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168 Cards in this Set
- Front
- Back
Cardiac Diseases with NO murmur
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DCM
HCM HWD Pericardial Dzs Some Congenital Dzs |
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Chronic Cough DDX (2)
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LHF
Pulmonary Disease (Collapsing Trachea, Bronchitis, HWD, Asthma) PL |
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Acute Cough DDX (7)
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LHF
Tonsillitis Pharyngitis Tracheobronchitis Acute bronchitis Pleuritis Pneumonia P3T2LA |
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Types of cough (8)
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Loud, harsh, coarse dry - larynx, trachea, or bronchi
Cardiac - harsh and low Chronic Non-productive - tumor Rattling with whistling - Bronchiectasis Honking - Collapsing trachea After drinking - CT, Cardiac dzs, chronic tracheitis tracheobronchitis With an inciting factor - Cardiac/pulmonary dzs extrapulmonary disorder, neoplasia At eating - achalasia or vascular ring anomalies, esophageal diverticula |
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How to tell upper airway cough from lower
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rattling, wheeze - lower
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Difference between dyspnea and tachypnea
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Tachypnea = increased rate
Dyspnea = rate and effort |
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Types of Dyspnea
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Paroxysmal (comes and goes)
Exertional (early sign of Dyspnea) Orthopneic (when lying down) |
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Inspiratory vs. Expiratory Dyspnea
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Increased Inspiratory effort = upper airway
Increased Expiratory = lower |
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Causes of hemoptysis
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Pulmonary contusions from trauma
Pulmonary edema Lung/bronchi diseases Pulmonary embolism Clotting problems DIC |
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Cause of head, neck, forelimb edema
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mediastinal mass obstructing venous return
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Causes of abnormal jugular pulses
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RHF w/tricuspid regurg
Heart block or arrhythmia where right atrium contracts agains a closed tricuspid valve PSten Pulm hypertension |
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Jugular distension caused by
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RHF (congestive)
Obstruction Pulmonary Dzs |
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PMI displacement caused by
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Cardiac enlargement
Mass pushing on heart Collapsed lung lobe on R side Just got up from right lat recumbency |
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Decreased intensity of heart sounds caused by
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pleural/pericardial effusion
thoracic masses Hernia with liver/intestines in thorax Obesity Arrhythmias |
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Causes of Hyperkinetic pulse (3)
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PDA
Aortic regurg Left ventricular hypertrophy |
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Causes of weak pulses (6)
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myocardial disease
arrhythmia Pericardial dzs dehydration ASten Systemic Hypertension |
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Normal HR for Dog
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Dog - 70-180
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Valve areas for ascultation
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Left side
Pulmonic 2-4 ICS, sternal Aortic 4th ICS, costal-chondral junction Mitral 5th ICS, costal-chondral junction Right side Tricuspid 3-5 costal-chondral junction |
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S1 Heart Sounds and causes
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Blood surging to the AV valves to start AV closure; abrupt deceleration of blood as valves close
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S2 Heart Sounds and causes
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closure of semilunar valves
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S1 splitting caused by
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delayed closure of mitral or tricuspid valve from RBBB, VP beats
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S2 splitting caused by
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delayed closure of the pulmonic valve from
Pulmonic Hypertension (HWD) RBBB VP Beats from Left Ventricle ASD PSten RHF COPD (horses) |
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S3 heart sound caused by
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Rapid Ventricular filling
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S4 heart sound caused by
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Atrial contraction of blood into ventricles
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Types of murmurs
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1. Functional - increased velocity
2. Pathologic - structural problem |
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Types of Pathologic murmurs
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1. Stenosis (aortic, pulmonic)
2. Shunt (VSD, ASD) 3. Regurg (PAMT) |
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Most common type of murmur
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Systolic
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These valves should be open during systole
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Aortic & Pulmonic
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Causes of systolic murmurs
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flow obstruction (aortic/pulmonic)
Leaky valves (mitral/tricuspid) Holes (ASD/VSD) |
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Causes of continuous murmurs
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PDA
Arteriovenous connections Ateriopulmonary windows flow disturbance (pulmonary emboli) |
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Significance of systolic clicks
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Idiopathic. Leads to mitral valve problems.
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99% of murmurs are ____.
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Systolic
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Endocardiosis is defined as _____ and is found two places (____ & _____ (with____ being the most common).
