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96 Cards in this Set
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Furosemide
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loop diuretic, "high-ceiling" effect
Can give IM to cats if they are fragile |
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Thiazide
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inhibit sodium reabsorption w/in the DCT
synergistic w/loop diuretics (dose every 3rd day to minimize hypokalemia and dehydration) |
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Spironolactone
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Potassium-sparing
weak diuretics, acts w/in the DCT & CD by antagonizing aldosterone DO NOT use K+ supplements |
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Digoxin
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+ inotrope
high risk of toxicity "triple therapy" moderate-severe CHF |
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Other indications for spironolactone
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anti-fibrolytic capabilities
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Digoxin mechanism
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Blocks K+, so Na+ exchanges more with Ca++, allowing a large Ca induced Ca response
renal excretion: be careful w/low GFRs |
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What is triple therapy?
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Loop Diuretic
ACE inhibitor + Inotrope |
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Other + Inotropes
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Amrinone lactate
Milrinone *use for refractory HF patients Pimobendan |
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Pimobendan mechanism
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Ca++ sensitizer to troponin C
Increase in IC cAMP: increase inotrope & vasodilation |
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Catecholamines used in cardio
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Dobutamine: increase inotrope w/o effect on heart rate
Dopamine: Don't use; vascular resistance & tachycardia |
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Furosemide
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loop diuretic, "high-ceiling" effect
Can give IM to cats if they are fragile |
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Thiazide
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inhibit sodium reabsorption w/in the DCT
synergistic w/loop diuretics (dose every 3rd day to minimize hypokalemia and dehydration) |
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Spironolactone
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Potassium-sparing
weak diuretics, acts w/in the DCT & CD by antagonizing aldosterone DO NOT use K+ supplements |
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Digoxin
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+ inotrope
high risk of toxicity "triple therapy" moderate-severe CHF |
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Other indications for spironolactone
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anti-fibrolytic capabilities
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Digoxin mechanism
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Blocks K+, so Na+ exchanges more with Ca++, allowing a large Ca induced Ca response
renal excretion: be careful w/low GFRs |
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What is triple therapy?
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Loop Diuretic
ACE inhibitor + Inotrope |
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Other + Inotropes
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Amrinone lactate
Milrinone *use for refractory HF patients Pimobendan |
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Pimobendan mechanism
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Ca++ sensitizer to troponin C
Increase in IC cAMP: increase inotrope & vasodilation |
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Catecholamines used in cardio
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Dobutamine: increase inotrope w/o effect on heart rate
Dopamine: Don't use; vascular resistance & tachycardia |
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Arterial Vasodilators
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Amlodipine: more peripheral, Ca channel blocker
Hydralazine: fast working: GI issues Na nitroprusside: decrease NO |
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Venous vasodilators
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Nitroglycerine ointment
Isosorbide dinitrate |
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Mixed vasodilators
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ACE inhibitors such as:
Enalapril, Lisinopril, Benazepril, Na nitroprusside |
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Angiotensin 2
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vasoconstrictor
increases afterload |
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Natriuretic peptides
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Decrease Na & water
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Sympathetic role in cardio
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vasoconstriction
Renin release arginine vasopressin release |
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Main indications for Digoxin
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atrial fibrillation
improve baroreceptor fx and decrease sympathetic tone |
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Beta-blockers
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atenolol
metoprolol carvedilol inhibit beta-1 w/in the heart |
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Early CHF Tx
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furosemide
ACE - Digoxin +/- Spironolactone |
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Moderate CHF
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High-dose Furosemide
ACE - Digoxin +/- Spironolactone |
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Severe/Refractory CHF
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Furosemide
Hydrocholorothiazide ACE- maximine digoxine +/- arterial & venous dilators +/- Spironolactone |
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Emergency Tx of CHF
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Furosemide
Oxygen Nitroprusside Dobutamine |
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Inotropy
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contractile property of heart; strength
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Lusitropy
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relaxant property of heart; compliance
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Chronotropy
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heart rate (SA nodal discharge rate)
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Dromotropy
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conduction velocity
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What determines cardiac work?
