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597 Cards in this Set
- Front
- Back
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Hypertonia, hyperreflexia are UMN or LMN problem?
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UMN (UMN is inhibitory so if diseased then exaggerated)
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Hypotonia, hyporeflexia, and atrophy are UMN or LMN problem?
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LMN
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Menace reaction tests what 2 cranial nerves and what should you do to the other eye when performing this test?
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CN 2 and somewhat CN 7 (if there is CN7 problems (facial nerve paralysis) the animal will pull head away from menace hand but NOT blink and should also have signs of facial nerve paralysis)
Cover other eye (some nerve fibers cross at optic chiasm which account for overlap of left and right field) |
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If you have an animal with unequal pupil sizes, how will the good eye respond to PLR?
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It will constrict no matter what eye is being illuminated
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Pupillary size is determined by what 2 cranial nerves?
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CN 2 and 3
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What causes abnormally small pupils?
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Diminished sympathetic tone to eye (Horner's Syndrome)
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What causes abnormally large pupils?
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Diminished parasympathetic tone to eye
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What is Horner's Syndrome, does it have anisocoria, does it have abnormal PLR?
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Loss of sympathetic tone (efferent) to eye
Animal will have anisocoria (unequal pupil size) Animal will have normal PLR |
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What is anisocoria?
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Unequal pupil size
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What is strabismus? What causes ventrolateral, medial, androtational strabismus?
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Disconjugate gaze - eyes not looking in same direction
Ventrolateral = lesion of CN 3 or 8 Medial = lesion of CN6 Rotational = lesion of CN4 (difficult to see in animal with round pupils but can see in cats) |
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What is nystagmus?
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Rhythmic, conjugate oscillations of eyes
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In what breed of cat is nystagmus common?
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Siamese
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What is vistibular-ocular reflex and what are the normal and abnormal responses?
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Turn patient's head back and forth creating nystagmus due to imbalance
Normal = head turn initiates directional nystagmus Abnormal = eyes remain at rest (vestibular), eye movement is ataxic (cerebellum), fast component absent (cerebrum) |
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What is directional and oscillatory nystagmus?
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Directional = fast and slow components; vestibular
Oscillatory = non-directional; visual (rare) |
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What nerve controls muscles of expression (eyes, lips, eyelids)?
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CN 7
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What nerve controls muscles of mastication (temporal and masticatory)?
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CN 5
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What nerves (2) does the Palpebral reflex test?
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CN 5 and 7
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What nerves (2) does the retractor oculi reflex test?
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CN 5 and 6
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What nerves (2) does the gag reflex test and how do you perform this test?
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CN 9 and 10
Squeeze the larynx and animal should swallow |
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How do you test sensory to tongue and what nerves (2) does it test?
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Pinch tongue on either side and tongue should retract
CN 5 and 12 |
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What 2 nerves run near the inner ear?
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CN 7 and 8
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What should you think if you see crossed extensor?
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UMN disease of non-stimulated limb
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Nociception only tests ___?
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Reflex arc
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What is the Babinski test and what is normal/abnormal results?
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Light scratch on plantar side of MT
Normal = toes curl down Abnormal = toes curl up |
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Which nerve supplies the perineum and where does that nerve come from?
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Pudendal nerve comes from S1-S3
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Where is the lesion if you localize a spinal injury?
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1-4 spinal cord segments cranial
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If the animal is demented and circling to the left, is the lesion in the forebrain on the left or right?
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Left
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If the animal is demented and has decreased menace on the right, decreased palpebral reflexes on right, and decreased postural reactions in limbs on right, then is the lesion on the left or right in the forebrain?
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Left
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If an animal is demented, where is the lesion?
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Forebrain (cerebrum)
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If the animal has altered mental status, where is the lesion?
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Cerebrum/brainstem
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If the animal has problems with orientation to gravity, where is the lesion?
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Vestibular system
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If the animal has strange head (head tilt) and limb posture, where could the lesion be (3)?
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Vestibular, conscious propoiception, somatic motor
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If the animal has strange head coordination, where is the lesion?
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Cerebellar (maybe vestibular)
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If the animal is circling, is this a primary or secondary problem?
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Secondary to vestibular (head tilt) or cerebrum (mental status)
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What is the predominant sign or motor unit disorder?
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Weakness
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What does an EMG test (2)?
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Health of muscle
Integrity of LMN |
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What are some categories of focal motor unit disorders (3)?
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Trauma
Neoplasms Compressions |
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What are some categories of diffuse motor unit disorders (4)?
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Inflammation
Degenerations Toxins Metabolic processes |
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What is a neuronopathy and what are the 2 types of neuronopathies and how quickly do they occur?
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Cell body disease
Inflammatory - rapid Degenerative - gradual |
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What is a neuropathy and what are the 3 types?
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Disease of axon
Degenerative Metabolic (diabetes, hypothyroid, hyperadrenocorticism) Inflammatory |
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What is the difference between neuropathy and neuronopathy?
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Neuropathy - disease of axon
Neuronopathy - disease of cell body |
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If an animal present with a dropped neck and weakness, what do you suspect and what are 3 ways it occurred?
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Hypokalemia
Nutritional, renal, iatrogenic |
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What might you think in an animal with exercise intolerance, muscle pain, fever, regurguitation, and atrophy/fibrosis and what are 4 categories of this disease?
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Polymyositis
Immune-mediated, infectious, metabolic, nutritional |
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What is myasthenia gravis and is it acquired or congenital and how do the animals present?
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Decreased ACh receptor numbers
Acquired (autoimmune) or congenital Exertional weakness, regurgitation, facial weakness, young (2-3) or old (9-10) |
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What is an animal presents with exertional weakness, regurgitation, facial weakness, and is 2.5 years old?
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Myasthenia gravis (patient would also be older - bimodal disease - 2-3 years or 9-10 years)
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What is a complication you need to worry about with my. gravis?
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Pneumonia
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What does botulism toxicity do to the body and how would the animal present?
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Blocks ACh release and Ca entry is blocked
Peracute onset, history of wound or eating carrion, cranial nerves affected |
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What would you think is an animal presents with a peracute onset of cranial nerve problems after eating a dead animal?
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Botulism toxin
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When looking under the microscope at a gram stained fecal specimen you see safety pins/tennis racket, what are these?
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Clostridium
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When looking under the microscope at a gram stained fecal specimen you see seagulls/squiggles, what are these?
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Campylobacter
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How do you treat an animal with botulism toxicity?
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Antibiotics and supportive therapy
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What is cauda equina syndrome and how do these animals present?
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Injury to nerve roots L6-Ca
Present with pain, incontinence, weakness, dropped tail, and ataxia |
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What is ataxia and what part of the CNS does it indicate?
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Uncoordinated muscle movements
Cerebellum |
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What should you think if an animal presents with pain, incontinence, weakness, dropped tail, and ataxia?
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Cauda equina syndrome
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What is something in teh face that you might see with brachial plexus nerve root injury?
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Horner's Syndrome
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CNI
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Olfactory - sense of smell
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CNII
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Optic - vision
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CNIII
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Oculomotor - constrict pupils and movement of globes
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CNIV
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Trochlear - dorsal optic muscle
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CNV and major branches
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Trigeminal - proprioceptive and tactile sensory innervation to face and head (including eyes and mouth)
Mandibular - muscles of mastication |
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CNVI
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Abducent - retractor bulbi muscle of eye and lateral movement of globes
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CNVII
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Facial - facial expression (blinking and wrinkling lip), sensory to medial pinna, promotes lacrimation, promotes salivation
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CNVIII
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Vestibulocochlear - sound and equilibrium/balance
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CNIX
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Glossopharyngeal - pharynx and larynx
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CNX
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Vagus - parasympathetic to thoracic and abdominal viscera; and larynx and pharynx
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CNXI
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Accessory - trapezius, sternocephalicus, brachycephalicus muscles
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CNXII
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Hypoglossal - tongue and geniohyoid muscles
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What is there is a problem with C1-C5?
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In front of reflex arc of thoracic limb so will result in UMN signs in thoracic and pelvic limbs
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What if there is a lesion at C6-T2?
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LMN signs in thoracic limb
UMN signs in pelvic limb |
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What is Schiff-Sherington exception?
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Lesion caudal to T3 will only have pelvic limb clinical appearance except L2-L4 that sends info back to thoracic limb; will show UMN signs when in lateral recumbency but will be normal if standing
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What if there is a lesion T3-L3?
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UMN of pelvic limb
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What if there is a lesion L4-S3?
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LMN of pelvic limbs
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What is the lesion caudal to if there is urinary and fecal incontinence?
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T2
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How does an animal with cauda equina present?
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Able to support rear limbs, but plantagrade stance (femoral nerve is normal but LMN for sciatic and sacral nerves)
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If animal with sp cord problems is anesthetic after 24 hours of therapy then __% chance to recover; and after 48 hours of therapy then __% to recover.
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10%
1% |
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What categories of disease should you think if there is an animal with sp cord problems and focal signs?
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Mass effects
Tumor Trauma Hematoma Disc disease |
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What categories of diseases should you think if there is an animal with sp cord problems and disseminated signs?
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Degenerative
Toxic Nutritional Metabolic |
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Where is the lesion (intra/extramedullary) if the animal has sp cord problems and is painful?
