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97 Cards in this Set

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  • Back
What are 2 causes of canine dilated cardiomyopathy?
1) Generalized cardiomegaly
-Typically left side predominant
-Left atrial enlargement & left auricular enlargement
2) Left, right or biventricular heart failure
What breed of dogs usually get dilated cardiomyopathy? What breed typically has a normal sized heart with dilated cardiomyopathy?
Dobermans
What type of lung pattern is seen with dilated cardiomyopathy?
Interstitial to alveolar
Often severe, diffuse
What is an important differential for dilated cardiomyopathy?
Mitral endocardiosis, but this is more common in small breeds
Feline cardiomyopathy=______.
Hypertrophic cardiomyopathy
What shape is the heart in a cat with hypertrophic cardiomyopathy?
bean shaped
How does a heart appear with left atrial enlargement? What shape?
Valentine heart (not biatrial enlargement)
Can get so long get an apex shift
Can look like left atrium is ice cream on a cone
How do you only put contrast medium in the left atrium?
=Selective
-place catheter into heart and inject contrast into where you want it
in this case went into left ventricle and injected contrast so can see the slim lumen in left ventricle, thickening of left ventricle wall, gigantic LA and aorta outflow tract
What is the sequel to an inflow obstruction at the left ventricle?
Left atrium enlarges as reservoir and buffer
How come left atrial enlargement can result from left ventricular obstruction and not result in pulmonary edema?
If increase in volume back up occurred slowly the heart has time to compensate
The left atrium enlarges with chronic left ventricular disease to accommodate what 3 conditions?
1) In mitral regurgitation, regurgitant volume
2) In DCM, with LV, to maintain stroke volume
3) In HCM, inflow from lungs
What is the buffer b/w the left ventricle and the lung?
Left atrium
What happens to pressure if the heart has time to accommodate and enlarges?
pressure remains normal (indicates pulmonary veins might distend but still no cardiogenic failure)
True or false. Pressures rises with a chronic mitral regurgitation.
False, the left atrium is very compliant so pressures does not rise in chronic MR
True or false. Pressure rises with an acute mitral regurgitation.
True, heart doesn't have time to compensate and enlarge the LA
The left ventricle remains compliant in mitral regurgitation but not in _____.
Dilated cardiomyopathy
-Have thinning of ventricle so it can't maintain function, but it can with MR
What develops as a sequel to acute left ventricular failure?
Heart can't compensate==> edema
What is the sequence of edema patterns with acute left ventricular failure? (5)
1) Interstitium
2) Alveoli
3) Peribronchial
4) Subpleural
5) Pleural cavity
What is the definition of left sided heart failure?
Inability of the heart to adequately handle volume of blood returning from pulmonary circulation.
What are 3 sequelae to left sided heart failure?
1) Pulmonary venous congestion
-May not see changes in animals on diuretics
2) Pulmonary edema
-Caudodorsal/perihilar pulmonary infiltrate
-Interstitial>>> alveolar
3) Left-sided or generalized cardiomegaly
Are the pulmonary veins or arteries larger with pulmonary venous congestion from left sided heart failure?
Pulmonary veins
What does it mean if the caudal vena cava is elevated dorsally?
Sign of left atrial enlargement
What is sometimes the only sign of heart failure in cats?
Bronchial thickening (can look like donuts)
Pleural effusion
What is sometimes the only sign of heart failure in cats?
Bronchial thickening (can look like donuts)
Pleural effusion
Explain how interstitial edema develops.
Have loose CT surrounding bronchioles, artery and venule-all run together
lymphatics drain from CT connecting space, separated from tight interstitial space on other side of capillary..
When increase in fluid get more lymph and at first drainage can support increase in fluid but over time too much fluid in drainage and can't be supported so over time get an increase in fluid in interstitial space surrounding bronchi (stage 2) so see increase in interstitial space, potential thickening around bronchioles and lose ability to see vessels in lung
How does interstitial edema develop into alveolar edema?
Over time the tight junction b/w alveoli and capillary isn't tight anymore from fluid distention so get leakage of fluid towards alveolar space and in severe stage end up with interstitial to alveolar lung pattern adn only see air filling in bronchi
What are 3 right sided heart diseases that result in "right heart" enlargement?
1) Pulmonic stenosis
2) Tricuspid regurgitation
-Congenital
-Acquired w/ mitral endocardiosus
3) Heartworm (severe cor pulmonale-Cor pulmonale is failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart.)
What are 2 signs of right atrial enlargement on a lateral view?
1) Dorsal bowing of trachea cranial to carina
2) Loss of cranial waist of heart
What is a sign of right atrial enlargement on a VD/DV view?
Increased prominence in 9-11 region
What are 3 radiographic signs of right ventricular enlargement on a lateral view?
