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;
101 Cards in this Set
- Front
- Back
What are some common presenting complaints w/ heart failure?
|
cough (dog), dyspnea, ↓ appetite, wt. loss, lethargy, episodic weakness, abdominal distension
|
|
What are some causes of cough resulting from heart dz & what type of cough does each produce?
|
cough resulting from heart dz may manifest as a large airway cough:
-LA enlargement --> compression of bronchi HW dz --> inflammation of airways & lung parenchyma -should be distinguished from noncardiogenic causes such as tracheitis, bronchitis, tracheal collapse, & neoplasia small airway cough is less frequently assoc. w/ heart dz -may result from cardiogenic pulmonary edema -should be distinguished from noncardiogenic causes such as pulmonary fibrosis |
|
What do gallop sounds indicate & when might you hear:
a. S3 b. S4 |
indicate a stiff ventricle
a. early diastole (ventricular filling): hear w/ DCM b. atrial contraction: hear w/ HCM |
|
What are some cardiovascular causes of syncope?
|
usually brief & often occurs w/ exertion
• bradarrhythmia, ex. sick sinus syndrome, 3º AV block • tachyarrhythmia, ex. paroxysms of atrial or ventricular tachycardia • inadequate CO relative to demand caused by cardiomyopathy, acquired valvular dz, HW dz, or severe congenital stenosis of a great vessel (aortic or pulmonic stenosis) |
|
What are some causes of:
a. pulse deficits b. hypokinetic (weak) pulses c. hyperkinetic (bounding) pulses |
a. usually indicate arrhythmia
b. volume contraction or shock, HF, aortic stenosis c. aortic regurg, PDA, high sympathetic tone, hyperthyroidism, fever, anemia |
|
How can you differentiate b'twn syncope & seizure?
|
syncope: often assoc. w/ excitement or exertion, can have rear limb weakness or sudden collapse, lateral recumbency, stiffening of forelimbs & opisthotonos, micturition, vocalization
do NOT have tonic/clonic motion, facial fits, postictal dementia, neuro deficits or defecation w/ syncope |
|
What are some common PE abnormalities assoc. w/ left heart failure?
|
pulmonary edema --> cough, tachypnea, dyspnea, orthopnea, pulmonary crackles, tiring, hemoptysis, cyanosis; secondary RHF, arrhythmias
|
|
What are some common PE abnormalities assoc. w/ R heart failure?
|
ascites, pleural effusion --> dyspnea, orthopnea, cyanosis, systemic venous congestion --> high CVP, jugular venous distension, hepatojugular reflex, heaptic +/- splenic congestion, small pericardial effusion, SQ edema, arrhythmias
|
|
What are some general PE findings in HF?
|
hypothermia (esp. cats)
tachycardia: bradycardia in ~20% of cats +/- arrhythmia murmur or gallop: 1/2 of cats don't have either +/- weak or irregular pulses tachypnea breath sounds: loud +/- crackles w/ edema, soft w/ effusion pale mm |
|
What are some ways to distinguish b'twn cardiac dz & respiratory dz?
|
cardiac dz: previous heart dz, signalment, dec. appetite, wt. loss, new cough (dog), sinus tachycardia (dog), concurrent tachypnea, lethargy
resp. dz: chronic cough, cough (cat), no wt. loss, vomiting, sinus arrhythmia (dog), eupnea, normal activity |
|
What is the highest yield test in dyspneic or coughing animals?
|
thoracic rads
|
|
What are 3 thoracic rad findings consistent w/ congestive heart failure?
|
venous distension: pulmonary vv. are ventral & central
cardiomegaly: vertebral heart score > 10.7 consistent pulmonary patterns •dog: progressive pattern is typical in both distribution & nature of infiltrates; perihilar to caudal dorsal to diffuse, interstitial to alveolar •cat: variable pattern that is usally multifocal patchy interstitial; variable amts. of pleural effusion may be present |
|
What clinically relevant info can be derived from echo?
|
o anatomy: ID each chamber, valve anatomy, & cause of murmur
o cardiac function o pulmonary arterial pressure: pulmonary venous inflow patterns, tissue Doppler (mitral valve motion) o measurements may be helpful in differentiating cardiac vs. non-cardiac causes of dyspnea |
|
What clinically relevant info can be derived from ECG?