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Chronic Valvular Disease; Mitral; Tricuspid; Mitral
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Systolic murmur over the pulmonic region
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psten
T of F ASD |
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Systolic murmur over the aortic region
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Subaortic Stenosis
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Systolic murmur over tricuspid region
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Tric. regurg
VSD Tric. dysplasia |
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Continuous murmurs
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PDA
AV Fistula |
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Diastolic Murmurs
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Aortic Regurg
Pulm Regurg Mitral Sten Tric. Sten |
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4 most important things to do on a cardiac PE
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Signalment
Complaint/Clinical History PE/Ascult Rads |
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Common breeds with PSten
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Bassett
Beagle Boxer Boykin Chihuahua Chow Cocker English Bulldog Lab Mastiff Newfie Samoyed Schnauzer Terrier (All) Westie |
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Common breeds with PDA
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Bichon
Chihuahua Cocker Collie Springer GSD Keeshond Lab Maltese Pom Poodle Shetland Corgi Yorkie |
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Common breeds with SAS
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Boxer
GSD GSP Golden Great Dane Newfie Rottie Samoyed |
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Common breeds with ASD
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Boxer
Dobie Samoyed |
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Common breeds with MVD (mitral valve dysplasia)
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Bull Terrier
GSD Golden Dane Mastiff Newfie |
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Common breeds with CTD (Cor Toratatum Dexter)
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Chow
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Common breeds with AS
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Bull Terrier
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Common breeds with T of F
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English Bulldog
Keeshond |
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Common breeds with VSD
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English Bulldog
Springer Spaniel |
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Common breeds with TVD
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GSD
Golden Dane Lab |
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Tx for Acute heart failure Cat
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Lasix
O2 +/- vasodilation (nitroglycerine) |
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Tx for Chronic HF Cat
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Lasix - NOTHING ELSE EFFECTIVE.
Enalapril MAY affect RAAS, but no evidence up to this point. |
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Normal Hr for Cat
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Cat 145-220
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Normal HR for cattle
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Cattle 60 - 80
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Normal HR for Horse (and foal)
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Horse 30-40 (80 in foals)
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Normal HR for sheep/goats
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Sheep/goats 70-90
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Normal HR for pig
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Pig 60-100
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S3 and S4 normal in what species?
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Cow and horse at rest
Always abnormal in small animals |
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Respiratory abnormality found on both inspiration and expiration
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Pleural Friction rubs
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P wave reflects what?
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Atrial depolarization
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PR interval reflects what?
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time for AV node conduction
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P wave with NO QRS
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AV node blockage
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QRS reflects what?
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Ventricular depolarization
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T wave reflects what?
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Ventricular repolarization
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How many seconds should you count for HR?
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3 sec. = 1 bic pen
50mm/sec = multiply by 20 25mm/sec = multiply by 10 |
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Characteristics of a Sinus Rhythm
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No sudden starts/stops
Positive P wave in 1, 2, 3, and aVF Normal QRS Can't sustain high rates for long |
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Places non-sinus rhythyms can originate
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Atrium (has a P wave, but might look weird
AV Node (abnormal PR) Ventricle (VPCs) |
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Describe the Atrial Premature Contraction
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Funny P wave
Normal QRS |
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Describe the AV node/Junctional rhythm
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+/- P wave
Weird PR interval |
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Describe the propagation of a normal heartbeat
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Starts at the Upper right atrium at the sinus node
Upper RA>Lower LA>Cross AV node>Upper R AV node>Lower LV |
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Where is the normal Mean electrical axis (MEA)
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LL quadrant
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What happens with a Right Axis Shift?
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MEA moves to Right side
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What happens with a Left Axis Shift?
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MEA moves to the Upper Left Quadrant
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Which bundle branch feeds the upper L part of the LV?
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Anterior. Posterior gets everything else.
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What to expect in a RBBB?
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Right axis shift
Wide and bizarre QRS |
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What to expect in a LBBB?
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Normal MEA
Wide and bizarre QRS |
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RBBB makes you worry about?
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Psten
tricuspid displasia tricuspid regurg RV CM |
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LBBB makes you worry about what?
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SAS
PDA Mitral sten Mitral regurg DCM |
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3rd heart sounds come from?
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Big Atrium
Big Ventricle Systolic Click (non-pathologic) Gallop Premature |
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Why don't you usually have a murmur with ASD?