1) Increased width of the cardiac silhouette
2) Increased convexity of cranial margin
3) Dorsal bowing of trachea cranial to carina (like w/ RAE)
What do are 2 signs of right ventricular enlargement on a VD/DV view?
1) Increased prominence in 5-9 region
2) Reverse D shape
What does it mean if it looks like the heart has 2 apexes?
RV enlargement
What are 3 examples of chronic airway and lung disease that results in cor pulmonale?
1) Thick soft palate
2) Collapsed trachea
3) Fibrosis of lung
-If lungs not air filled enough--> increased density--> icnreased pressure--> right side of heart has to work against pressure in pulmonary artery--> muscle gets larger
How does the heart appear when an animal has a chronic airway and lung disease that results in cor pulmonale?
Enlargement of pulmonary outflow tract
Rounding of RV
Lung fibrosis is rare except in what specie?
Westies
What is the worst case scenario for a dog with cor pulmonale from for example a thick soft palate?
Rarely develops to RH failure
Where are the worms mostly located in cases of heartowrm (dirofilariasis)?
Mostly in pulmonary arteries and obstruct them
What is the cause of clinical signs related to heartworms?
Worms cause severe lung reaction that causes the clinical signs
What causes the changes in the heart in a dog with dirofilariasis?
Cor pulmonale causes heart changes
What are 4 radiographic signs of heartworm disease?
1) Pulmonary arteries dilated and larger than veins
2) Right ventricular enlargement
3) Right atrial enlargement
4) Enlarged main pulmonary artery
What kind of pulmonary infiltrates are seen with heartworm disease?
Pulmonary interstitial edema
Pulmonary thromboembolic disease
How does heartworm disease cause right heart failure?
Due to massive inflammation get the thrombi spread and get thromboembolic disease--> right sided heart failure
What will you see when there's a severe lung reaction to heartworms?
massive increased density can see in both cranial ventral and caudodorsal lung field, only see bronchiole trees
What is the definition of right sided heart failure?
Inability of the heart to adequately handle volume of blood returning from systemic circulation
What are 3 sequelae to right sided heart failure?
1) Systemic venous congestion
-Enlargement of caudal vena cava
2) Visceral congestion
-Generalized hepatosplenomegaly
3) 3rd space fluid transudation
Canine-ascites predominates
Feline-pleural effusion predominates
What are 4 radiographic signs of right sided heart failure?
1) CVC enlargement
2) Pleural effusion
3) Hepatomegaly w/or w/o splenomegaly
4) Ascites
What is the normal ratio b/w the size of the aorta and caudal vena cava?
1:1 ratio
How does pleural effusion appear on a radiograph?
Can see the lung retracting from the thoracic wall due to the fluid in the pleural space
What are 6 differential diagnoses for a small dog that's coughing other than mitral regurgitation and congestive heart failure?
1) Collapsed trachea
2) Chronic bronchitis
3) Idiopathic pulmonary fibrosis
4) Heartworms
5) Collapsed main bronchus
6) Compressed L main bronchus
Will you see a collapsed main bronchus on a radiograph taken upon inspiration or expiration?
Expiration
What dogs tend to get tracheal collapse?
Small dogs & chondrodystrophic breeds
What are 3 differentials for an enlarged heart without signs of primary heart disease?
1) Pericardial effusion
2) Pericardio-diaphragmatic hernia
3) Cor pulmonale
What are your next 2 steps when evaluating an enlarged heart that doesn't have signs of primary heart disease?
1) Identify the apex
2) Rule out Left atrial enlargement in large dogs (to rule out DCM)
If a heart is enlarged, but there's no apex or left atrial enlargement, what should you suspect?
Pericardial disease
In animals with a pericardial effusion, will the heart shift left or right on a VD/DV?
Can shift left
What are 2 signs of pericardial effusion?
1) Spherically enlarged, globoid cardiac silhouette
-Very sharp curved caudo-dorsal border on left lateral
2) Lack of discrete chamber definition
-Differentiate from generalized cardiomegaly
What type of additional imaging should be used for pericardial effusion?
Ultrasound
What happens when there's pericardial tamponade in a heart with constrictive pericarditis?
Get severe increase in pressure because pericardium can't expand so get a drastic increase in pressure
True or false. Pericardial effusion results in an increase in pressure with a relatively small amount of fluid increase.
False, Pericardial effusion that is long standing can increase the fluid pretty drastically and not get increased pressure for quite a while
The degree of cardiomegaly present with pericardial effusion depends upon _____.
Volume
True or false. Pericardial effusion results in cardiogenic edema.
False
What are 5 signs of congenital peritoneopericardial diaphragmatic hernia?
1) Irregular shape of enlarged heart shadow (giant heart)
2) Faint lucencies in heart (omental fat)
3) Gas shadows (bowel gas)
4) Effacement of diaphragm border near heart
5) Cranially displaced stomach
Congenital PPDH can be seen together with _______.
