charles Spaniel
|
|
|
What are some possible treatments for asymptomatic CDVD with cardiomegaly?
|
Enalapril/ ACE inhibitor
Beta blocker |
|
|
What is the prognosis for a patient in CHF due to CDVD?
|
6 months-2 years, with therapy
|
|
|
Inflammation of the endocardial surface of the heart.
|
Endocarditis
|
|
|
What comprises the "vegetations" in vegetative endocarditis?
|
Platelets, fibrin, microorganisms, inflammatory cells
|
|
|
In which species is endocarditis more rare: dogs or cats?
|
Cats
|
|
|
Is endocarditis seen more frequently in large breed dogs or small breed dogs?
|
Large breeds
|
|
|
Is endocarditis seen more frequently in male dogs or female dogs?
|
Males
|
|
|
Which valves tend to be affected by endocarditis more frrequently?
|
Mitral and aortic
|
|
|
List some predisposing factors in the development of endocarditis.
|
Congenital aortic valve disease
Steroid use Chronic bacteremia IV catheters Cardiac catheterization CV implants Immunosuppression |
|
|
List some clinical signs associated with endocarditis.
|
FEVER
Lethargy Anorexia Polyarthritis Back pain Urinary signs Neurologic signs |
|
|
What kind of murmur is associated with endocarditis: systolic or diastolic?
|
Diastolic
|
|
|
Most common form of cardiac disease in the feline.
|
Myocardial disease
|
|
|
Heart muscle disease associated with dysfunction.
|
Cardiomyopathy
|
|
|
List 5 primary cardiomyopathies.
|
HCM
RCM DCM ARVC Unclassified |
|
|
List 2 secondary cardiomyopathies.
|
Thyrotoxic heart disease
Hypertensive heart disease |
|
|
Hypertrophy of a non-dilated ventricle that interferes with cardivascular filling.
|
Hypertrophic cardiomyopathy
|
|
|
In felines, this primary cardiomyopathy is associated with taurine deficiency.
|
Dilated cardiomyopathy
|
|
|
Maine Coon and Ragdoll cats have been shown to have a heritable predisposition to this cardiomyopathy.
|
HCM
|
|
|
Is HCM characterized by diastolic or systolic dysfunction?
|
Diastolic
|
|
|
Two factors upon which diastolic function relies.
|
Myocardial relaxation
Compliance |
|
|
A large atrium in relation to a normal ventricle is indicative of this kind of cardiac dysfunction/
|
Diastolic
|
|
|
What is systolic anterior motion (SAM) of the mitral valve in cats?
|
Mitral leaflets move cranially in systole. Invariably accompanied by mitral valve regurgitation.
|
|
|
What are some potential effects of SAM in a cats affected by HCM?
|
Obstruction of LV outflow tract
Subvalvular pressure gradient Murmur possibly |
|
|
Typical signalment of a cat with HCM.
|
Male, middle aged
(may affect any age though) |
|
|
When are many feline cardiomyopathies detected?
|
Incidentally discovered murmur/gallop
Clinical signs associated with CHF, STE, or SCD |
|
|
How common are innocent flow murmurs in adult cats?
|
Fairly common
|
|
|
True or false: Tachycardia is a consistent feature of CHF in feline patients.
|
False
|
|
|
How significant is the presence of a gallop rhythm in cats and dogs?
|
Almost always indicative of presence of clinically important heart disease
|
|
|
Is pleural effusion or ascites more common in cats with heart failure?
|
Pleural effusion
|
|
|
Which species is more likely to have pleural effusion in association with heart failure: Dogs or cats?
|
Cats
|
|
|
True or false: Coughing is a common sign of heart disease in cats.
|
False
|
|
|
True or false: Coughing is a common sign of heart disease in dogs.
|
True
|
|
|
How is feline myocardial disease typically treated?
|
Diuresis: Furosemide
Thoracocentesis as needed for effusion Beta blockers, Ca++ blockers to slow HR |
|
|
Primary sign of heart disease in cats.
|
Onset of respiratory distress due to edema/effusion
|
|
|
Atrial dilation with normal or nearly normal ventricular dimensions and wall thicknesses. Systolic ventricular performance is normal or nearly so. What is the condition?
|
Restrictive cardiomyopathy
|
|
|
Fatty or fibrofatty replacement of RV myocardium is a kep component of this disease.
|
Right ventricular arrhythmogenic cardiomyopathy
|
|
|
True or false: Corticosteroid use has been associated with the development of feline heart failure
|
True
|
|
|
List some of the clinical signs associated with FATE.
|
Pain
Paresis/paralysis Absent arterial pulse |
|
|
Paitents with myocardial disease are predisposed to the formation of...
|
Arterial thromboemboli
|
|
|
What besides obstruction of BV contributes to the clinical signs associated with FATE
|
Release of vasoactive mediators
|
|
|
How may FATE be treated?
|
Many ways tried...
