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95 Cards in this Set

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Where is the heart located?
Internally between the 3 & 6th intercostal space, more on the left behind the Left elbow
List the 4 layers of the heart and their composition/function.
1) Pericardium- outermost sac, covering surrounding the heart
Has 2 layers that make it up. FIBEROUS Layer-the tough sac
SEROUS layer- secretes serous fluid to decrease friction from beating heat within the chest cavity.
2) EPICARDIUM- outer lining of heart
3) MYOCARDIUM-muscular layer, largest portion of the heart
4) ENDOCARDIUM-innermost layer, tissues that line the chambers
What is systole and what occurs?
*ventricular systole the contraction of the cardiac ventricles by which blood is forced into the aorta and pulmonary artery.
What is diastole?
The normal rhythmically occurring RELAXATION and DILATION of the heart chambers, especially the ventricles, during which they fill with blood.
What valves are closed during systole?
Both AV valves (tricuspid and Bicuspid)
What valves are open during systole?
Pulmonic and aortic valves are open
What valves are open during diastole?
During the relaxation/dilation phase of the cardiac cycle, the AV valves, Tricuspid and bicuspid open and allow blood to fill the ventricles
What valves are closed during diastole?
Pulmonary valve and aortic valve close during diastole while the ventricles fill.
Why is maintaining a normal BP important?
1) Brings oxygen and important nutrients to tissues throughout the body.
2) Waste products are removed from the body
3) Endocrine system function and transporting of these important hormones.
What is the SA node?
Mass of specialized cells located in Right atrium near cranial vena cava
*Often called the PACEMAKER
*generates electrical impulses and initiate conduction which causes heart to contract in a regular set rhythmic rate.
What the main functions of the cardiovascular system?
*Continuously pumping blood with enough force to maintain bp for circulation throughout the body.
What is the Atrioventricular (AV) node?
After the SA node fires an impulse that flows across the atria, it localizes at this node, which then holds the impulse for a moment to allow ventricles to fill completely, then moves to Bundle of HIS
The Bundle of HIS bifurcates into 2 branches, the Right and Left Bundle branches which further differentiate into __________________that innervate each ventricle.
Purkinje fibers
If the SA node is damaged or no longer works effectively, what can occur?
The AV node and Purkinje fibers can fire/generate impulses, however, the further along the system these impulses are generated, the slower the heart rate.
What is an ECG?
The recording of electrical changes that occur in the myocardium during a cardiac cycle.
How is an ECG done?
By hooking up electrodes on the skin in a particular pattern to trace the spread of electrical activity within the heart.
What is a lead?
Each different angle is called a lead. It is a particular view of electrical activity of the heart. It is similar to DV or lateral views in radiographs.
The most common ECG looked at is the ___________
Lead II view

Lead systems allow you to look at the heart from a variety of angles
Diagnostic ECG requires that an animal be placed on/in?
Right lateral recumbancy

*on a blanket if placed on a metal table
Leads should be placed _________ to the body and ______ to each other.
perpendicular

Parallel
List the placement of each ECG electrode
WHITE- Right axillary
GREEN- Right inguinal
BLACK-Left axillary
RED-Left inguinal
BROWN-chest
What does the P wave represen on an ECGt?
The depolarization of the atria and its duration indicates the time required for an impulse to pass from an SA node to the AV node.
**ALWAYS POSITIVE on the ECG
What does the Q-R-S complex represent on an ECG?
Represents Systole-ventricular depolarization/contraction

-Q or S may be absent and it is still considered normal
What does the T wave represent on an ECG?
Represents Diastole-ventricular repolarization/relaxation

Can be positive or negative but should be consistant
What is the R-R interval?
distance between 2 R waves and should be consistent
What is the P-R interval?
Distance/time between P wave to R wave.
* It is the Atrial contraction to beginning of ventricular contraction. Represents atrial filling
What is the ST segment?
It represents the end of systole/ventricular contraction.

It shows the period of time between completion of ventricular contraction and beginning of ventricular repolarization.
What is an arrythmia?
ANY deviation from normal rhythm of the heart. Can be a variation of rate, regularity, site of impulse origin.
What are the four things that we evaluate on an ECG
1) GENERAL INSPECTION-fast, slow, pattern to irregularities or completely irregular
-Obtain HR
2) ANALYZE P WAVES--Regular and -P Wave before every QRS
3) ANALYZE-QRS complexes
* reg in apperance, uniform interval
*All parts present
* Normal in width (time)
* Should be quick
4) RELATIONSHIP of P waves to QRS complexes
If your ECG tape is running at 50mm/sec, to figure HR, you count the number of heartbeats between 2 markers and multiply it by
20
If the ECG tape is running at 25 mm/sec, to figure HR you count the number of beats, R intervals, and multiply it times
10
In regards to the heart, sinus means
electrical activity is traveling normally

Normal sinus rhythm = normal heat rhythm
What is one advantage of a slower tape speed?
More detail
What is the definition of a heart murmur?
extra heart sound

area of turbulent blood flow causes an extra heart sound
The 1st heart sound (S1) is the LUBB and is representative of
Systole, AV valves closing, Ventricular contractions
The 2nd heart sound (S2) is the DUBB and is representative of
Diastole/ventricular relaxation, AV valves opening
Systolic murmurs occur
during systole with the pulse