|
o can be helpful to detect chamber enlargement but NOT as sensitive or specific as rads or echo
o can detect conduction, electrolyte, & ischemic abnormalities - presence of atrial fib or L BBB in animal w/ consistent clinical signs is VERY suggestive of HF |
|
What are the ECG findings w/ atrial fibrillation?
|
loss of P waves
chaotic rhythm fast rate normal QRS complexes |
|
What are the 4 basic determinants of cardiac output, & define each.
|
preload: amt. of stretch on ventricle just prior to contraction
afterload: sum of forces that resist ejection of blood from ventricle contractility: pumping ability of ventricle, independent of how stretched the myocardium is heart rate/rhythm |
|
What is the definition of heart failure?
|
diminished CO assoc. w/ normal or high ventricular filling pressures
|
|
What are some neurohumoral abnormalities that contribute to heart failure?
|
o short term good: ↑ water, sodium resorption, vasoconstriction, baroreceptor dysfunction (epi, norepi), ↑ HR/inotropy
o long term bad --> ↑ preload, edema, effusion, ↑ afterload, ↑ workload, ↑ myocardial O2 consumption, death o ↑ sympathetic tone: norepi, epi o ↑ RAAS --> ↑ aldosterone, ADH & NE release; vasoconstriction; ↑ thirst; renal sodium & water resorption; myocardial toxic o ↑ cortisol o ↑ atrial & b-type natriuertic peptide (ANP, BNP): body’s attempt to antagonize vasoconstriction & salt & water retention (weak) o ↑ ADH, ↑ endothelin, ↑ TNF-α, IL-1 |
|
What tests are used to dx heart failure?
|
no single test: hx, PE, chest rads, ECG, echo, plasma or serum NT-pro BNP, response to therapy
|
|
What specific test findings, abnormalities, etc. are highly suggestive of heart failure?
|
o diuretic response
o radiographic or physical evidence of venous distention o consistent radiographic pulmonary pattern & cardiomegaly o ↑ pro-NT BNP o tachypnea & abnormal breath sounds o murmur + arrhythmia + gallop sound o pulses paradoxus o A fib o LBBB o large atria on echo (pulmonary venous outflow abnormalities) o CVP > 15 mm Hg |
|
What are the goals for tx of acute heart failure?
|
o restore comfort at rest
- mechanical removal of life threatening fluid accumulations - O2 supplementations - ↓ anxiety - ↓ work of breathing o hemodynamic stabilization: assess & optimize preload, afterload, HR & rhythm, contractility o keep them eating |
|
What are the goals for tx of chronic heart failure?
|
o maintain acute hemodynamic gains
o improve quality of life: exercise tolerance, appetite/weight o improve survival: blunt neurohumoral aberrations o minimize hospitalizations o optimize owner & patient compliance o economic impact o moderately low salt intake |
|
What is the signalment assoc. w/ PDA?
|
-breeds: poodles, collies, shelties, GSDs, Pomeranians, Cockers, English springer spaniels, maltese
-F > M (3:1) |
|
What is the signalment assoc. w/ subaortic stenosis in dogs?
|
goldens, Newfies, boxers, GSDs, rotties
|
|
What are common historical complaints assoc. w/ PDA in dogs?
|
asymptomatic or signs of CHF
|
|
What are common historical complaints assoc. w/ subaortic stenosis in dogs?
|
many asymptomatic, exercise intolerance, syncope, CHF
|
|
What are common historical complaints assoc. w/ pulmonic stenosis in dogs?
|
many asymptomatic, RHF (ascites), low CO (syncope, exercise intolerance), hypoxemia/dyspnea (L --> R shunting across AV defect)
|
|
What PE findings are assoc. w/ PDA?
|
loud continuous machinery murmur at L base, hyperdynamic arterial pulses
|
|
What PE findings are assoc. w/ subaortic stenosis?
|
-L basilar systolic ejection murmur: radiates well to R axilla
-weak, late rising pulse w/ severe dz -rarely, concurrent soft diastolic murmur of aortic insufficiency |
|
What PE findings are assoc. w/ pulmonic stenosis?