Analgesia Anticoagulation Vasodilation? |
|
|
What is the prognosis for cats with FATE?
|
Very poor
|
|
|
List some possible etiologies of DCM in dogs.
|
Genetic factors
Chemical toxins Viral infections Microvascular spasm Metabolic disorders Nutritional abnormalities Immune mediated processes |
|
|
An autosomal dominant gene for DCM has been found in these three dog breeds.
|
Irish wolfhound
Newfoundland Doberman pinscher |
|
|
List some of the signalment factors associated with canine DCM.
|
Large and giant breed dogs
Males Young to middle aged |
|
|
Deficiencies of these nutrients are associated with DCM in dogs.
|
Taurine
Carnitine |
|
|
These arrhythmias are often seen in conjucntion with DCM.
|
Atrial fibrillation
Ventricular arrhythmias |
|
|
Pleural effusion in a dog is associated with failure of which side of the heart?
|
Right
|
|
|
Pleural effusion in a cat is associated with failure of which side of the heart?
|
Left
|
|
|
Chamber most affected by DCM.
|
Left ventricle
|
|
|
How are BNP and cTn1 levels affected by DCM?
|
Elevated
|
|
|
How is asymptomatic DCM treated?
|
ACE inhibitor +/- beta blockers
Avoid high Na diet and heavy exercise Recheck every 6-12 months |
|
|
True or false: Sudden cardiac death may precede the onset of clinical signs in the development of DCM.
|
True
|
|
|
What is an appropriate treatment regimen for symptomatic DCM?
|
Treat CHF with an ACE-inhibitor, pimobendan, furosemide
Treat atrial fib with digoxin and beta/Ca++ blocker Treat ventricular tachycardia with sotalol or mexilitine and beta blocker |
|
|
What is the prognosis for symptomatic DCM?
|
Few months to 1-2 years with medical management.
|
|
|
What are the two typical terminal events seen with DCM?
|
Sudden death
Refractory CHF |
|
|
The presence of these factors in a patient with DCM worsen the prognosis.
|
Young age at onset
Dyspnea Ascites Biventricular failure in Dobermans |
|
|
In which breed of dog is arrhythmogenic right ventricular cardiomyopathy most common?
|
Boxer
|
|
|
What are three possible outcomes of ARVC in affected dogs?
|
Lethal ventricular arrhythmias and sudden cardiac death
Systolic myocardial dysfunction and CHF Asymptomatic life, with frequent ventricular ectopy |
|
|
How large should the normal right ventricle be in relation to the left ventricle of a healthy heart?
|
RV 1/3 of LV
|
|
|
In most dogs with ARVC, is fatty infiltration usually restricted to one ventricle or expanded to both?
|
Usually confined to RV
|
|
|
The presence of a left apical systolic murmur in a Boxer dog may be suggestive of...
|
Myocardial dysfunction
(Mitral valve insufficiency) |
|
|
Many Boxer dogs have a left basilar systolic ejection murmur due to...
|
Subvalvular aortic stenosis
Small ascending aorta |
|
|
Sustained VPC's are seen in dogs with...
|
ARVC
|
|
|
True or false: A normal ECG may be used to rule out ARVC in a Boxer dog.
|
False, b/c arrhythmias are intermittent
|
|
|
If ARVC is suspected b/c of an arrhythmia, suggestive CS, family history, or presence of genetic mutation, what diagnostic test would be appropriate to screen for the disease?
|
24-hour Holter monitor
|
|
|
How do most ARVC cases appear on echocardiograph?
|
Normal
(Some have systolic myocardial dysfunction) |
|
|
Holter monitoring in cases of ARVC is done in part to determine if synocpal episodes are associated with...
|
Paroxysms of ventricular tachycardia
|
|
|
What is the primary treatment goal with ARVC?
|
Decrease in number of VPC's with antiarrhythmics
|
|
|
In an asymptomatic patient with ARVC, treatment may be warranted if...
|
Over 1000 VPC's in 24 hours
Runs of ventricular tachycardia Evidence of R on T |
|
|
List some drugs used for treatment of ARVC.
|
Sotalol (Class III)
Mexilitine (Class Ib) and atenolol (Class II) |
|
|
What is the prognosis for dogs with ARVC?
|
Risk of sudden cardiac death, but many affected dogs may live for years, even without treatment.
|
|
|
These two breeds have the highest incidence of AV myopathy.
|
English Springer Spaniel
Old English Sheepdog |
|
|
What CS are associated with AV myopathy?
|
Weakness, collapse, syncope--> Severe bradycardia
Signs of RHF or biventricular CHF |
|
|
AV myopathy is also called...
|
Persistent silent atria
Persistent atrial standstill |
|
|
The EKG for this condition shows an idioventricular rhythm with escape complexes and NO P wave.
|
AV myopathy
|
|
|
DIlated, immobile atria and progressive ventricular dilation are associated with this cardiac condition.
|
AV myopathy
|
|
|
How can AV myopathy be treated?
|
Artificial pacemaker for bradyarrhythmia
Furosemide/enalapril/pimobendan for CHF |
|
|
Pericardial effusion is observed most often in what breeds of dog?
|
Large breed dogs like German shepherds, retrievers
|
|
|
List some CS of pericardial disease.
|
Abdominal distension from ascites
Weakness/syncope Lethargy Inappetance Circulatory collapse +/- |
|
|
List some PE findings associated with cardiac tamponade.
|
Tachycardia
Quiet heart sounds Ascites/ jugular distension Hypokinetic (weak) arterial pulse Pulsus paradoxus |
|
|
Are the pulmonary vessels enlarged, small, or normal on radiographs in most suspected cases of pericardial disease?
|
Often small
|
|
|
QRS alternans and sinus tachycardia are seen in associated with this condition...
|
Pericardial effusion
|
|
|
Most specific means to detect pericardial effusion
|
Echocardiography
|
|
|
What is the appropriate initial therapy for addressing of cardiac tamponade?
|
Pericardiocentisis
|
|
|
What is the prognosis for dogs with idiopathic PE?
|
Excellent
|
|
|
True or false: In the dog, almost all pericardial effusions are hemorrhagic.
|
True (many also neoplastic)
|
|
|
Syndrome of impaired ventricular filling due to presence of intrapericardial fluid.
|
Tamponade
|
|
|
Describe pulsus paradoxus.
|
Arterial pulse is exaggeratedly weak during inspiration
|