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Wall Tension: the heart thickens to lower tension
Heart rate |
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Eccentric Hypertrophy
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More volume
PDA, VSD, Reversed PDA, Mitral Regurgiation, Dilated Cardiomyopathy, Tetralogy |
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Concentric Hypertrophy
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More pressure
PS, SAS, Hypertrophic cardiomyopathy |
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Congenital Pericardial Disease
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focal or complete
often asymptomatic; problematic on the right side |
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Pericardial-peritoneal Diaphragmatic hernia (PPDH)
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Pericardium is fused with the central tendinous portion of the diaphragm
most common in cats & Weimaraners |
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Tx for PPDH
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Surgical correction - remove organs and suture up diaphragm
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2 causes for Jugular pulses, ascites, and weak femoral pulses
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Right Heart failure
Pericardial Dx (Tamponade) |
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Tamponade definition
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enough fluid to increase pressure, not just effusion
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Dx of Pericardial Tamponade
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"Basketball Heart"
small complexes on ECG Echo: see the heart move around |
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Causes for Pericardial Tamponade
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Idipathic: dogs (hemorrhagic)
NEOPLASM *Hemangiosarc *Chemodectoma *Mesotheliomaa *Lymphosarcoma Infectious: FIP, Blasto, Coccioides |
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Constrictive Pericarditis
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thick non-compliant heart
chambers normal in size, but no RA/RV collapse diastolically If it look like Pericardial Dz, but can't Dx it !!! |
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Patent Ductus Arteriosus
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Eccentric hypertrophy
Left Heart signs Medical Managment: not enough Pulmonary overcirulation |
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reversed PDA
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pulmonary hypertension, undercirculation
RVE differential cyanosis polycythemia NO LOUD murmur |
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Subaortic stenosis
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concentric hypertorphy
LVE reduced coronary flow dilation of ascending aorta Large Breeds (Newfies, Goldens, Rott) |
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Subaortic stenosis murmur
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Loud murmur
weak pulses the louder the murmur the worse it is should stabalize by a year of age treat w/B-blockers |
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Pulmonic stenosis murmur
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Loud murmur, radiates dorsally
normal pulses |
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Pulmonic stenosis types
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Subvalvular
Valvular*most common Supravalvular Aberrant Left coronary artery |
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Pulmonic Stenosis signs
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RVE: concentric
right CHF signs Low C.O. Reverse D radiograph |
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Pulmonic Stenosis Tx
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Dogs w/ >80mmHg should have intervention
B-blockers for management Balloon valvuloplasty-rip fused leaflets |
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Ventricular Septal Defect
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Restrictive VSD
Non-restrictive VSD |
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Restrictive VSD
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Really loud murmur
Left side overload small hole w/large pressure gradient (L->R) directly itno RVOT |
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Non-restrictive VSD
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pressures not maintained b/w chambers
than you get pulmonary hypertension shunt R->L, cyanotic all over |
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VSD signs
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often asymp. or exercise intolerance
Pansystolic murmur; right cranial sternal border LVE; eccentric (volume); pulmonary overcirculaiton |
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VSD Tx
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medically treat CHF
it can become smaller over time Pulmonary Artery banding to increase right side pressure |
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Tetralogy lesions
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VSD
Dextrapositioned aorta RV outflow obstruction RVH: 2nd to obstruction |
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Keeshond breed predisposition
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Tetralogy
VSD |
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Breeds that are predisposed to pulmonic stenosis?