|
-L basilar ejection systolic murmur
-R ventricular lift: apex beat felt better on R side -jugular venous pulsation -R holosystolic murmur: tricuspid regurg |
|
What PE findings are assoc. w/ ventricular septal defect?
|
holosystolic R sided murmur
• concurrent loud L basilar systolic ejection murmur may be heard d/t relative pulmonic stenosis: too much blood going thru pulmonary a. • sometimes assoc. w/ aortic insufficiency & soft diastolic murmur |
|
What PE findings are assoc. w/ mitral valve dysplasia in cats?
|
-similar to MR in older dogs: L apical systolic murmur, signs of L HF (cough, dyspnea, lethargy, exercise intolerance)
|
|
What PE findings are assoc. w/ tetrology of Fallot?
|
small size (stunted growth), variable cyanosis, esp. worse w/ exertion, variable, +/- soft holosystolic murumur at L base
|
|
What PE findings are assoc. w/ reverse PDA (R --> L)?
|
clinical signs, px, tx similar to tetralogy of fallot
• one important PE difference: caudal cyanosis d/t position of PDA after L subclavian a. & brachiocephalic trunk (head & neck blood supply may not be as desaturated) |
|
What thoracic rad patterns are typical for PDA?
|
LA & LV enlargement
pulmonary overcirculation dilation of pulmonary a. & aorta: “ductus bump” |
|
What thoracic rad patterns are typical for subaortic stenosis?
|
LV enlargement, prominent aorta (d/t post-stenotic dilation)
|
|
What thoracic rad patterns are typical for pulmonic stenosis?
|
under perfusion of pulmonary circulation
RV enlargement post-stenotic dilation of pulmonary a. |
|
What thoracic rad patterns are typical for ventricular septal defect?
|
variable: large shunts cause pulmonary overcirculation & L cardiomegaly
|
|
What is the tx & px for PDA?
|
if in CHF: stabilize medically 1st
surgical ligation: excellent px if not in CHF (5% mortality rate) transcatheter occlusion: alternative to surgical ligation •↓ mortality & morbidity - generally can’t do in dogs < 3 kg •retrograde approach via femoral a. o px w/o correction of PDA - ~80% die of HF w/in 1-2 yrs: most common cause of CHF in young dogs (LV failure, pulmonary edema, A fib) - if PDA is small, occ. dog will survive to be mature adult |
|
What is the tx & px for subaortic stenosis?
|
mild to moderate SAS: no tx
• ↑ risk for endocarditis • mild exercise restriction severe SAS • medical o B-blockers (atenolol) may ↓ myocardial O2 demand, have a mild ventricular anti-arrhythmic effect, & improve survival o if CHF: furosemide, enalapril, digoxin, pimo, low salt diet •surgical o transvalvular dilation: not recommended: no improvement in survival compared to no sx •balloon valvuloplasty: rarely performed o initial ↓ in pressure gradient: 50% o 85% have re-stenosis w/in 1 yr px severe SAS: pressure gradient from aorta --> LV > 80 mm Hg (normal: < 16 mm Hg) • median survival: 3-6 yrs • sudden cardiac death common mild SAS: pressure gradient < 50 mm Hg • median survival: 10-11 yrs • occasional sudden cardiac death, CHF, infectious endocarditis |
|
What is the tx & px for pulmonic stenosis?
|
mild to moderate PS: no tx
severe PS (gradient > 75 mm Hg) • if in CHF, tx medically 1st • surgery vs. balloon valvuloplasty o sx: many types (modified patch graft is probably best) - ↑ morbidity & mortality - sx may be preferred if pulmonic valve annulus is hypoplastic o balloon valvuloplasty - ↓ morbidity & mortality (< 5%) - tx of choice if normal pulmonic valve annulus - infundibular hypertrophy will regress w/ time - re-stenosis uncommon o caution w/ English bulldogs & boxers: may have anomalous L coronary a. encircles RV outflow tract & contributes to stenosis - high risk of death w/ balloon valvuloplasty, patch graft sx contraindicated |
|
What is the signalment assoc. w/ chronic degenerative mitral valve dz in dogs?