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Extramedullary
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Where is the lesion (intra/extramedullary) if the animal has sp cord problems and is not painful?
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Intramedullary (possibly extramedullary)
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What is the onset and progression of type 1 disc disease?
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Acute onset
Usually stable progression |
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What is the onset and progression of type 2 disc disease?
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Variable onset
Progressive progression |
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What is an advanced imaging used to look for spinal cord problems and what are the 3 categories of lesions?
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Myelography
Extradural Intradural/Extramedullary Intramedullary |
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What should you suspect if a patient presents with loss of balance, tremors, and/or ataxia?
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vestibulo-cerebellar system
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What does the vestibular system do?
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Orientation to gravity
Detects and corrects for angular/rotational movement Postural muscle tone |
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Can vestibular or cerebellar disease result in paraylsis?
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NO
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What does the cerebellum do?
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Changes in muscle tension
Integration/coordination of voluntary movement Rine-tune postural adjustments |
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Animal will fall (towards/away from) the lesion?
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Towards
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What is a regular oscillatory movement usually involving alternating contraction and relaxation of agonist and antagonist muscles
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Tremor
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If the animal has tremors on the body only, where is the lesion?
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Sp cord
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If the animal has tremors on the head and body, where is the lesion?
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Cerebellum
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In an animal with horizontal nystagmus, the fast segment is (towards/away from) side of body with the vestibular lesion?
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Away from lesion
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An animal with a head tilt to the left and circling to the left has a vestibular lesion on the (right/left) side?
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Left
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Does an animal circle (towards/away from) the vestibular lesioN?
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Towards
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Which cranial nerves are not in the brainstem?
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CN 1,2,11
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90% of peripheral vestibular disorders are due to what 2 causes?...and what are 2 other minor causes?
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Otitis media/interna
Idiopathic Trauma & Neoplasia |
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What might you see with central vestibular disorder that you won't see with peripheral vestibular disorder?
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Mental changes
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If any of CN 3-12 are disrupted on the right side, what side is the lesion on (and name one exception)
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Right sided lesion (normally ipsilateral)
Exception is paradoxical vestibular syndrome |
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Does hyperthermia have to do with fever or outside temperature?
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Hyperthermia is due to increased environmental temp - hot outside
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What element would cause metabolic tremors and would this element be high or low concentration in the body?
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Hypocalcemia
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What are 3 categories of diseases that cause tremors?
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Toxins - molds, metronidazole, lead, organophosphates, fentanyl
Metabolic - acid base disturbances, uremia, hypocalcemia Idiopathic - dx of exclusion |
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What if a dog presents with inability to close jaw (REST OF NEURO EXAM IS FINE) and what is the prognosis and what should be a ddx?
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Idiopathic Trigeminal Neuropathy (CN V)
4-5 weeks and then full recovery Rabies |
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What do you assume is affected if animal presents with change in consciousness, seizures, sensory abnormalities, gait change, and cranial nerve deficits?
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Forebrain disorder
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If there is decreased proprioception/paresis in the right limbs, the forebrain lesion is on what side?
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Left
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What if you suspect a forebrain disease that waxes and wanes and it is symmetric - what category of disease do you suspect?
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Metabolic (forebrain very susceptible to metabolic problems)
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What are some diseases that cause Metabolic encephalopathy?
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Hepatoencephalopathy (portosystemic shunt or acq liver diease) - ammonia toxic to brain
Renal failure - increased parathyroid levels toxic to brain Hypoglycemia Hypothyroidism Hyperthyroidism Hyperadrenocorticism Diabetes mellitus |
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Which seizure medication is not metabolized by the liver?
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KBr
(since Phenobarb is met by liver, you cannot use it in animal that has HE) |
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How can you treat HE?
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Surgical ligation of shunt (if due to PSS)
Decrease blood ammonia levels via a low protein diet, abx that decrease ammonia producing bacteria (ampicillin or neomycin), and give lactulose to decrease absorption of ammonia |
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Why can you use lactulose to treat HE?
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Lactulose decreases the absorption of ammonia
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What 2 antibiotics decrease ammonia producing bacteria and are thereful helpful in treatment of HE?
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Ampicillin
Neomycin |
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What do you suspect if a cat presents obtunded/comatose, dilated pupils, head tremors, and ventroflexion of head and neck?
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Thiamine deficiency
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What 2 types of dogs do you often see hydrocephalus congenitally?
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Toy breeds
Brachycephalic |
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What type of brain tumors do dolicocephalics normally get?
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Meningiomas
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What types of tumors often met to the brain?
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Carcinomas
Hemangiosarcomas Malignant melanomas Lymphosarcomas |
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What are the most common feline brain tumors?q
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Meningiomas
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What body systems are affected in canine distemper?
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GI
Resp CNS - forebrain (seizures/myoclonus/dimentia) |
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What 2 secondary problems do you need to watch for with chronic tremors?
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Hypoglycemia
Fever |
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What CN are involved in Horner's Sydrome?
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CN 3, 4, 6
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What class of drugs is known to facilitate seizure activity?
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Phenothiazine tranquilizers
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What is the cause of primary epileptic seizure?
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Idiopathic
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What is the cause of secondary epileptic seizure?
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Structural
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What is the cause of a reactive epileptic seizure?
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Metabolic
Reaction of normal brain to a transient systemic or physiologic event |
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When do seizures become epilepsy?
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When they recur
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What are the 3 main stages of seizure?
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Pre-ictal
Ictal (the actual seizure) Post-ictal |
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What do you call 2+ seizures in 24 hours?
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Cluster seizures
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What do you call seizure activity of 30 minute duration or failure to return to normal consciousness in between events for 30 minutes?
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Status epilepticus - this is an emergency due to energy deprivation
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What do you call excessive sleepiness or stress/excitement induced sleep?
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Narcolepsy
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What do you call a decrease in blood flow to brain, animal passes out and wakes up within seconds/minutes and is normal?
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Syncope
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What do you call a brief, hypotonic collapse in an animal that was stressed/excited?
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Cataplexy
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What breeds of dogs and at what age do you normally see narcolepsy/cataplexy?
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Dobes
Labs Min poodle 1-6 months |
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How do you treat cataplexy?
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Antidepressants (Imipramine, Protryptiline, Amytriptyline, Fluoxetine)
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How do you treat narcolepsy?
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Stimulants (Methylphenidate, dextroamthetamine, selegiline)
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What type of breed is known to have benign head tremors?
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Brachycephalic breeds
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How and when should you treat a dog with benign head tremors?
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Rectal valium if lasts over 15 min
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What is a great diagnostic to do on a young animal that seizures?
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Pre and post bile acids (detects shunts)
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Should you treat an animal after 1 seizure?
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No, but you should treat if they have another seizure in 2-4 months
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Shoudl you treat an animal after a cluster seizure?
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Yes, treat right away
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How should you treat an animal that seizures once or more per month?
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Phenobarbital
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How shoudl you treat an animal that seizures once every 2-3 months
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KBr
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How shoudl you treat an animal with cluster seizures?
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KBr and Phenobarb
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What are some adverse effects with seizure medications?
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PU/PD, polyphagia, lethargy
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What 2 things should you warn owners about especially with KBr to treat seizure?
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No high salt diets
Mix with food to avoid GI upset (in addition to PU/PD, polyphagis, lethargy) |
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What organ function should you test when putting animal on phenobarbital and an increase in what is NEVER acceptable?
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Liver function (every 6 months)
Increase in ALP is expected but increase in ALT is NEVER allowed |
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What can you give to patient having cluster seizure?
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Rectal diazepam
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Can you use Phenobarbital and KBr in cats?
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No - do not use KBr (causes reaction in lung - coughing cats)
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Is epilepsy progressive?
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YES
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Name 3 causes of episodic (not continuous) abnormal behavior?
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Toxicities
Metabolic disease (HE) Seizures |
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What is the name of the natural tendency of an animal to rise from a position of lateral recumbency and what area of brain does this?
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Righting reaction
Vestibular disease |
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What is the most common abnormal posture seen in animals with neuro disease?
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Head tilt
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What is the name of the posture where the head and neck are held in extreme extension?
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Opisthotonus
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What neuro section do yoususpect if animal has head tilt, circling, and nystagmus?
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Vestibular
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What neuro section do you suspect if animal has abnormal mental status?
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Cerebrum
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Where do you suspect a lesion if animal has left sided blindness, circling to right, left sided gait abnormalities, and mildly decreased consciousness?
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right cerebrum
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Where is the lesion if the animal is circling left, head tilt to the left, fast nystagmus to thr right, and left sided cranial nerve deficits?
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Left vestibular
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Where is the lesion if the animal is circling right, head tilt right, fast nystagmus to left, left proprioceptive defects, and left cranial nerve deficits
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Left cerebellum (paradoxical)
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What do you call opisthotonus occuring in conjunction with extensor rigidity of all four limbs and decreased mentation and what brain section does it indicate?
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Decerebrate rigidity
Midbrain |
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What do you call opisthotonus occuring in conjunction with extensor rigidity of the forelimbs with intention tremor?
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Decerebellate rigidity
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What do you call extensor regidity of the forelimbs without opisthotonus and what section of CNS does it indicate?