LUBB---shhhhhh---DUBB
S1 S2

Most murmurs are systolic
Diastolic murmurs occur during
Diastole or AFTER pulse, S2

LUBB-DUBB ----shhhhhhh--LUBB--DUBB------Shhhhh
What are the 3 most common causes of heart murmurs?
Valvular insufficiency
Valvular Stenosis
PDA-Patent Ductus Arteriosis
What are the hallmarks of valvular insufficiency murmur?
AV valves are not closing completely or efficiently when the ventricles contract which results in a backflow of blood into the atria.
*Most common type of murmur
*Rarely affects Pulmonary or atrial valves
*considered a DIASTOLIC MURMUR
What are the hallmarks of murmurs related to Valvular stenosis?
*stricture, narrowing of valves
*Aortic and Pulmonary valves most commonly affected
*Reduces amount of blood that is able to be pumped to ventricles--->increases pressure in heart because not all blood that should be pumped out is actually pumped out.
What are the hallmarks of PDA in relation to heart murmurs?
In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart.

Before birth, the two major arteries—the aorta and the pulmonary artery—are connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation.

Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby's circulation.

In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. (a left to right shunt) This can put strain on the heart and increase blood pressure in the lung arteries.
What are the clinical signs of a PDA?
Pulmonary edema, exercise intolerance, weight loss, CHF
What is the treatment for PDA?
Sx
Application of a self closing band
How many levels of Murmurs on the Murmur Grading scale and which is the worst?
6 levels and 6 is the worst
A grade one Murmur is:
*A very soft localized murmur
*Can be detected only after intense listening
A grade two murmur is:
A soft murmur
May be heard immediately
A grade three murmur is:
Low to moderate intensity murmur
Can be heard over a wider area
A level four heart murmur is:
Moderate to loud intensity murmur heard over most of heart.
Does NOT have a precordial thrill (palpable heatbeat)
A level five heart murmur involves:
Loud murmur with a precordial thrill
A level 6 heart murmur involves:
A loud murmur w/a precordial thrill that is audible when stethoscope is liftted off chest wall
What 2 levels of murmurs can have a significant affect on the heart possibly leading to heart failure
5 & 6
In cardiology, what does stroke volume refer to?
The volume of blood ejected from the heart during each contraction/heartbeat/systole
In cardiology, what does Cardiac output refer to?
is the volume of blood pumped by the heart per minute.
It is figured by HR times Stroke volume
In cardiology, what does Pre-load refer to?
The pressure stretching the ventricle after passive filling and and atrial contraction.
-affected by Venous bp & return
*before respiring, how much blood is getting into atria
In cardiology,what does afterload refer to?
A measurement used to measure the tension produced by a chamber of the heart in order to contract.

Pressure chamber has to generate in order to eject blood out of the heart.
3 ways the heart compensates for a decrease in cardiac output?
* Increase heart rate by 2-3x