|
poodles (toys, minis), Chihuahuas, dachshunds, beagles, cocker spaniels, CKC spaniels, yorkies, malteses, shelties, mini schnauzers, whippets
age • usually > 10 yo, but varies • unusual in dogs < 5 yo, except CKC spaniels o CKC spaniels usually have a more rapid progression than other dogs |
|
What is the common signalment assoc. w/ endocarditis in dogs?
|
o most commonly affects large breed dogs: GSDs, Boxers, golden retrievers
o M > F (2:1) o average age: 4-7 yrs |
|
What is the common signalment assoc. w/ DCM in dogs?
|
o strong breed & family predispositions
o Dobermans, Boxers, Cockers, Labs, Goldens, GIANT breeds (Great Danes, Irish Setters, St. Bernards, Great Pyrennes) o M > F o usually young to middle aged |
|
What are the common historical complaints & PE findings assoc. w/ valvular endocardiosis?
|
usually 1st noted as asymptomatic murmur
LHF: cough, dyspnea, exercise intolerance, wt. loss less common: RHF (ascites, abdominal distension) rare: acute onset of HF assoc. w/ acute chordae tendinae rupture |
|
What are the common historical complaints & PE findings assoc. w/ infectious endocarditis?
|
hx
- patient is SICK - predisposing event: ex. dentistry, sx, or prior infection - lethargy, inappetance, weakness - signs of HF: cough, shortness of breath, syncope - lameness: d/t IM polyarthritis - signs of thrombosis: hematuria, epistaxis, seizure, paresis PE findings: variable - NEW murmur + fever + lameness: HIGH suspicion for endocarditis - +/- fever (> 103º) - murmur: 50-75% - lameness - arrhythmia: common |
|
What are the common historical complaints & PE findings assoc. w/ DCM?
|
hx
o usually signs of CHF o occ. asymptomatic o syncope more common in Boxers & Dobermans PE findings o depends on clinical stage of heart dz o soft systolic murmur of AV insufficiency, gallop sound, arrhythmia/pulse deficits o signs of CHF: thin, weak pulses, pale mm, long CRT, ascites, pleural effusion or pulmonary edema |
|
What thoracic rad patterns are typical of endocardiosis?
|
normal to L/generalized cardiomegaly
- if CHF: perihilar pulmonary edema (interstitial to alveolar pattern in caudodorsal lungs) w/ pulmonary venous distension |
|
What is the tx & px for valvular endocardiosis w/ acute or chronic symptomatic CHF?
|
acute symptomatic CHF
• FONSE: furosemide, enalapril, +/- nitroglycerin, +/- oxygen, +/- sedation • +/- pimobendan • +/- Ca channel blocker (dilitiazem) if significant concurrent SV arrhythmias chronic symptomatic CHF • furosemide: lowest effective dose • enalapril • +/- pimobendan: esp. if recurrent or refractory HF or azotemia on furosemide & enalapril o can ↓ furosemide dose • +/- spironolactone • +/- digoxin: esp. if persistent tachycardia or refractory CHF • +/- amlodipine: 2nd vasodilator if recurrent or refractory CHF or concurrent hypertension • +/- β-blocker: once in stable CHF • px: 6 mo. to 2 yrs w/ therapy |
|
What thoracic rad patterns are typical of DCM?
|
- normal to left or generalized cardiomegaly
- typical CHF findings: pulmonary edema, pleural effusion or both, pulmonary venous distention |
|
What arrhythmias are commonly assoc. w/ DCM?
|
often A fib or ventricular arrhythmias (ex. VPCs)
• A fib: SA node not firing: doesn’t cause heartbeat • hundred of re-entrant circuits bombard AV node normal to L atrial & ventricular enlargement holter monitoring helpful for screening & for better assessment of arrhythmia • don’t breed animal w > 100 VPCs in 24 hrs |
|
What is the tx & px for asymptomatic valvular endocardiosis?