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Schiff-Sherington syndrome
Thoracolumbar spinal cord disease |
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Animals with was disease will not rise from lateral recumbency when the side of the lesion is toward the ground?
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Vestibular disease
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What is loss of smell most commonly due to?
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Disease in nasal area (NOT neuro problem)
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How cna you detect a problem with CN IV?
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The dorsal retinal vein is deviated (normally vertically oriented in k9 and Fe)
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How do you test CN VI function?
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Use wet cotton tip applicator to touch surface of central cornea. Globe should retract.
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Inability to retract the globe of eye does not always indicate a neuro problem. What other problem could be occuring and how would you figure it out?
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Retrobulbar lesion
Do a complete opthamological exam |
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What 3 CN usually are affected simultaneously?
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3,4,6
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What 4 things characterize Horner's Syndrome?
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Ptosis - drooping of uper eyelid
Miosis Enophthalmos - sinking of globe into orbit Protrusion of third eyelid |
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How do you test CN V?
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Touch nares, touch periorbital area, touch cheeks, touch lower jaw, palpate and observe temporalis and masseter muscles, jaw tone, observe animal eating
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If the animal has cerebral lesions, which side of face may appear to have reduced sonsory function?
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Contralateral side of face
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What is an important differential (besides CN V lesion)in an animal with dropped jaw.
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RABIES
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Is deafness more likely to be a central lesion or peripheral?
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Peripheral - trauma, lesions in ear, CN VIII problem
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How do you test CN IX and X??
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Gag reflex
Listen for stertorour breathing |
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What are 3 DDX for laryngeal/pharyngeal dysfunction (besides CN IX and X lesions)
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Botulism
Myasthenia gravis Hypothyroidism |
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How do you test for lesions in CN XII?
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Tongue deviates toward normal side
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What word describes an animal to walks drunk and has scraped dorsum of paws and has worn toenails?
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Ataxic
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What is another word for weakness?
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Paresis
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What is weaknedd of all 4 limbs?
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Quadriparesis or tetraparesis
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What is weakness of both limbs on one side of body?
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Hemiparesis
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What is weakness of the hind limbs alone?
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Paraparesis
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What do you call a patient that cannot walk and has not pain in limbs?
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Paralysis
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What do you call an animal that is paralyzed in all 4 limbs?
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Quatriplegia or tetraplegia
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What do you call an animal that is paralyzed in both limbs on one side of body?
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Hemiplegia
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What do you call animal that is paralyzed in hind limbs?
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Paraplegia
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What side do abnormalities in gait, proprioception, and posture occur if lesion is in brain and rostral to medulla oblongata?
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Contralateral
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What side do abnormalities occur in gait, proprioception, and posture if lesion in cerebellum, spinal cord, or peripheral nerves?
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Ipsilateral
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What is loss of control of the range and force of movement?
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Dysmetria
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Is gait better evaluated when patient is brisk walking or trotting?
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Brisk walk
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When testing hopping in animal, should you have them hop medially or laterally?
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Laterally
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What testing wheelbarrowing, shoudl you make the patient move forwards or backwards?
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Forwards
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Is bunny hopping when ascending stairs normal? What about when walking on level ground?
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May be normal in some small legged breed dogs
Never normal on level ground |
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Does the ascending spinal tracts work with sensory or motor?
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Sensory
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Is the descending spinal cord sensory of motor?
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Motor
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What is clonus when testing reflexes?
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The response is repeated several time; limb seems to oscillate
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What muscle, nerve, and spinal origin does the biceps reflex test?
|
Biceps brachii
Musculocutaneous C6-C8 |
|
|
What muscle, nerve, and spinal cord origin does the extensor carpi reflex test?
|
Extensor carpi radialis
Radial n C7-T2 |
|
|
What muscle, nerve, and spinal cord origin does the triceps reflex test?
|
Triceps brachii
Radial nerve C7-T2 |
|
|
What muscle, nerve, and spinal cord origin does the patellar reflex test?
|
Quadriceps femoris
Femoral n L4-L6 |
|
|
What muscle, nerve, and spinal cord origin does the gastrocnemius reflex test?
|
Gastrocnemius
Sciatic L6-S2 |
|
|
What muscle, nerve, and spinal cord origin does the cranial tibial reflex test?
|
Cranial tibial
Sciatic L6-S2 |
|
|
What muscle, nerve, and spinal cord origin does the sciatic reflex test?
|
All hind limb muscles with sciatic innervation
Sciatic L6-S2 |
|
|
Where should the panniculus test begin and end?
|
Begin cranial to wing of ilium and end at caudal scapula
|
|
|
What type of animals may not have panniculus reflex?
|
Obese
Generalized neuropathies or myopathies |
|
|
When might anal tone be decreased in normal animals?
|
When feces are present
|
|
|
What is the most common site of lesions that cause loss of pain perception inthe limbs?
|
Spinal cord
|
|
|
If you are flexing the right limb and the left limb suddenly extends, what is this called and which limb is affected?
|
Crossed extensor reflex
Left limb is affected and lesion is ipsilateral |
|
|
Name 2 B receptor agonists
|
Epinephrine
Nor-epinephrine |
|
|
Name 1 muscarinic receptor agonist
|
Acetylcholine
|
|
|
Name 1 A receptor agonist
|
Nor-epinephrine
|
|
|
What is the precursor to NE?
|
Dopamine
|
|
|
What if an A receptor is stimulated on a vessel?
|
Vasoconstriction
|
|
|
What is a B receptor is stimulated on a vessel?
|
Vasodilation
|
|
|
Which drug is only A1 agonist?
|
Phenylephrine
|
|
|
Which drug is only B agonist?
|
Isoproterenol
|
|
|
What receptors does NE effect?
|
A and B adrenergic agonist
|
|
|
What receptors does EPI effect?
|
B and A adrenergic agonist
|
|
|
What receptors does acetylchiline effect?
|
Muscarinic and cholinergic agonist
|
|
|
What receptors does phenylephrine effect?
|
A1 agonist
|
|
|
What receptors does isoproterenol effect?
|
B1 and B2 agonist
|
|
|
What receptors does Dopamine effect?
|
A and B adrenergic agonist
|
|
|
What receptors does dobutamine/ephedrine effect?
|
B and A adrenergic agonist
|
|
|
What receptors does Prazosin effect?
|
A1 receptor blocker
|
|
|
What receptors does Phentolamine effect?
|
A adrenergic blocker
|
|
|
What receptors does metoprolol, atenolol, propranolol, and carvedilol effect?
|
B receptor blocker
|
|
|
What receptors does atropine effect?
|
Muscarinic receptor blocker
|
|
|
What receptors does glycopyrrolate effect?
|
Muscarinic receptor blocker
|
|
|
What does nitric oxide do to vessels?
|
VD
|
|
|
What does endothelin do to vessels?
|
VC (esp in disease)
|
|
|
What do kinins do to vessels?
|
VD
|
|
|
What does histamine do to vessels?
|
VD
|
|
|
What is the main source of vascular resistance?
|
Arterioles
|
|
|
Name the 3 triggers for renin release from kidney.
|
Decreased renal blood flow
Increased sympathetic nervous system (B receptor) Decreased Na delivery |
|
|
Where does renin come from?
|
Kidney
|
|
|
What 2 things does angiotensin II do?
|
VC
Releases aldosterone (retains Na) |
|
|
What does aldosterone do?
|
Na retention
|
|
|
Where does aldosterone come from?
|
Adrenal cortex
|
|
|
What is another name for ADH?
|
Vasopressin
|
|
|
If an animal is dehydrated (increased Na) and has a low arterial blood pressure, what hormone is being released?
|
ADH
|
|
|
What does ADH do?
|
Lowers serum Na
VC |
|
|
What 3 things stimulate NO?
|
Acetylcholine
Exercise Drugs (nitroglycerine) |
|
|
What may excessive endothelin produced in the lung do?
|
Pulmonary VC
Pulmonary hypertension (will also stimulate inflammatory response and fibroblast proliferation) |
|
|
What effectes does prostaglandins have on vessels?
|
VD (and prevents platelet aggregation)
|
|
|
What is preload?
|
Related to venous pressures and ventricular filling; Z-Z distance; degree of stretch in the cell and sarcomere
|
|
|
What is inotropy?
|
Rate of actin/myosin interaction that is modulated by increased or decreased SNS activity; related to Ca availability
|
|
|
What is afterload?
|
Ventricular wall tension required to open the semilunar valve and to eject blood; tension needed to overcome force; force that must be overcome to shorten the muscle
|
|
|
Name 3 types of drugs that are anti-hypertensive
|
B blocker
ACE inhibitor Ca channel blocker |
|
|
What is pulse pressure?
|
Systolic minus diastolic
|
|
|
What is mean pressure?
|
Diastolic pressure + (1/3 pulse pressure)
"the best estimate of perfusion" |
|
|
What is the best estimate of perfusion?
|
Mean pressure
|
|
|
What causes S1?
|
Mitral and tricuspid valve closure
|
|
|
What causes S2?
|
Aortic and Pulmonary valve closure
|
|
|
What causes S3?
|
Rapid ventricular filling
|
|
|
What causes S4?
|
Atrial contraction
|
|
|
What is a pulse deficit and what does it indicate?