*Hypertrophy- chronic overworked heart muscle heart hypertrophies

*Dilation of chambers-walls of ventricles get thinner, heart muscle mass decreases, is less effective. Tries to let more blood in to compensate for lack of cardiac output.
What are some of the C/S of heart disease?
Lethargic
Tachycardia
Tachypnea
Exercise intolerance
Cough-dry, unproductive cough
Heart failure is defined as the heart is unable to maintain cardiac output. It has the same C/S as heart disease and you may also see what in addition?
Cynosis
Cachexia
Orthopnea
Ascites
Pulmonary edema
What is cachexia?
Physical wasting with loss of weight and muscle mass caused by disease
What is orthopnea?
tendency towards postural positioning as the animal tries to get front end higher to relieve pressure from ascites.
What is is ascites?
fluid buildup in the abdomen as a reult of right heart failure?s
What is pulmonary edema?
Fluid buildup in the lungs as a result of left sided heart failure
What kind of tests are done for Heart disease?
*Auscultation
*Echocardiography
*BP-Doppler evaluation of Norm is 80-120 mm of Mercury
*Blood gas eval
-CO2, O2, Pulse Ox machine evals how much of hemoglobin is saturated with O2
* Radiographs-size, fluid buildup
* ECG-check electrical activity
What are the 3 most common Congenital heart disease issues?
PDA
Septal defects
-Atrial septal fects
-Venticular septal defect
Aortic & Pulmonic stenosis
What are the 6 most common types of Acquired Heart disease?
* AV VALVE INSUFFICIENCY
Valve(s) atrophy and no longer meet and/or Chordae tendinae ruptures and no longer holds valves right
*HEARTWORMS-obstruction of pulmonary artery leads to Right heart failure
*VEGATATIVE ENDOCARDITIS-Gram +, Bacterial infection leads to settling on AV valves
*HYPERTROPHIC CARDIOMYOPATHY-muscle thickens, less room in chambers, more common in cats, can be somewhat genetic.
*DIALATED CARDIOMYOPATHY- Expanded heart chambers to try to accept more blood, heart muscles thin and weaken, More common in dogs (GSD, Cockers, Boxers, dobies, Danes)
*PERICARDITIS-inflammation of pericardium due to infection-can be viral, bacterial, fungal in origin. Other causes are kidney failure, metastatic disease, trauma, idiopathic
What is a major cause of vegatative endocarditis?
Poor dental prophalaxis and major dental disease
What is a clinical sign for pericarditis?
Mufffled heart sounds
What are the four categories of cardiac drugs?
Inotropes
Chronotropes
Anti-arrhythmics
Vasodialators
What does an inotrope do?
Affect how the heart contracts, + is harder, - is softer contractions
What does a chronotrope do?
affect the heart rate
Positive chronotropes increase, negative chronotropes decrease heart rate
How does a local anesthetic function as an antiarrhythmic?
Calms the nerves and muscles in the heart to allow normal electrical activity
Propanolol is used to treat what type of heart disease in what species?
Ventricular tachycardia in cats
What is Bretylium used for?
Decreases heart rate, lengthens time between action potentials in ventricular tachycardia treatment
What do catecholamines mimic in the body?
the sympathetic nervous system, fight or flight division
Give an example of an ACE inhibitor and tell how it works.
Enapril
Medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, the blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart.
Why is furosamide used in patients with heart failure?
It is a diuretic that reduces blodd volume and lessens the hearts workload
Why is Hydrocodon used in patients with heart failure?
It is a cough suppressant that is given to animals with a heart that enlarged to the point of irritating the trachea.
What does CPCR stand for?
Cardiopulmonary Cerebrovascular Resuscitation
What does CPA stand for?
Cardiopulmonary arrest
5 signs an animal is in CPA
Not breathing or trying to
MM discolored
NO pulse
No heartbeat heard
Pupils fixed and dilated
What are some potential causes of CPA?
Hypoxia
Metabolic disorders
Trauma
Anesthetic or other drugs
Environmental influences such as toxins or extreme temperatures
What are some factors influencing survival rate of CPA?
*Pre-arrest condition -healthy, sick, geriatric
*Time elapsed since arrest
*Etiology of arrest
* Effectiveness of cardiac massage
*client wishes
What are the 3 phases of CPR?
BASIC LIFE SUPPORT-Airway, breathing, heart compressions
ADVANCED LIFE SUPPORT- drugs and defibrillation
PROLONGED life support-Fix primary cause, monitor for 2nd arrest, 24-48 hrs at least
What is the goal of CPCR?
Support cardiovascular system and provide ventilitory support until body can do it on its own
What are the 5 tasks involved in CPCR?
*Airway management-open patent airway established, maintained.
*Cardiovascular management
* Venous access-cath placed
* Monitoring
Drug Administration
What are 3 catagories of supplies that go in the crash cart?
*CIRCULATORY supplies-cath, tourni, t-ports, injection caps, heprinized flush, fluids
*AIRWAY & BREATHING supplies-ET tubes, +/- laryngescope, stylets, suction, ambubag
*DRUGS- Epinephrine, Dextrose, Atropine, Lidocaine, DMSO
What are some signs of impending CPA?
* Decreased mentation, lack of response
*Respiratory changes, depth, pattern
*Pulse changes-rhythm, quality, missing, thready
*Abnormal ECG patterns
*Unexplained changes in anesthetic depth
How do we verify arrest?
*Check for femoral pulses
*listen for heart sounds
*Palpate apical beat
*If under GA, turn off anesthetic gases immediately
*Notify appropriate personnel
*Once verified, begin CPCR
What are the ABCD's of CPCR?
* A-airway, ensure patent airway, ET tube, tracheostomy
* B-Breathing-ventilating with 100% O2, 15-20 cm H2O pressure if on anesthesia machine or 2 breaths of 1.5 seconds each initially.
Ventilation rate: 1 breath per 3-5 compressions given concurrently
* C- CIRCULATION/Cardiac massage: 80-120 compressions/minute
-compress and release-each for count of 1
-check for adequate femoral pulses-should be felt if compressions are adequate/effective
D-DRUGS/Defibrillation- place IVC, may apply compression wraps, Defib charged and ready to go
What is the ventilation rate for CPCR?
1 breath per 3-5 compressions
What is the correct method for giving compressions for CPCR?
Preferred Right lateral recumbancy
-Dorsal is ok in barrel chested dogs over 30 lbs

-Compress mid-thorax with elbows locked
-Check rhythm with ECG
-If external is ineffective after ~5 minutes, internal may be done
What is the fluid dose for animals with CPA?
Initial dosage:
dogs 70-90 mls/kg
cats 40-60mls/kg
*Administer as a bolus-wide open
What are the routes of administration for emergency medication administration?
#1-Jugular
#2-IT, Atropine, Lidocaine, Epinephrine
#3-Peripheral - cephalic
IC becoming less common
IO
What is the Jen-Chung GV-26 site used? How is it performed?
May reverse RESPIRATORY arrest

-needle is inserted at nasal philtrum just below nose. all the way to the bone and the twirled and moved up and down.