|
if asymptomatic & no cardiomegaly
• no medical tx • feed geriatric diet: mildly salt restricted • px: usually many yrs if asymptomatic & cardiomegaly (implies remodeling d/t more significant regurg) • +/- ACE inhibitor o enalapril & early MV dz no ↑ in adverse effects modest benefit in delay of HF: 4 mo. important benefit in delaying death d/t all causes: extended life 10.6 mo. • suggests non-cardiac (perhaps renal protective) benefits • +/- β-blocker if tachycardic • mild to moderately low salt diet • px: difficult to predict (1-5 yrs?) |
|
What is the tx for infectious endocarditis?
|
o principles: kill infecting organism, tx complications (cardiac manifestations)
o long term ABs: > 3 mo. o hard to cure: poor penetration of ABs, altered metabolic state of bacteria w/in lesion, absence of adequate host defense response |
|
What is the px for infectious endocarditis?
|
o extremely poor
o median survival time: ~2 mo, occasionally have a long term survivor |
|
What is the tx & px for asymptomatic DCM?
|
uncommon, but may be seen if screening breeding Boxers or Dobermans
- ACE inhibitor &/or β-blocker may delay progression of dz - avoid high salt diets & heavy exercise - recheck q 6-12 mo. - px: usually years, even in giant breeds |
|
What is the tx & px for symptomatic DCM?
|
tx CHF: furosemide, enalapril, low salt diet, cage rest, usually Pimobendan
• usually add Digoxin once stabilized if no contraindications • once out of CHF, slowly titrate in β-blocker, if owners are committed tx arrhythmias • A fib: Digoxin, then add β-blocker (atenolol) or Ca channel blocker (diltiazem) • significant V tach: chronic tx w/ β-blocker, K channel blocker (sotolol), or Na channel blocker (mexilitine: oral version of lidocaine) if recurrent or refractory CHF, seek consult for additional therapies (additional diuretics or vasodilators) px • once in CHF: a few months – 1-2 yrs w/ drug therapy o Doberman, Boxer: up to 1 yr • most of these dogs will die from sudden death (~50%) or CHF |
|
What are the clinical signs & PE findings assoc. w/ canine pericardial dz?
|
signs: usually sudden onset of weakness, collapse, anorexia, lethargy, dyspnea, abdominal distention, occ. cough
PE findings: basis of dx - combo of low CO signs & RHF signs - muffled heart sounds, weak pulses, +/- pulses paradoxus (pulses go away w/ inspiration: pathognomonic), jugular venous distension, positive hepatojugular reflex, hepatomegaly, ascites |
|
What are the common etiologies of canine pericardial dz?
|
neoplasia: #1 cause
- HSA: common at R auricle (GSDs, goldens) - chemodectoma: tumor of chemoreceptors of aortic body (brachycephalic breeds) - also mesothelioma, metastatic carcinoma o idiopathic: middle aged large breed dogs o less common: coagulopathy (ex. rat poisoning), L atrial tear d/t chronic MR, trauma, infectious dz (ex. Coccidiomycosis) |
|
How is canine pericardial dz diagnosed?
|
PE findings: basis of dx
o rads: greatly enlarged, spherical cardiac silhouette (basketball heart), +/- pleural effusion o ECG: sinus tachycardia, low voltage (small) QRS, electrical alternans (alternating QRS heights d/t heart swinging back & forth w/ each beat: almost pathognomonic) o echo: most sensitive & specific test - ideally perform prior to pericardiocentesis: look for tumors |
|
What is the tx for canine pericardial dz?
|
o pericardiocentesis: only effective tx for cardiac tamponade
- fluid analysis rarely helpful in dx: usually hemorrhagic o furosemide/ACE inhibitors may be helpful |
|
What is the px for canine pericardial dz?
|
o idiopathic
- px variable, usually years, but most will recur - if recurs more than twice, sx (pericardectomy) or balloon pericardiotomy are options o neoplasia generally poor HSA: days to weeks, occ. will tx w/ chemo w/ mixed results chemodectoma: months to years • slow growing tumors, slow to met • surgical pericardectomy significantly improves survival |
|
What clinical signs & PE findings are assoc. w/ canine HW dz?
|
usually asymptomatic, cough, exercise intolerance, lethargy, poor condition, syncope, dyspnea
o if in RHF: hepatomegaly, ascites, ↑ breath sounds, split S2, tricuspid insufficiency murmur |
|
What thoracic rad findings are consistent w/ clinically significant HW dz?