Sternal deformity
What are 2 diagnostic aids for diagnosing a PPDH?
1) Contrast passage
2) Ultrasound
What is the prognosis like if a young animal has an enlarged heart?
Very bad
Why is it so important to catch a congenital heart disease early on?
Because heart is plastic when younger so surgical intervention can be done
What are the heredity/breeding concerns related to congenital heart diseases?
Need to have a conversation with the owner and tell them not to breed the animal
What are the 3 most common congenital cardiac diseases?
1) Pulmonic stenosis
2) Aortic stenosis
3) Patent ductus arteriosus
What are 3 treatments for congenital cardiac diseases?
1) Surgical treatment
2) Catheter-placed coils
3) Ballon dilation of valve
-PDA< aortic stenosis, pulmonic stenosis
Place supravalvular, valvular and subvalvular in order of occurence with pulmonic valvular stenosis.
Valvular> subvalvular>> supravalvular
What are 4 sequelae to pulmonic valvular stenosis?
1) Right heart enlargement
RVE +/- RAE
2) Main pulmonary artery segment enlargement (usually a post stenotic dilation)
3) Normal to small pulmonary vessels
4) Right heart failure
Whate are 2 signs of a subvalvular aortic stenosis?
1) LVE +/- LAE
-Elongation of cardiac silhouette
2) Increased prominence of aortic arch
What is a sign of increased prominence of aortic arch (such as seen with a subvalvular aortic stenosis on a lateral and on a VD/DV?
1) Bulge in cranial waste (lateral)
2) Widening of 11-1 area (DV/VD)
True or false. Radiographs may be normal in a heart with aortic valvular stenosis.
True
What is a patent ductus arteriosus?
Shunt from aorta to pulmonary artery
What are 4 sequelae to pulmonic valvular stenosis?
1) Right heart enlargement
RVE +/- RAE
2) Main pulmonary artery segment enlargement (usually a post stenotic dilation)
3) Normal to small pulmonary vessels
4) Right heart failure
Whate are 2 signs of a subvalvular aortic stenosis?
1) LVE +/- LAE
-Elongation of cardiac silhouette
2) Increased prominence of aortic arch
What is a sign of increased prominence of aortic arch (such as seen with a subvalvular aortic stenosis on a lateral and on a VD/DV?
1) Bulge in cranial waste (lateral)
2) Widening of 11-1 area (DV/VD)
True or false. Radiographs may be normal in a heart with aortic valvular stenosis.
True
What is a patent ductus arteriosus?
Shunt from aorta to pulmonary artery
What are 5 sequelae of a patent ductus arteriosus?
1) LVE, LAE, Left auricular enlargement
2) Aneurysmal dilatation of proximal descending aorta
3) Pulmonary artery segment enlargement
4) Normal to large pulmonary vessels (get large pulmonary vessels if a lot of blood is shunted)
5) Left heart failure
Why can a PDA result in mitral problems?
if go out through aorta and shunt to pulmonary arteries blood has to come back to left atrium--> volume overload of left atrium--> mitral problems
What direction do most PDA's shunt blood? Why?
Left to right bc the left is the high pressure side
If you see the 3 knuckles on the left side of the heart, what's on your differentials?
Patent ductus arteriosus
What are 3 diseases (excluding congenital disease) that can still have a normal sized heart?
1) Hypertrophic cardiomyopathy (cats)
2) Dilated cardiomyopathy (large dog)
3) Mitral insufficiency/ tricuspid insufficiency (subclinical)
What are 3 differentials for generalized cardiomegaly in a small dog?
1) MI/ TI
2) Pericardial effusion
3) PPDH
What are 3 differentials for generalized cardiomegaly in a large dog?
1) DCM
2) Pericardial effusion
3) PPDH
What are 3 differentials for generalized cardiomegaly in a cat?
1) HCM
2) DCM (Rare!)
3) PPDH
What is a differential for left sided heart enlargement in a small dog?
Mitral insufficiency
What is a differential for left sided enlargement in a large dog?
DCM
What is a differential for left sided heart enlargement in a cat?
Hypertrophic cardiomyopathy
What are 2 differentials for right sided heart enlargement in a small dog?
Tricuspid insufficiency
HWD
What is a differential for right sided heart enlargement in a large dog?
HWD
What are 2 differentials for a small heart?
Hypovolemia
Addison's disease
Wgat are 2 signs of left sided heart failure?
1) Pulmonary edema
2) Veins> artery, not always
What are 4 signs of right sided heart failure?
1) Enlarged CVC
2) Pleural effusion
3) Hepato/splenomegaly
4) Ascites
What are 6 possible signs of biventricular heart failure?
1) Pulmonary edema
2) Veins> artery
3) Enlarged CVC
4) Pleural effusion
5) Hepatosplenomegaly
6) Ascites
*Combo of right and left sided heart failure