|
More S1 than arterial pulses
Cardiac arrhythmia |
|
|
What if S3 is very loud in small animal?
|
Heart failure
|
|
|
What if S4 is very loud in small animal?
|
Impaired ventricular relaxation
|
|
|
What can doppler echocardiography measure?
|
Direction
Velocity |
|
|
What could cause LV HCM?
|
Aortic stenosis
Hypertension HCM - genetics |
|
|
What could cause RV HCM?
|
Pulmonary stenosis
Pulmonic hypertension |
|
|
How should the E and A waves compare to eachother normally?
|
E > A
|
|
|
What is the normal pressure in Aorta?
|
120/80
|
|
|
What is the normal pressure in LV?
|
120/0
|
|
|
What is the normal pressure in LA?
|
12/0
|
|
|
WHat is the normal pressure in RV?
|
25/0
|
|
|
What is the normal pressure in PA?
|
25/12
|
|
|
What is normal pressure in RA?
|
5/0
|
|
|
What term describes ventricle ejecting blood at higher than normal systolic pressure and would could it be due to?
|
Pressure overload
High arterial BP or Stenosis of outflow tract |
|
|
What term describes ventricle must eject a greater than normal total stroke volume with each contraction and what could it be due to?
|
Volume overload
Shunt or regurgitation |
|
|
What is the normal speed of blood going out a normal outflow tract.
|
1.5 m/s
|
|
|
Is heart failure a disease?
|
No, its a clinical syndrome due to heart's inability to pump efficiently
|
|
|
Name 4 clinical signs of heart failure
|
Low cardiac output
Reduced tissue perfusion Pulmonary venous congestion Systemic venous congestion |
|
|
Name some patient problems you may see with chronic heart failure
|
Exercise intolerance (less sk muscle perfusion)
Fluid retention Pulmonary dysfunction - tachypnea/dyspnea/coughing Pulmonary edema (decreased LV output so blood backs up in lungs) Metabolic disturbances - azotemia Cardiac cachexia Syncope Decreased quality/duration of life MM pale (due to VC) Normal BP (due to low CO and high vascular resistance) but if low BP then poor prognostic sign |
|
|
Name 4 compensatory mechanisms in heart failure
|
SNS activation (increased contractility and HR)
Arteriolar vasoconstriction Renal retention of sodium and water Cardiac remodeling |
|
|
What 3 things cause renin release
|
Low renal perfusion
High sympathetic tone Low Na delivery to kidney |
|
|
What does angiotensin II do?
|
Inc aldosterone release
Inc VC Inc thirst Inc vasopressin release Inc NE release Inc renal Na retention Hypertrophy and dilitation (growth and fibrosis) of vessels and heart |
|
|
Name 2 things that increase during heart failure that are cardiotoxic and what class of drug could you use to inhibit this?
|
ATII and aldosterone
ACE inhibitors` |
|
|
What is oncotic pressure?
|
Pulls fluids back into vessel; albumin
|
|
|
What is hydrostatic pressure?
|
Pushes fluids out of vessel
|
|
|
How does edema develop in heart failure?
|
Decreased CO
Blood backs up in veins and increases venous pressure Increased capillary pressure Increased filtration across capillary If lymphatic drainage is exceeded then you get edema |
|
|
What type of HF gets edema in the lung?
|
LHF
|
|
|
What type of HF gets edema in SQ?
|
RHF
|
|
|
What drains parietal pleura?
|
RA
|
|
|
What drains visceral pleura?
|
LA
|
|
|
What type of HF gets pleural effusion?
|
biventricular heart failure (most common) or right or left
|
|
|
What is profound and widespread reduced tissue perfusion leading to cellular injury?
|
Shock
|
|
|
What is happening to this dog:
HR = 190 MM = pale CRT = 3sec cannot feel pulses |
SHOCK
|
|
|
What is the predominant sign of shock in dogs? ...cats?
|
Dogs = tachycardia
Cats = hypothermia and hypotension |
|
|
What is anaphylactic shock?
|
Immunological reaction where IgE causes mast cells to degranulate and blood leaks out into extravasc space (give fluids and EPI)
|
|
|
Should you give an animal in shock steroids?
|
NEVER
|
|
|
What treatments should you give to a shock patient?
|
Fluids if hypovolemic shock
VC agents if distributive shock(EPI, a agonist, NE, phenylephrine, vasopressin) Inotropic agents ifcardiogenic shock (B agonist - dobutamine) Analgesia (opioids) after complete cardiovasc assessment Antibiotic therapy (due to risk of bacterial translocation from gut) |
|
|
What is a reason a shock patient may continue to have prolonged CRT despite him looking better?
|
Pain
|
|
|
What is a localized, blood-filled dilation of a blood vessel caused by disease or weakening of vessel wall?
|
Aneurysm
|
|
|
What is fluid accumulation in pericardium
|
Cardiac tamponade (emergency!!)
|
|
|
What is a (usually) benign tumor originating in chemoreceptor tissue
|
Chemodectoma
Ao body tumor Paraganglioma |
|
|
What types of dogs are predisposed to chemodectomas?
|
Brachycephalic dogs
|
|
|
What is abnormal accumulation of fluid in intercellular spaces of the body?
|
Edema
|
|
|
What is chronic fibrosis and nodular thickening of free edges of AV valves?
|
Endocardiosis
|
|
|
What is exudative and proliferative inflammatory alterations of endocardiosis?
|
Endocarditis
|
|
|
What is a malignant tumor of vascular origin; formed by proliferation of endothelial tissue lining irregular vascular channels
|
Hemangiosarcoma
|
|
|
What is PPDH?
|
Peritoneopericardial Diaphragmatic Hernia; congenital; defect of septum transversum; peritoneal and pericardium cavities are joined
|
|
|
Pericardial effusions are commonly associated with _____
|
Cardiac and heart-based neoplasms
|
|
|
What is the most common cause of pericardial hemorrhage in dogs?
|
Idiopathic
|
|
|
If an HSA is found at the heart; what parts of the heart is it near usually?
|
RA and RAu
|
|
|
What heart tumors are common in cows and cats?
|
Cardiac lymphoma
|
|
|
What heart tumors are common in dogs?
|
HSA
Chemodectomas (brachycephalics esp) Mesotheliomas |
|
|
What does doxorubicin do to heart?
|
Cardiotoxin
|
|
|
What is a heart disease of cats that affects the endomyocardium and what causes it?
|
Fline Endomyocarditis (cause is unknown)
|
|
|
Name 4 causes for atrial dilation
|
Ventricular failure
AV regurg Shunt CHF |
|
|
What is an endocrine reason for cardiac concentric hypertrophy
|
Hyperthyroidism
|
|
|
What are 2 pressure reasons for cardiac concentric hypertrophy?
|
Stenosis
Hypertension |
|
|
Name 2 pressure, 1 idiopathic, and 1 endocrine cause of concentric hypertrophy.
|
Stenosis
Hypertension Genetic HCM in cats Hyperthyroidism |
|
|
Name 2 volume, 1 idiopathic, and 1 chronic reason for eccentric ventricular hypertrophy.
|
Valvular regurgitation
L to R shunts Idiopathic DCM Chronic myocardial injury |
|
|
What is the 2nd most common heart problem in dogs?
|
DCM
|
|
|
Name 3 problems that create secondary cardiomyopathy?
|
Taurine deficiency (esp DCM in cats)
Hyperthyroidism Systemic hypertension |
|
|
What do you give if your patient has SAM?
|
Atenolol
|
|
|
What is RCM and what animal does it affect?
|
Restrictive Cardiomyopathy - increased myocardial/endomyocardial fibrosis of the left ventricular myocardium/subendocardium with severe dilation of LA(+/- RA); causes systolic and diastolic dysfunction
Affects cats |
|
|
What is ARVC and what dog breed is it very common in?
|
Arrhythmogenic RV Cardiomyopathy - fibro-fatty replacement of RV myocardium which leads to electrical instability (PVCs and VTs)
Common in Boxers |
|
|
What is RA Cardiomyopathy and what dog breed is genetically predisposed?
|
Right Atrial Cardiomyopathy - rare, loss of electrical activity in a condition called "silent atrium" and animal relies on escape pacemaker (no P waves) - bradycardic
English Springer Spaniel |
|
|
How does an animal's gums look with Tetralogy of Fallot and what is happening to the blood?
|
Cyanotic
Seconday polycythemia due to decreased PaO2 reaching the kidneys so kidneys make more EPO and increase RBC production |
|
|
Cardiomyopathies lead to what 2 problems?
|
CHF
Arrhythmias |
|
|
Faster heart rates shorten (systole or diastole)?
|
Diastole (make heart difficult to fill and limits time for coronary blood flow)!!
|
|
|
What is the most common cardiac disese of dogs and is it common in cats or horses?
|
Endocardiosis (degenerative canine disease)
NEVER reported in cats Occurs in horses |
|
|
What side of the heart do dogs and horses get endocarditis?
|
Left
|
|
|
What side of the heart do cows get endocarditis?
|
Right
|
|
|
Which valves are most commonly affected by endocardiosis?
|
Mitral>Tricuspid>Aortic
|
|
|
How does a dog present if it has a persistence rigth 4th Ao arch?
|
Regurgitation due to ligamentum arteriosum constricting the esophagus
|
|
|
If an animal has limb edema, what cardiac disease might you think the animal has?