|
abnormalities develop early in course of dz
• pulmonary a. enlargement: main pulmonary a. & caudal pulmonary aa. • blunting of & tortuous pulmonary aa. • R heart enlargement: “reverse D” • pulmonary interstitial opacities suggestive of inflammation |
|
What are the indications & clinically relevant info available from various blood tests for HW dz?
|
o serology (ELISA): tests for adult female Ag
- screening test of choice: 100% specificity & > 85% sensitivity - allows semi-quantification of worm burden: must be interpreted w/ hx, rads o microfilaria test: Knotts or filter test - perform if positive Ag test - 1% of Ag (-) dogs may be microfilaria (+) |
|
What is recommended tx for canine HW dz?
|
o adulticide therapy: melarsomine (Immiticide)
arsenical administered IM (deep epaxial) 2 protocols • mild infection: 2 injections 24 hrs apart • more severe infection: 3 injections (give 1, then a month later give 2 injections 24 hours apart) o NCSU cardio recommends 3 injections for ALL cases (+): more efficacious, safer (1 injection kills ~50% of worms) (-): more expensive, more cage rest required prior to adulticide tx • start Heartgard as microfilaricide on day of dx • doxycycline PO BID x 2 weeks prior to adulticide tx o killing Wolbachia prior to adulticide may ↓ post adulticide inflammation & improve efficacy of worm kill • CAGE REST: very important before & after tx o exercise worsens lesions o 1 month of rest recommended for each injection: 3 injection protocol requires 3 mo. of rest - prednisone can be given if pulmonary parenchymal complications occur (ex. lung inflammation --> coughing) - if dog is in CHF, tx w/ diuretics & ACE inhibitors prior to adulticide tx |
|
What are some adverse effects of melarsomine used to tx canine HW dz?
|
• pain & swelling at injection site: 30-40%
o give NSAIDs unless using prednisone, then give an opiate (ex. butorphanol, tramadol) • neurologic signs, fever, cough, anorexia, pulmonary thromboembolism 1-2 weeks post injection |
|
feline HW dz
a. clinical signs b. dx c. tx |
a. cough, dyspnea, vomiting, neuro signs, syncope, sudden death; RHF uncommon
b. definitive: positive Ag test or echo if suspicious clinical signs: chest rads showing enlarged caudal pulmonary aa., positive Ag test c. o NO chemical adulticide o prophylaxis o prednisone: used to control signs until worm death in 2-3 yrs o worm extraction if no improvement w/ medical tx |
|
What signalment is commonly assoc. w/ feline HCM?
|
o suspected genetic etiology in some families of cats (Maine Coons, Persians, Mixed, British Shorthairs, etc.)
o point mutation of myosin binding protein C identified in Main Coons & Ragdolls: genetic testing available at Washington St. CVM o M > F (2:1) o mean age: 5-7 yrs |
|
What are the common clinical signs & PE findings asoc. w/ HCM?
|
clinical signs: 3 main presentations: asymptomatic murmur or arrhythmia OR CHF signs OR thromboembolism
PE findings o systolic murmur (intensity does NOT correlate w/ severity of dz), gallop sound, +/- arrhythmias o sometimes no murmur or gallop o dyspnea: cats often present w/ biventricular failure (pleural effusion more common than ascites) - muffled heart & lung sounds: pleural effusion - ↑ breath sounds, crackles: pulmonary edema o weak or absent femoral pulses o if saddle thrombus: cold, painful, weak rear legs w/ cyanotic pads & nail beds |
|
What thoracic rad patterns are assoc. w/ HCM?
|
best test to help understand cause of dyspnea
DV is best view in dyspneic cat: DO NOT STRESS may be normal abnormalities: pulmonary edema, pleural effusion, classic valentine shaped heart beware of fat cat: tend to lay fat around heart |
|
What is the tx & px for asymptomatic HCM?
|
tx optional: no evidence to show delay of progression of dz
• case by case basis: B-blocker (atenolol) or enalapril, aspirin (or other antithrombotic) if moderate to severe LA enlargement maintain normal diet: avoid salty snacks - preferably keep cat indoors px: good, avg. survival of 4-7 yrs • progression of dz is VARIABLE |
|
What is the tx & px for HCM if patient is in CHF?