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Pressure gradient NSF
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Holosystolic/Pansystolic murmur causes
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Mitral regurg
Tricuspid regurg VSD |
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Mid-systolic murmur causes
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Asten
Psten Tachycardia pleural effusion pericardial effusion anemia fever |
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Most common Diastolic murmurs
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Aortic regurg
Mitral regurg |
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All causes of systolic murmurs
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Obstruction to outflow (aortic and pulmonic)
Leaky valves (mitral and tricuspid regurg) Holes (VSD and ASD) |
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Causes of diastolic murmurs
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Leaky valves (aortic and pulmonic)
Stiff valves (mitral and tricuspid stenosis) - rare |
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Causes of continuous murmurs
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PDA
Pulmonary emboli |
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True/False: APCs and VPCs are often associated with underlying structural heart disease
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True
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Tx for tachycardias
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AADs
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AADs targeting muscle (VeAt)
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NCB
KCB |
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AADs targeting nodal cells (AV/Sinus)
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B
C D |
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Tx for Sinus tachycardia
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Treat underlying problem
B-blockers |
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Tx for Atach
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Target muscle
NBCs KCBs Bbs Slow conduction Bbs CCBs Dig |
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Names of NCBs
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Procainamide
Lidocaine (No FX in atrium) Mexiletine Quinidine |
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Names of KCBs
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Amiodarone
Sotalol |
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Names of Bbs
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Esmolol
Propanolol Altenolol |
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Tx for JTach
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B
C D |
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Tx for VTach
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Go on a hunt for extra cardiac dzs
NCBs KCBs Bbs MgSO4 (horses only) |
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Tx for Afib
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Rhythm control - Cardiovert
NCBs KCBs Electrical Rate control - slow conduction through AV Bbs CCBs Digoxin |
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Names of CCBs
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Diltiazem
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About Quinidine
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Class Ia NCB - most commonly used AAD for cardioversion
DO NOT USE IN SA! DO NOT GIVE ORALLY! Toxic levels cause: UR Stridor Wide QRS Ataxia But NOT: Tach Hypotension Diarrhea Colic |
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About Digoxin
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Direct Vagal FX - decreases Vent response in Afib
+ inotrope |
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Class I AADs
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NCBs
1A - Quinidine, Procainamide 1B - Lidocaine, Mexilitine |
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Class 2 AADs
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B-blockers
Selective - Altenolol, Esmolol Non-selective - Propanolol |
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Class 3 AADs
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KCBs
Sotalol, Amiodarone |
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Class 4 AADs
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CCBs
Diltiazem, Digoxin |
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NCBs good for
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Vent arrhythmias
Atach |
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Bbs good for
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Stach
Jtach Afib rate |
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KCBs good for
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Vent arrythmias
Atach |
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CCBs good for
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Afib rate
Atach Jtach |
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About lidocaine
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doesn't do anything in Atrial tissue
hypoK makes less effective Have to bolus then CRI |
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About Mexiletine
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Good for Atach, VtArr
Good for use with Altenolol or sotalol |
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About Amiodarone
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Lots of Side FX (hepatic toxicity, erythema, pruritus, swelling, hives, pain at injxn site)
Pretreat w/Benadryl or steroids Great at VtArr, Atach |
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About Diltiazem + Digoxin
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great to slow Vt response to Afib
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Tx for AV Block and SSS
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Pacemaker or + chronotropes
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Names of + Chronotropes
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Theophylline
Terbutaline Hycosamine |
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Define HF
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When the heart can no longer maintain normal function resulting in:
low arterial BP NSF perfusion of tissues at rest Increased Venous BP Increased Capillary pressures |
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Define CO
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CO=HR*[(Contractility*Preload)/Afterload]
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Name the six major principles of cardiac performance
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1. Preload - amount of blood that goes back into the heart
2. Afterload - what the LV works against 3. Contractility - can the heart contract? 4. Compliance - can the heart fill? 5. HR 6. Synergy - how well does it all come together? |
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Types of Heart failure
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1. Congestive
2. Low Output |
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L CHF cascade
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LV Pressure>LA Pressure>Pulmonary pressure>increased oncotic pressure>pulmonary edema>decreased O2 exchange in lungs
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Causes of increased L Vt Diastolic Pressure
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1. increased preload (leaking mitral due to endocarditis)
2. decreased compliance (HCM) 3. Increased after load (ASten, hypertension) 4. Combination |
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Signs of L CHF
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edema
dyspnea |
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R CHF cascade
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RV Pressure>RA Pressure>Central Venous pressure (jugular distension)>Systemic VP>Systemic Capillary Pressure>Hepatic Sinusoid pressure>Ascites (dogs)/pleural effusion (cats)/ ventral (horses) or brisket (cows) edema
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Causes of increased R Vt Diastolic pressure
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Increased RV Preload
Increased Afterload (plum art hypertension) Decreased compliance Combination |
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Low output failure is a result of what?
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Big, flabby heart. NSF blood pumped.
Symptoms: hypotension, cool extremities, depression, lethargy |
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Pressure overload is a systolic dysfunction and a cause of heart failure. Name some causes.
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SAS, PSten, ToF, Hypertension, HWD, L to R Shunt, pheochromocytoma
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Volume overload/excessive preload is a systolic dysfunction and a cause of heart failure Name some causes.
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M, T, or A Regurg
Shunts (PDA, VSD, ASD) AV Fistula |
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Pump/low output failure (NSF contractility) is a systolic dysfunction and a cause of heart failure. Name some causes.
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Cardiomyopathy
Infarct Cardiodepressive drugs (- Inotropes) |
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Myocardial restriction is a diastolic dysfunction and a cause of heart failure. Name some causes.