|
AV fistula - due to increased venous pressure
|
|
|
What cardiac condition do you think if animal has congested, nutmeg liver?
|
RHF
|
|
|
What is arteriosclerosis and do animals get it?
|
"Hardening of arteries"; loss of elasticity of medium/large arteries
Common finding in old dogs (often observed with endocardiosis, SAS, or HCM) and idiopathic in the cat |
|
|
How does medial hypertrophy of pulmonary artery arise and what does it cause?
|
Primary hyperplasia of sm muscle or seconday response to pulmonary injury
Causes pulmonic hypertension |
|
|
What is atherosclerosis?
|
Degenerative Arterial Disease due to lipid and cholesterol deposits; a specific form of arteriosclerosis
|
|
|
What disease often results in secondary atheroslerosis?
|
Hypothyroidism
|
|
|
Name 5 causes of vascular mineralization
|
Hyper-vitaminosis D
renal failure Hyperparathyroidism Paraneoplastic syndromes Idiopathic (Paratuberculosis aka Johne's Disease in cattle) |
|
|
Should you be worried if you find aortoannular ectasia on a radiograph of an older cat?
|
This is a common radiographic finding in older cats
|
|
|
What are the 2 common causes of arteritis?
|
Infection - Rocky Mtn Spotted Fever, HW disease, strongylus vulgaris
Immune mediated disease (vasculitis) |
|
|
Name 2 consequences of arteritis/vasculitis.
|
Edema
Hemorrhage |
|
|
What is inflammation of a vein?
|
Phlebitis
|
|
|
What is a common consequence in cats with idiopathic cardiomyopathies?
|
Thrombosis and Thromboembolism - form in LA and dislodge to other parts of body
|
|
|
What do you suspect if a cat presents with acute paresis of rear limbs?
|
Saddle Thromboembolism
|
|
|
What changes will you see on biochem profile if cat has arterial TE?
|
Increased CK, AST, ALT (striated muscle enzymes)
|
|
|
What 4 body organs are affected by systemic hypertension?
|
Brain
Eyes Heart Kidneys |
|
|
What is another word for history?
|
Anamnesis
|
|
|
Name 3 signs of low CO?
|
Exercise Intolerance
Weakness Syncope |
|
|
Pulmonary edema is associated with which side heart failure? What about pleural effusion?
|
Pulm edema = L-CHF
Pl Eff = CHF (either side) |
|
|
Name the 3 top causes of exercise intolerance.
|
1. M/S diseases
2. Resp diseases 3. CV diseases (others are neuro, systemic(infectious, metabolic, endocrine, cancer), anemia) |
|
|
What is syncope?
|
Sudden (reversible) loss of consciousness and postural tone, MAY stiffen and urinate, generally recovers quickly and acts normally
|
|
|
Name the main causes of syncope.
|
Arrhythmias
Structural heart disease Reflex-mediated syncope (vasovagal, vasodepressor, neurocardiogenic) Inappropriate activation of cardiac baroreceptors Drugs (diuretics and vasodilators) |
|
|
What is a pulse deficit and what does it indicate?
|
More heart beats than peripheral pulses
Indicated an arrhythmia |
|
|
What are the jugular venous pulse waves and what are they due to??
|
A (wave)- atrial contraction
C (wave) - TV closure X (trough) - systolic suction in atrium V (wave) - veous return and atrial filling Y (trough) - opening of TV and atrial emptying during rapid ventricular filling Due to positive and negative pressure waves in the RA transmitted to veins |
|
|
Name to causes of hyperkinetic pulse?
|
increased stroke volume
increased pulse pressure |
|
|
Name 2 causes of hypokinetic pulse
|
decreased stroke volume
obstructions (AS) |
|
|
What is a decrease in pulse strength?
|
Hypokinetic
|
|
|
What is an increase in pulse strength?
|
Hyperkinetic
|
|
|
An increase in jugular venous pressure indicates what?
|
RCHF
Pericardial disease Large pleural effusion Volume over-infusion Cranial mediastinal or pulmonary masses Cranial VC thrombosis |
|
|
What can pale mucous membranes indicate?
|
Anemia
Hypotension (reflex VC and slow CRT) |
|
|
What could systemic hypertension do to the eyes?
|
Retinal hemorrhage and retinal detachment
|
|
|
What 4 organ systems does hypertension affect?
|
Heart
Eyes Kidneys Brain |
|
|
What does cyanotic mucous membranes indicate?
|
Decreased O2 (desaturated Hb)
Increased 02 extraction Reversed PDA (reversed shunt) |
|
|
Has dental disease been proven to cause heart disease in dogs?
|
NO
|
|
|
Why would an abdomen be distended in a cat with RCHF?
|
Hepatomegaly
Ascites |
|
|
Name some non-cardiac causes of SQ edema
|
Lack of venous pump
Local tissue reaction to inflammation or infection Low serium protein Vasculitis Venous obstruction Lymphatic obstruction, inflammation, or malformation |
|
|
What is a heart problem that causes SQ edema and what type of animals is it more common in?
|
RCHF
Large animals |
|
|
What if a cat comes in with cold, pulseless hind limbs, elevated CK, and loss of motor, sensory and proprioception to hind limbs
|
Aortic thromboembolism
|
|
|
What causes resp crackles?
|
Explosive opening of collapsed small airways
|
|
|
What causes resp wheezes and give 4 specific examples
|
Bronchial narrowing (LA dilation, hilar lymphadenopathy, primary bronchial collapse, pulmonary mass lesion)
|
|
|
What is stridor and what does it indicate?
|
Inspiratory wheeze over larynx
Upper airway obstruction |
|
|
What is stertor and what does it indicate?
|
Inspiratory snoring
Pharyngeal/nasopharyngeal obstruction |
|
|
Pulmonary edema would cause (inc or dec) lung sounds?
|
Increased
|
|
|
Pleural effusion woudl cause (inc or dec) lung sounds?
|
Decreased
|
|
|
Pneumothorax would cause (inc or dec) lung sounds?
|
Decreased
|
|
|
What is an cardiac arrhythmia and what does it predict?
|
Electrical disturbance that predicts mechanical disturbance
|
|
|
Why would the heart sounds be sofer than expected?
|
Obesity
Fluid accumulation - pleural effusion or pericardial effusion Myocardial failure or reduced contractility Mass lesion |
|
|
Why would the heart sounds be louder than expected?
|
Increased SNS tone
Hypertension |
|
|
What is S3 and what is it associated with?
|
Ventricular gallop
Associated with high atrial pressure and a poorly compliant ventricle MR or DCM with CHF |
|
|
What is S4 and what is it associated with?
|
Atrial Gallop
Abnormal ventricle relaxation (LVH) and increased atrial kick Hypertrophic left ventricle or aging heart |
|
|
What is a split heart sound, what does it indicate, and is this ever normal?
|
Asynchronous closure of heart valvesIndicated abnormal conduction through ventricles or asynchronous ejection times (RBBB or VPCs)
Normal in horses |
|
|
What is a systolic click and what is the most common reason they are heard on dogs?
|
Most commonly due to mitral or tricuspid valve prolapse
Degenerative mitral valve disease |
|
|
How do you differentiate click from gallop?
|
Click - during systole
Gallop - during diastole |
|
|
What causes a holosystolic murmur?
|
MR
TR VSD |
|
|
What causes a crescendo-decrescendo murmur?
|
Functional
AS PS |
|
|
What causes a systolic decrescendo murmur?
|
MR
TR |
|
|
What causes a diastolic decrescendo murmur?
|
AR
|
|
|
What causes a continuous murmur?
|
PDA
|
|
|
What is a V/VI murmur?
|
Has a palpable thrill
|
|
|
What is a VI/VI murmur?
|
Audible with stethoscope off the chest
|
|
|
What is a functional murmur?
|
Murmur unrelated to structural heart disease
|
|
|
What are examples of high output states that cause functional murmurs?
|
Anemia
Fever Hyperthyroidism High adrenergic tone Athlete |
|
|
Do functional murmurs change with exercise?
|
Yes, they will increase
|
|
|
What is an innicent functional murmur?
|
A murmur of unknown cause in young animals
|
|
|
What is the cause of most functional murmurs?
|
Ejection of blood into great vessels
|
|
|
What are causes of mitral regurgitation in dogs?
|
Endocardiosis
DCM Systemic hypertension |
|
|
What are causes of mitral regurgitation in cats?
|
Malformation of mitral valve
Cardiomyopathy |
|
|
What is a common cause of mitral regurg in horses?
|
Degeneration (fibrosis)
|
|
|
What type of animal are VSDs common in?
|
Camelids
|
|
|
Is a loud murmur (due to a shunt) correlated with a large shunt?
|
NO - the louder the murmur the smaller the shunt
|
|
|
AS is common in what types of animal? What about PS?
|
Dog
Dog |
|
|
Does loudness of murmur (due to AS or PS) correlate with stenosis severity?
|
YES - the louder the murmur the more stenotic the valve is
|
|
|
What causes a diastolic murmur?
|
AR
|
|
|
Are AS, PS, VSD, and PDAs congenital or acquired?