|
furosemide, enalapril
O2 supplementation +/- atenolol or dilitiazem if tachycardic aspirin (or other antithrombotic) ideally, low salt diet, but if anorexic let cat eat anything px: 6 mo. to 2 yr • some cats will live > 2 yrs, esp. if “pushed into” HF by stress, steroids |
|
What is an alternative tx for canine HW dz when melarsimone is not used?
|
Heartgard Plus given for 16 mo. caused a significant (50%) reduction in adult worms & a 100% worm kill in 30 mos.
|
|
What is the tx & px for HCM cats that present w/ saddle thrombus?
|
px: 60-70% die or are euthanized during 1st episode
• partial or forelimb thrombus assoc. w/ better survival • avg. long term survival: months to 1 yr (CHF, re-embolization) • 2/3 of cats will be in CHF: worse px if concurrent HF buprenorphine: analagesia anticoagulant therapy • acute: UF heparin IV bolus, then CRI or SQ TID • chronic: Clodipogrel (Plavix) or low molecular wt. heparin o clodipogrel: inhibits ADP-induced platelet aggregation |
|
furosemide
a. mechanism of action/effects b. indications for use c. adverse effects |
a. potent loop diuretic
-inhibits electrolyte reabsorption if given IV: vasodilation --> inc. renal blood flow, dec. preload monotherapy: activates RAAS b. "outpatient" (chronic) HF: low dose, severe decompensated acute HF, c. hypovolemia, hypokalemia, hyponatremia |
|
enalapril
a. mechanism of action/effects b. indications for use c. adverse effects |
a. ACE inhibitor
prevents release of angiotensin II --> dec. symp. tone, dec. aldosterone, ADH release (--> diuresis) inhibits degradation of bradykinin (vasodilator) balanced vasodilator --> dec. preload & afterload b. "outpatient" (chronic) HF: max dose, severe decompensated acute HF, asymptomatic mitral valve dz w/ cardiomegaly, +/- asymptomatic HCM c. hypotension, acute renal ischemic injury, electrolyte disturbances |
|
digoxin
a. mechanism of action/effects b. indications for use c. adverse effects |
a. Na/K ATPase inhibitor --> positive inotrope (inc. contractility)
increased PS (vagal)tone --> dec. HR, dec. conduction thru AV node incr. baroreceptor reflex sensitivity b. -CHF in DCM (together w/ pimobendan): might add on 1st recheck for example - supraventricular arrhythmia (A fib, SVT) in dogs w/ HF & MR or DCM -refractory CHF & sinus tachycardia in MR c. narrow therapeutic window clearance highly dependent on renal function don't use in patients w/ sinus node dysfunction, advanced AV node dz, moderate to severe bradycardia --> heart block, arrhythmias |
|
dilitiazem
a. mechanism of action/effects b. indications for use c. adverse effects |
a. Ca channel blocker --> neg. chronotropic & inotropic effects --> dec. HR, dec. AV conduction, vasodilation
b. HCM patients in CHF if tachycardic, SV arrhythmias c. hypotension, bradycardia, AV block, dec. contractility |
|
atenolol
a. mechanism of action/effects b. indications for use c. adverse effects |
a. beta blocker (selective for B-1) --> dec. HR, dec. AV conduction, depresses SA node
b. • prior to onset of symptomatic HF in animals w/ evidence of remodeling in both MR & DCM • after stabilization of HF of both MR & DCM, esp. if SV or V arrhythmias: β-blockers slow HR & AV nodal conduction c. dec. cardiac contractility, excessive bradycardia, weakness/fatigue |
|
carvedilol
a. mechanism of action/effects b. indications for use c. adverse effects |
a. non-selective β blockade, α-1 blockade, anti-oxidant
b. prior to onset of symptomatic HF in animals w/ evidence of remodeling in both MR & DCM • after stabilization of HF of both MR & DCM, esp. if SV or V arrhythmias: β-blockers slow HR & AV nodal conduction c. worsening of CHF (edema), bradycardia, hypotension expensive, variable bioavailability in dog |