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Beagles, bulldogs, and Boxers
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Restrictive VSD signs
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really loud murmur
shunts left to right, but it is high on IVS, in line w/RVOT Left heart overload |
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Non-restrictive VSD signs
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pressures in chambers not maintained
increased Right heart afterload, increase pressure -> pulmonary hypertension -> RVE |
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Feline dilated cardiomyopathy
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taurine-deficient **
Thromboembolic events are common S3 gallop due LV dilation small complexes from effusion on ECG LCHF or biventricular |
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Feline dilate cardiomyopathy breeds
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male
Abyssinian, Siamese, Burmese |
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Feline DCM Tx
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Taurine prn
chronic oral of: Triple therapy + anticoagulant |
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Top 7 differentials for CM in cats
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Hypertrophic cardiomyopathy
Esp. Maine Coon & ASH |
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What is the main influence of Hypertrophic Obstructive Cardiomyopathy?
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The movement of the anterior mitral valve leaflet into the LVOT
Treat w/Beta-blockers -> see if HCM resolves |
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Feline HCM signs?
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LVE: concentric hypertrophy
LCHF; rarely cough, more dyspnea Thromoboembolic events are common "Valentine Heart" rads |
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HCM Tx
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Diuretics
B-blockers maybe: especially effective in HOCM (decr. contraction to allow the valve to stop being pulled anteriorly) |
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Canine HCM
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rare
might be 2nd to obstruction from SAS or mitral dysplasia concentric hypertrophy of the IVS and LVFW |
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Canine HCM Tx
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Diuretics if congested
Beta-blockers for obstructions Calcium channel blocker: Enhance relaxation |
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Restrictive CM in cats
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Treat like HCM
Myocardial or endomyocardial |
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Thyrotoxic Cardiomyopathy
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elevated T4 induces a trophic effect on the myocardium
main treatment -> hyperthyroidism obstruction is common of LVOT/Rvot Systemic Hypertension common |
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Types of Infectious Myocarditis
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Parvo: 3-10 wks of age usually
Trypanosomiasis "Chagas' Dz" |
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Drug induced CM
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Doxorubicin
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Endocardiosis characteristics
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degenerative Dz
non-inflammatory myxomatous degeneration of the valve |
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Class 1 mechanism
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inhibits the sodium channels preventing the influx of Na responsible for depolarization
Phase 0 |
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Class 1a
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effective on normal and abnormal cells; PROLONG A.P. duration
Supraventricular & Ventricular Arrhy. Quinidine & Procainamide |
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Can you give Quinidine gluconate IV to dogs?
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NO
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Class 1b
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Only effective in abnormal cells and ventricular arrhythmias
SHORTEN A.P. duration but lengthen the refractory period Lidocaine & Mexelitine |
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What is the route of lidocaine and Mexelitine?
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Lidocaine: Parental
Mexelitine: oral |
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Class 2 drugs
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Beta Blockers
Greatest effect on the AV node w/slowing of conduction velocity Slow the response rate of the ventricles to supraventricles |
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Class 2 drugs
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Propanolol
Atenolol |
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Class 3 drugs
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Generally cosidered K+ channel blockers -> prolong A.P. duration
Supraventricular & Ventricular |
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Which class do you not use with Class 3 drugs?
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Class 1A
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Class 3 drugs
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Sotaolol
Amiodarone |
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Class 4 mechanism
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Calcium channel blockers that block slow Ca++ channels primarily affecting the AV node
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Class 4 drugs
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Diltiazem
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Determinants of Hypertension
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Cardiac output
=SV x HR Systemic Vascular Resistance |
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Causes of systemic hypertension in cats
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Hyperthyroidism #1
Renal Dz #2 Hyperaldosteronism Acromegaly Diabetes Mellitus |
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Causes of systemic hypertension in dogs
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Renal Dz
Hyperadrenocorticism Pheochromocytoma Diabetes Mellitus |
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Treatment of choice for systemic hypertension
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Vasodilator: precapillary arteriolar
#1 Dihydropyridine Ca++ Channel*** ACE - |
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Amlodipine
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Dihydropyridine Ca++ Channel Blockers
Peripheral arterial vasodilation Treatment of choice Predictable in cats, not as much in dogs |