|
Congenital
|
|
|
Name some causes of pericardial effusion
|
Idiopathic
Neoplastic Inflammation Pericarditis Traumatic Ruptured cardiac chamber Congenital |
|
|
What is PPDH?
|
Peritoneopericardial diaphragmatic hernia - herniation of abdominal viscera into pericardial sac via congenital hiatus formed between diaphragm and pericardial sac
|
|
|
Name some causes of microcardia
|
Decreased circulating blood volume
Dehydration Addison's disease Hypovolemic shock |
|
|
Name some causes of enlarged pulmonary arteries and veins
|
PDA
VSD/ASD Iatrogenic fluid overload |
|
|
Name some causes of enlarged pulmonary arteries
|
Dirofilariasis
Thromboembolism Chronic lung disease |
|
|
Name some causes of enlarged pulmonary veins
|
Left heart failure
LA neoplasia or thrombus |
|
|
Name some causes for small pulmonary arteries/veins
|
Hypovolemia (shock or dehydration)
Addison's disease Tetralogy of Fallot |
|
|
Name general causes of LA dilatation
|
Volume overload
Idiopathic Mitral valve disease LV systolic dysfunction LV diastolic dysfunction |
|
|
Name causes of LV dilatation
|
Volume overload
LV systolic dysfunction |
|
|
What could cause volume overload of LV?
|
MR
PDA VSD ASD Chronic tachycardia/bradycardia Anemia HyperT4 |
|
|
What could cause LV systolic dysfunction
|
DCM
Hypothyroidism Taurine deficiency Muscular dystrophy Exhaustion from chronic overload |
|
|
Name general causes of LV hypertrophy
|
LV pressure overload
Abnromal myocardial growth Infiltrative disease - neoplasia Pseudohypertrophy |
|
|
What is pseudohypertrophy of LV caused by?
|
Dehydration
|
|
|
What could cause abnormal myocardial growth?
|
HCM
Hyperthyroidism Growth hormone excess |
|
|
What could cause LV pressure overload?
|
AS
Systemic hypertension Dynamic LVOTO |
|
|
Name 3 types of mitral valve abnormalities
|
Endocardiosis
Dysplasia Vegetative endocarditis |
|
|
Name 5 aortic valve/LVOT abnormalities
|
Aortic stenosis (common in dogs)
Aortic valve endocaritis Aortic root dilatation Vegetative endocarditis HOCM |
|
|
Which leaflet causes the obstructions in HOCM?
|
Septal leaflet
|
|
|
What are the 4 components of Tetralogy of Fallot
|
PS
RV hypertrophy VSD Overriding aorta |
|
|
What is a PDA?
|
Connection between desc Ao and main PA
|
|
|
What is pericardial temponade?
|
Pericardial effusion causing collapse of right heart chambers which impedes filling of the right heart
|
|
|
Name some common causes of pericardial effusion?
|
Neoplasia
Idiopathic CHF (cats) Trauma Infectious (FIP, pericarditis) |
|
|
Name some causes of LV systolic dysfunction
|
Idiopathic DCM
Chronic volume overload Chronic pressure overload Endocrinopathies (hyperT4, DM, Addison's) RCM Nutritional Muscular dystrophy Myocarditis Doxorubicin Chronic tachy/bradyarrhythmias |
|
|
Name some causes of LV diastolic dysfunction
|
HCM
Systemic hypertension Infiltrative myocardial disease Ischemic cardiomyopathy Severe Ao stenosis Muscular dystrophy |
|
|
How will the E and A waves look with relaxation abnormality?
|
E:A <1.0
|
|
|
How will the E and A waves look with restrictive abnormality?
|
E:A >>1.0
|
|
|
How does the E and A waves normally look?
|
E:A 1-2
|
|
|
Name some causes of RA dilatation
|
Volume overload
Idiopathic Tricuspid valve disease RV systolic dysfunction Complete AV block |
|
|
Name some causes of RV dilatation
|
Volume overload
Idiopathic (ARVC) Tricuspid valve diease RV systolic dysfunction |
|
|
Name some causes of RV hypertrophy
|
Pressure overload
Infiltrative disease (neoplasia) |
|
|
Name some causes of pressure overlaod of RV
|
PS
Dynamic RVOTO Tetralogy of Fallot Pulm hypertension Cor Pulmonale |
|
|
If the IVS is flat, what does that imply?
|
RV systolic pressure is at least 2/3 of LV systolic pressure
|
|
|
Name some causes of RV systolic dysfunction
|
Arrhythmogenic RVCM
Chronic volume overload Chronic pressure overload Doxorubicin Chronic arrhythmias |
|
|
What is the Bernoulli equation?
|
change pressure = 4 x Vmax^2
|
|
|
What causes a wide P wave?
|
LA dilataion (P mitrale)
|
|
|
What causes a tall QRS?
|
LV hypertrophy (eccentric)
|
|
|
If the ECG is 50 mm/s, how many sec is a square?
|
0.02 sec
|
|
|
If the ECG speed is 25 mm/s, how many sec is a square?
|
0.04 sec
|
|
|
If the ECG leads are black, white, and red, where do they go in a right lateral recumbent animal?
|
Black = LA
White = RA Red = LL |
|
|
What causes a tall P wave?
|
RA dilitation (P pulmonale)
|
|
|
What causes a wide QRS complex?
|
LV bundle block
|
|
|
What causes an S wave that is very pointed?
|
RV hypertrophy
|
|
|
What causes a deep S wave (but its not sharp)?
|
Right bundle branch block
|
|
|
What causes big, tented T waves?
|
Hyperkalemia
|
|
|
Name 4 diuretics
|
Furosemide (Lasix)
Spironolactone Hydrochlorothiazide Nesiritide (BNP) |
|
|
How does furosemide work and what is it used for?
|
Inhibits the co-transporter of chloride in Henle's Loop with resultant losses of Cl, Na, H2O, Ca, Mg, K, and water-soluble vitamins
Used for long-term treatment of CHF |
|
|
What are some adverse effects of diuretics and how do you prevent these?
|
Azotemia
Hypochloremia Metabolic alkalosis Hypokalemia Prevent these by regular measurement of BP, serum BUN, creatinine, and electrolytes |
|
|
How does spironolactone work?
|
Weak diuretic that is a K-sparring diuretic that antagonizes the effects of aldosteron on the heart by binding to mineralocorticoid receptors in the distal collecting duct
|
|
|
What is a typical treatment for CHF?
|
Furosemide (Lasix)
Spironolactone ACEI Pos inotrope |
|
|
How does hydrochlorothiazide work?
|
Blocks Na transporter in distal convoluted tubule inhibiting Na, Cl, and H2O reabsorption
|
|
|
When is hydrochlorothiazide used?
|
Management of refractory fluid retention
|
|
|
What is a major risk of using hydrochlorothiazide with furosemide and spironolactone?
|
Acute renal failure, rapid volume depletion, and electrolyte disturbances
|
|
|
Name 4 positive inotropic drugs
|
PIMOBENDAN
Digoxin Catecholamines Milrinone/Amrinone |
|
|
When is digoxin used?
|
CHF caused by DCM, chronic valve disease, untreated congenital heart disease
*Especially useful when CHF complicated by atrial fibrillation or frequent premature atrial complexes |
|
|
Is digoxin used in cats?
|
RARELY!!
|
|
|
How is digoxin eliminated?
|
Kidney
|
|
|
Name some adverse effects of digoxin
|
Anorexia
Depression Vomiting Diarrhea Cardiac arrhythmias |
|
|
Do catecholamines cause VC or VD?
|
VD at lower doses
VC at higher doses |
|
|
Name 2 commonly used catecholamines to control emergent CHF
|
Dobutamine
Dopamine |
|
|
What is the principle use of catecholamines in cardiac problems
|
Cardiogenic shock (severe CHF with hypotension and poor perfusion (pale MM))
|
|
|
Name some adverse effects of catecholamines
|
Sinus tachycardia/ventricular tachycardia/ventricular fibrillation
PVCs Anxiety Tremors Elevated BP Seizures (mainly cats) |
|
|
How does Pimobendan work?
|
Increases the sensitivity of the actin-myosin contractile apparatus to available Ca
|
|
|
Is Pimobendan a VC or VD?
|
VD
|
|
|
When should you use Pimobendan?
|
CHF due to DCM, chronic valvular disease, or untreated congenital heart disease in dogs
|
|
|
Name 4 VDs
|
Nitroglycerine
Na nitroprusside Sildenafil Hydralazine |
|
|
How does nitroglycerine work?
|
Induces nitric oxide-mediated VD
|
|
|
What is an indication for using Nitroglycerine?
|
Pulmonary edema
|
|
|
When is Na nitroprusside indicated?
|
When initial doses of furosemida and nitroglycerine fail to provide relief from pulmonar edema
|
|
|
How does Sildenafil work?
|
Inhibits phosphodiesterase I to dilate pulmonary arteries
|
|
|
What are indications of Sildenafil?
|
Dogs with RCHF and pulmonary hypertension
|
|
|
What is special about benazepril?
|
Hepatic elimination (use in renal failure cases)
|
|
|
What is a good therapy plan for a cat with CHF?