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HCM
Restrictive CM Pericardial Effusion Pericarditis Tumors |
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High output states can cause HF. Name the causes.
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Chronic anemia
Chronic fever Hyperthyroidism |
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Differentiate between the stages of HF
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Mild - Coughing, dyspnea, and fatigue with exercise
Moderate - with mild activity Severe - at rest |
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Draw the RAAS
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How does the SNS attempt to combat HF?
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1. HR - speeds up conduction and discharge - at a certain point become detrimental because decr filling.
2. Contractility - E! and NE! released by SNS - incr contractility, but sensitizes the heart to arrhythmias 3. Systemic Art BP - causes vasoconstriction via A-!, but incr afterload |
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Eccentric Hypertrophy caused by what and lays more sarcomeres down how?
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Chronic volume overload; end-to-end
Internal dimensions increased |
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Concentric hypertrophy caused by what and lays more sarcomeres down how?
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Chronic pressure overload; parallel
Internal dimensions decreased>less compliant ventricle |
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What's the deal with ANF
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Comes from Atrial myocytes and is released when At is stretched
Increases GFR Antagonizes Renin, Ald. release, AT2 vasoc. Inhibits ADH Vasodilates |
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What are the cardiac peptides?
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ANF
Troponin Vasopressin |
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What's the deal with vasopressin?
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Increases with CHF
Retains water Causes vasoc |
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What's up with Troponin?
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Most commonly measured Cardiac peptide
Elevated in renal dz, PTE with dogs/cats Somewhat high in boxers with ARVC |
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How can you detect CHF in dogs/cats?
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1. Aldosterone ^ x 7
2. Renin ^ x 10 3. NE ^ 4. ANF ^ if Class 3-4 CHF 5. NT-proBNP - hi Sn/Sp |
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What's up with NT-proBNP?
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NOT a screening test.
Can tell you if it's cardiac and how bad. Hi Sn/Sp Poor prognosis if ^ AND ALT ^ |
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Canine LHF CS
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Rales
^ CRT Weak femoral pulses Pacing +/- murmur |
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Canine RV failure CS
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+/- murmur
Ascites Hepatomegaly Splenomegaly Distended jugular Cardiac cachexia |
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Feline Vent Failure
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dyspnea
murmur R - pleural effusion L - pulm edema |
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Equine/Cow LHF
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^ HR
^ RR +/-Murmur/gallop |
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Equine RHF
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^ HR
Murmur Legs swell Brisket edema |
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Cow RHF
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Brisket edema
^ HR +/- murmur |
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Goals of HF Tx?
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1. V fluid accumulation
2. ^ CO 3. V workload 4. Control rhythm 5. Find cause 6. Neurohormonal (RAAS, SAS, ADH) 7. Cardiac Remodeling |
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ACEI do what to RAAS?
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Prevent AT1>AT2
V preload V afterload |
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Bb do what to RAAS?
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V renin release from JG cells
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Bbs do what to the SNS?
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V contractility
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Aas do what to the SNS?
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Vasodilate
V afterload |
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How can you prevent Cardiac remodeling?
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ACEI - V fibrosis, V afterload, V preload
Aldant - V fibrosis Bbs - V remodel Lasix - V preload |
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Name an Aldant.
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Spironolactone
|
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Why/How reduce preload?
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v preload = v venous congestion
Lasix ACEI V sodium Venodilators |
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Why/How reduce after load?
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v afterload = v workload
ACEI Art.dilators |
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Why/how alter contractility with systolic dysfunction?
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Perfusion
+inotrope (pimo, dig, catecholamine) |
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Why/how alter Compliance with diastolic dysfunction?
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Improve filling time by v HR
CCB |
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LHF vs. RHF TX?
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LHF - Lasix, cage rest
RHF - tap it. |
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Name the arterial vasodilators.
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Hydralazine
Nitro ACEI |
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How to slow HR?
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Bb, CCB, Dig
|
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Why use + Inotropes and how do they work?
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Big Flabby Heart - ^ systolic contractility
alter Ca+ at actin/myosin level |
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Name + inotropes
|
Dig
Pimo Catecholamines (emergencies) |
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Name the catecholamines
|
Epi!
Isoproterenol Dopamine Dobutamine |
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Name the types of diuretic
|
Xanthines
Thiazides Aldant Lasix |
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Things that ^ blood digoxin levels
|
Quinidine
Aspirin Amiodarone Sotalol Spironolactone Cimetidine Phenobarb Hypothyroid CRF/ARF Hypokalemia |
|
When to NOT use dig
|
Sinus node dysfunction
HCM A/P Sten RCM Pericardial dzs Vt Arr A murmur Pulm Hypertension |
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When to use Isoproterenol
|
SSS
3rd Degree AV Block DO NOT USE unless you're getting ready to put in a pacemaker |
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When to use Dopamine
|
Sinus Tach
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