|
lidocaine
a. mechanism of action/effects b. indications for use c. adverse effects |
a. Na channel blocker: shortens AP & duration of refractory period
b. rapid sustained V tach c. vomiting, seizures, mental dullness |
|
spironolactone
a. mechanism of action/effects b. indications for use c. adverse effects |
a. K sparing diuretic: antagonizes aldosterone in distal tubule --> weak diuretic, K sparing effect
synergistic w/ furosemide b. chronic HF management: slow onset of action c. hyperkalemia, azotemia |
|
pimobendan
a. mechanism of action/effects b. indications for use c. adverse effects |
a. "inodilator": inhibits PDE III --> vasodilation, inc. Ca sensitivity --> inc. contractility
b. ALL 1st time HF patients 2° to DCM refractory or recurrent HF 2° to MVD or end-stage HCM c. tachyarrhythmias, potential for sudden death: humans, not proven in dogs although improves survival, does not appear to blunt RAAS activation |
|
amlodipine
a. mechanism of action/effects b. indications for use c. adverse effects |
a. Ca channel blocker --> vasodilation (dec. preload & afterload)
b. use as 2nd vasodilator in hypertensive patients in HF w/ MR, tx of primary hypertension in cats & dogs |
|
sotolol
a. mechanism of action/effects b. indications for use c. adverse effects |
a. K channel blocker & beta blocker: less neg. inotropic effect than other beta blockers
b. ventricular arrhythmias in dogs c. bradycardia, pro-arrhythmic (rare) |
|
What conditions can cause inc. preload?
|
pericardial effusion, diastolic dysfunction, HCM
|
|
What conditions can cause inc. afterload?
|
↑ PVR, aortic or pulmonic stenosis
|
|
What conditions can alter contractility?
|
DCM, valvular insufficiency
|
|
What conditions can alter heart rate/rhythm?
|
VT, SVT/AF, sick sinus syndrome, 3rd degree AV block
|
|
What drugs can be used to dec. preload?
|
diuretics, venodilators (nitroglycerin), mixed vasodilators (enalapril, amlodipine), NaCl restriciton
|
|
What drugs can be used to dec. afterload?
|
arterial vasodilators, mixed vasodilators (enalapril, amlodipine)
|
|
What drugs can be used to inc. cardiac contractility?
|
digoxin, catecholamines (epi, dobutamine, dopamine), pimobendan, (beta blockers)
|
|
What drugs can be used to dec. HR?
|
digoxin, beta blockers, Ca channel blockers (dilitiazem)
|
|
atrial fibrillation
a. ECG b. tx |
a. loss of P waves, chaotic rhythm, fast rate, normal QRS
b. dilitiazem |
|
supraventricular premature complexes: ECG
|
normal QRS, w/ or w/o abnormal P wave, that interrupts normal P-p & R-R intervals, usually pause follows SVPC
|
|
supraventricular tachycardia: ECG
|
rapid regular rhythm w/ normal QRS, P wave configuration somewhat different than sinus P waves
|
|
ventricular premature complexes: ECG
|
wide bizarre QRS w/ T in opp. direction that interrupts underlying rhythm, usually followed by a pause, P waves dissociated from QRS
|
|
ventricular tachycardia
a. ECG b. tx |
a. HR > 150, wide bizarre QRS, no relationship b'twn P wave & QRS ( 3 or more consecutive VPCs)
b. lidocaine IV or CRI, sotolol PO |
|
ventricular fibrillation: ECG
|
no P waves or QRS (rapidly undulating baseline w/ no organized electrical activity)
|
|
AV block: ECG
a. 1st deg. b. 2nd deg. c. 3rd deg. |
a. inc. PR interval (all else normal)
b. 1 or more P waves not followed by QRS, ventricular escape complexes may occur afterward c. no relationship b'twn P wave & QRS, ventricular escape rhythm is slow (< 40 bpm) |
|
bradyarrhythmias: complete AV block, sick sinus syndrome: tx
|
need pacemaker: medical tx usually doesn't work well
vagolytics: atropine, probantheline bronchodilators: terbutaline, theophylline (also inc. HR) |