|
Furosemide
ACEI |
|
|
Name some ACEI
|
Enalapril
Benazapril |
|
|
Name 2 Ca channel blockers and what is hteir main effect
|
Amlodipine
Diltiazam VD |
|
|
Name 3 phosphodiesterase inhibitors and their main effects
|
Milrinone
Pimobendan Sildenafil VD |
|
|
Name the different generations of B blockers, examples of drugs, and what the different generations mean
|
1st generation (non-selective)
Propranolol Esmolol 2nd generation (selective) Metroprolol Atenolol 3rd generation (a blocking and anti-oxidant) Carvedilol Sotalol |
|
|
Are there more B1 or B2 receptors on the heart?
|
B1
|
|
|
What do B blockers do?
|
Decrease HR, contractility, relaxation, conduction velocity, and pacemaker excitability
|
|
|
Name 4 indications for B blockers
|
Cardioprotection in cardiomyopathies
Chronic heart failure Congenital heart defects Outflow tract obstructions |
|
|
Name 2 B blockers that are commonly used for cardioprotection in HCM
|
Atenolol
Propranolol |
|
|
What are the contraindications of B blockers?
|
Untreated CHF (wet patients)
Systemic hypotension Bradyarrhythmias Peripheral vascular disease and Arterial thromboembolism Bronchial disease (esp asthma) |
|
|
Why is A blockade of 3rd generation B blockers important?
|
Causes peripheral VD and reduces LV afterload
|
|
|
How can you overcome bradycardia and cardiac depression due to B blockers?
|
Administer Atropine or dopamine and if thie fails use phenylephrine (A adrenergic) to raise ABP
|
|
|
When is amlodipine indicated?
|
Hypertension (it is a VD drug)
|
|
|
When is diltiazem indicated?
|
Supraventricular arrhythmias/tachycardias (atrial fibrillation)
|
|
|
What do Ca channel blockers do to heart and BP?
|
Increase diastolic function
Decrease BP (VD) |
|
|
What is a common therapy for cats with hypertension due to renal disease?
|
Amlodipine and ACEI
|
|
|
How do you treat a dog with a fib?
|
Digoxin and diltiazem inititally
Diltiazem and carvedilol later |
|
|
What are the different classes and drug examples of antiarrhythmic drugs?
|
Class I - decrease Na influx
Quinidine Procainamide Disopyramide Lidocaine Mexilatine Flecainide Propafenone Class II - block B adrenoceptors, decrease sinus node rate, slow AV conduction, and reduce arrhythmias related to high sympathetic tone All B blockers Class III - block K channel Amiodarone Sotalol Class IV - block Ca channel Verapamil Diltiazem |
|
|
When is procainamide indicated?
|
Acute a fib
Atrial/ventricular tachycardias |
|
|
What do you use to treat a fib/flutter in horses?
|
Quinidine
|
|
|
What drugs can you use to treat ventricular tachycardias
|
Lidocaine or Mexiletine
|
|
|
Why might arrhythmias become less responsive to lidocaine and what can you do?
|
Hypokalemia
Combine with Procainamide |
|
|
How do you treat malignant ventricular arrhythmias chronically?
|
Sotalol
|
|
|
Which antiarrhythmic drug is eleminated by the liver?
|
Amiodarone
|
|
|
What does it mean if a diuretic is K sparring and what is an example?
|
Keeps K in the body (normally diuretics release electrolytes such as Na, Cl, and water)
Spironolactone |
|
|
Which diuretic works at the Loop of Henle?
|
Furosemide (Lasix)
|
|
|
How does Furosemide work?
|
Inhibits the co-transporter of Cl so that Cl, Na, and water are lost in the urine
|
|
|
How do the thiazide diuretics work?
|
Inhibit Na reabsorption at the distal tubules
|
|
|
How does Spironolactone work?
|
Antagonizes the effects of aldosterone
|
|
|
What effect does aldosterone have on the kidneys
|
Reabsorbs Na and eliminated K
|
|
|
What is the primary use of diuretics?
|
CHF
|
|
|
What should always accompany therapy with a diuretic in a dog?
|
ACEI (or else will activate the RAAS)
|
|
|
Is it better to prevent K loss or supplement K in diet?
|
Prevent K loss (K supplements are nauseating)
|
|
|
If a dog presents with weakness and arrhythmias, what electrolytes could be low?
|
K and Mg
|
|
|
How do Pos Inotropic drugs work?
|
Control Ca influx in the myocardial cell; aka "cardiotonics"
|
|
|
Name the 4 groups of Pos Inotropic drugs and examples
|
Digitalis glucosides - digoxin and digitoxin
Catecholamines - dobutamine, dopamine, epinephrine, isoproterenol (B agonist), phenylephrine (A agonist) Phosphodiesterase inhibitors (prevent degradation of cAMP) - milrinone, pimobendan Calcium sensitizers - pimobendan |
|
|
What do you need to watch for when using digoxin?
|
Hypokalemia (also anorexia or V)
|
|
|
What are some indications for Digoxin?
|
CHF due to DCM or advanced chronic valvular disease
A fib Atrial arrhythmia with CHF |
|
|
Name some contraindications of using digoxin
|
Renal failure
Ventricular ectopic complexes Hypokalemia Diastolic heart failure HyperT4 Acute hypoxia |
|
|
What do B receptors do to the vessels?
|
VD
|
|
|
What do A receptors do to the vessels?
|
VC
|
|
|
What should you give patient coming in with cardiogenic shock (CHF with hypotension)?
|
Dobutamine or Dopamine
|
|
|
What is Pimobendan?
|
Calcium sensitizer - increases systolic sensitivity of actin-myosin-tropomyosin complex to cellular Ca - very potent inotrope; does not impair diastole; also a PDE III inhibitor leading to increased cAMP
|
|
|
How do Nitrates and Na Nitroprusside work to VD?
|
Relax vasc smooth muscle
|
|
|
How does Amlodipine and Diltiazem work to cause VD?
|
They are Ca Channel blockers and impair Ca influx into vascular smooth muscle
|
|
|
How does Milrinone and Pimobendan and Sidenafil work to cause VD?
|
They are all Phosphodiesterase inhibitors (increase cAMP)
|
|
|
How does ACEI work to cause VD?
|
Inhibit endogenous vasoconstricotrs
|
|
|
What receptor would you need to block to cause VD and name some examples of drugs that do that?
|
Block A receptors
Prazosin and Carvedilol (Could also block AT2 with Losartan) |
|
|
What are some effects of increased Angiotensin II?
|
Inc aldosterone release
Inc VC Inc thirst Inc vasopressin rls Inc NE rls Inc renal Na retention Hypertrophy of heart and vessels |
|
|
Name some effects of ACEI
|
Dec arterial VC
Dec degradation of kinins (causing vessels to dilate) Dec aldosterone formed Dec myocardial fibrosis and CV tissue remodeling |
|
|
Name the 2 most commonc causes of heart disease in dogs
|
1. Endocardiosis
2. DCM |
|
|
Name some types of cardiac protective drugs
|
B blockers
Spironolactone ACEI Omega 3 |
|
|
What are the only VD drugs that prolong life in CHF?
|
ACEI
|
|
|
What is the hospital therapy of CHF?
|
FON(S)!
Furosemide Oxygen Nitroglycerine (Sedation if necessary) |
|
|
What is the home therapy of CHF?
|
Dietary modification
Furosemide Spironolactone Inotropic drugs (pimobendan of digoxin) ACEI B blocker (once "dry") (Sildenafil if pulm hypertension and Diltiazem if a fib) |
|
|
Name 4 uses of B blockers
|
A fib (slows AV conduction)
Reduce dynamic outflow obstruction (in HCM) Cardioprotection (in DCM) Antihypertensive (dec CO and dec renin release) |
|
|
What is the drug of choice to decrease ABP?
|
Amlodipine (Norvasc)
|
|
|
What is the difference between DHP and non-DHP when talking about Ca channel blockers?
|
DHP - vascular selectivity
non-DHP - cardiac selectivity |
|
|
Name the 3 types of drugs that block AV conduction and can therefore be used for a. fib
|
Digoxin
B blockers Ca channel blockers (diltiazem) |
|
|
Name some non-cardiac causes of systemic hypertension
|
CRD
HyperT4 Cushing's DM Obesity Pheochromocytoma (neoplasm of ad medulla and secretes catecholamines) |
|
|
What 4 classes of drugs are antihypertensive?
|
ACEI
Ca channel blockers B blockers Na nitroprusside |
|
|
Name the 5 clinical associations for cardiac arrhythmias
|
Primary electrical disturbances of heart
Metabolic/endocrine Autonomic nervous system Drugs "Usual suspects" - trauma, systemic infections, neoplasms |
|
|
What are some causes of sinus arrest?
|
High vagal tone, sick sinus syndrome, drugs that depress the SA node
|
|
|
Name some causes of atrial standstill
|
Hyperkalemia
Hypoadrenocorticism Urinary obstruction Myocarditis DCM |
|
|
Name some causes of APCs
|
Atrial dilation
Valvular regurgitation and cardiomyopathy Hyperthyroidism Hypoxia Anemia Increased sympathetic tone or drugs that increase sympathetic tone Hypokalemia Atrial tumors IV catheter in atrium |
|
|
Name some causes of VPCs
|
Hypokalemia
Hypomagnesium Cardiomyopathy Heart failure Endomyocarditis Chronic valvular heart disease Pericarditis Neoplasia Hypoxia Anemia Acidosis Autonomic imbalance Thoracic and abdominal trauma GDV Sepsis Infection Pulmonary disease Digitalis intoxication Hyperthyroidism Administration of anesthetics or sympathomimetics Splenic diseases |
|
|
Name some causes of 1st and 2nd degree AV block
|
Normal in resting dogs
Increased vagal tone Digitalis glycosides, narcotics, xylaxine AV nodal disease Cardiomyopathy Myocarditis Doxorubicin cardiotoxicity |
|
|
Name some causes of 3rd degree AV block
|
AV nodal or junctional diesease including infarction, degeneration, or replacement with conn tissue
Neoplasia Digitalis, xylazine, doxorubicin Ao valve bac endocarditis Lyme disease Breed disposition: spaniels, German shepherds, lab retrievers |
|
|
What is the electrical pathways in the heart?
|
SAN
Intermodal pathways and atrial tissues AV node Bundle of His Bundle branches Purkinje fibers Ventricular tissues |
|
|
What part of the electrical cardiac pathway serves as the escape pacemaker?
|
Purkinje fibers
|
|
|
What are some fo the triggers for fibrillation?
|
Big heart
Diseased heart Ischemia Altered autonimic tone Drugs |
|
|
Name some causes for sinus bradycardia
|
Inc vagal tone
Metabolic diseases - hypothyroidism Drugs Sinus node dysfunction - sick sinus syndrome |
|
|
Name some causes for sinus tachycardia
|
Inc SNS activity - pain, dec BP, stressed
|
|
|
How do you speed up sinus rate?
|
Atropine
Glycopyrrolate Catecholamine |
|
|
How do you slow down the sinus rate?
|
B- blocker
|
|
|
Name 3 drug classes used to control atrial arrhythmias
|
Digoxin
B blockers Ca channel blockers |
|
|
How do you control a fib in horses?
|
Quinidine
|
|
|
What is bigeminy?
|
Altering sinus complex and VPC
|
|
|
What is the only treatment for ventricular fibrillation?
|
Shock the heart
|
|
|
What do you give for an animal in asystole?
|
Epinephrine
|
|
|
How do you treat ventricular arrhythmias in the hospital?
|
Lidocaine
Procainamide Amiodarone |
|
|
How do you treat ventricular arrhythmias at home?
|
SPAM
Sotalol Procainamide Atenolol/amiodarone Mexilatine |
|
|
What is 1st degree AV block?
|
Longer PQ interval
|
|
|
What is 2nd degree AV block? In what species is this normal?
|
Some P waves not conducted through AV conduction system
HORSES |
|
|
What is third degree AV block?
|
No relationship between P waves and QRS complex; no P waves are conducted across the AV conduction system; heart depends on escape pacemaker below the level of the block
|
|
|
Name some causes of transudates found on pericardial effusion
|
R CHF
PPDH Pericardial cysts Heart base mass Hypoalbuminemia Infectious/toxemia |
|
|
Name a cause of exudates found on pericardial effusion
|
Hardware's disease
|
|
|
Name some causes of hemorrhage found on pericardial effusion
|
<6 yers = idiopathic
6-8 years = neoplasia of heart, heart base, or pericardium Hemangiosarcoma of RA (esp Germ Shep, Golden ret, and Lab ret if over 8 years) Aortic body tumor (chemodectoma) - aged brachycephalic breeds Ectopic (heart-based) thyroid carcinoma Mesothelioma of pericardium Lymphosarcoma of RA and ventricles is most important cardiac neoplasm in cat and cow |
|
|
What is cardiac tamponade?
|
Low cardiac output and CHF develop with pericardial effusion
|
|
|
What is constrictuve pericardial disease?
|
Pericardium thickens and scars, ventricles become constricted, ventricular filling becomes limited; often due to chronic inflammation
|
|
|
Name the top 3 causes of hemorrhage in the pericardium in dogs (what about cats?)
|
HSA
hemodectoma Mesothelioma (cats = lymphoma) |
|
|
Name the classical features of cardiac tamponade
|
Distant heart sounds
Elevated jugular venous pressure Abnormal ABP "pulsus paradoxicus" |
|
|
Name the top 2 primary, idiopathic cardiomyopathies in cats.
|
HCM
RCM (restrictive cardiomyopathy) |
|
|
Name some secondary causes of cardiomyopathy in cats
|
HyperT4
Hypertension Chronic anemia Ischemia/Infarction Taurine deficiency Myocarditis DM/acromegaly/Corticosteroid induced |
|
|
What is the most common cardiomyopathy in cats?
|
HCM
|
|
|
What is FATE?
|
Fe Arterial Thromboembolism
|
|
|
Name some characteristics of ECG in feline with HCM
|
Normal
Increased R amplitude (LV enlargement) Increased P width (LA enlargement) - P mitrale Conduction disturbances/arrhythmias |
|
|
What is ventricular ectopy highly specific for in cats, Dobermans, and Boxers?
|
Myocardial disease
|
|
|
How might the heart look on a radiograph in a feline with HCM?
|
Normal
LV elongation LA enlargement |
|
|
How thick does the LV have to be and how large must be the LA to say the cat has HCM?
|
LV hypertrophy > 6mm
LA enlargement > 16 mm |
|
|
What leaflet causes SAM?
|
Septal mitral valve leaflet
|
|
|
If the E:A wave is <1.0, what disease does the animal have?
|
HCM due to relaxation delay
|
|
|
What might you find in patient's blood if cat has HCM?
|
Troponin I
|
|
|
What are some DDX for feline HCM?
|
Systemic hypertension
Feline hyperthyroidism Pseudohypertrophy (dehydration, infiltrative disease - neoplasia, myocarditis, hypereosinophilic syndrome) |
|
|
How do you treat cat with hypoxia, ischemia, or infarctions?
|
Atenolol
|
|
|
How do you treat cat with ventricular tachycardia or arrhythmias
|
Atenolol
|
|
|
How do you treat cat with supraventricular tachycardia and arrhythmias
|
Digoxin or Diltiazem
|
|
|
How do you treat cat with diastolic dysfunction
|
DILTIAZEM, FUROSEMIDE, enalapril, atenolol
|
|
|
How do you treat cat with systolic dysfunction?
|
Digoxin
Pimobendan |
|
|
How do you treat cat with increased preload?
|
Furosemide, enalapril, diet, nitroglycerine
|
|
|
How do you treat cat with increased afterload?
|
Atenolol
|
|
|
How do you treat cat with FATE hypercoagulolability?
|
Aspirin, clopidogrel (Plavix)
|
|
|
How do you treat HOCM?
|
Atenolol
|
|
|
What is Fe RCM?
|
Myocardial disease characterized by (1) diffuse LV endocardial fibrosis/scar or (2) LV myocardial fibrosis causing prograssive LV diastolic dysfunction
|
|
|
Will you find murmurs or gallops on PE of cat with RCM?
|
No murmurs
Loud gallops |
|
|
What if the E:A ration is >2 in a cat?
|
RCM
|
|
|
What is Fe ARVC?
|
Feline arrhythmogenic RV cardiomyopathy - primary, myocardial disease of unknown origin characterized by progressive RV and RA dilatation, arrhythmias, and RV systolic dysfunction
|
|
|
What might you see on ECG of cat with FeARVC?
|
RV ectopy (+/- atrial standstill)
|
|
|
What is Fe UCM?
|
Feline unclassified cardiomyopathy - myocardial disease of unknown origin that does not fit the characteristics of HCM, RCM, DCM, and ARVC
|
|
|
If a cat has DCM, what might be missing from their diet and what other things may cause DCM in cat?
|
Taurine
Secondary to chronic volume overload Ischemic heart disease Myocarditis |
|
|
What is a normal SF in cats?
|
35-45%
|
|
|
What are some problems with Fe RCM?
|
Restriction to filling
Fluid accumulation Chronic activation of neuroendocrine systems Ischemia/Infarct Systolic dysfunction LA dysfunction Hpercoagulability |
|
|
How do you treat Fe RCM?
|
Furosemide
Enalapril Digoxin (or Pimobendan) Aspirin Clopigogrel (Plavix) +/- Nitro |
|
|
FATE is common in Fe cardiomyopathy with an enlarged _____?
|
LA
|
|
|
What 3 factors are required for FATE clot formation?
|
Endothelial injury
Blood stasis Coagulopathy ("Virchow's triad") |
|
|
What are the predilection sites for FATE?
|
Front legs (R>L)
Aortic trifurcation |
|
|
What are the 5 P's of FATE and other things you may not on PE?
|
Pain
Paresis Pulselessness Pallor Poikilothermia (low body temp) Peracute Vocalization Tachypnea Open mouth breathing Cyanotic nail beds |
|
|
Name some DDX for FATE.
|
Spinal cord disease
Peripheral neuropathy Central lesion |
|
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What is acute therapy for FATE?
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Fentanyl (CRI)
Heparin (prevent thrombus expansion) Aspirin (inhibit platelet aggregation) FON (therapy for CHF) |
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What do you need to monitor when treating FATE acutely?
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Serum K, BUN ,creatinine, and ECG
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What is chronic treatment for FATE?
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Low-dose aspirin
Clopidogrel (Plavix) |
