Y3 Cardiology Rvc Finals

Front 1

What are the FOUR types of cause of heart failure?

Back 1

Pump/systolic failure (failure of muscular contractions)
Volume overload (increase in the amount of blood pumped by chamber)
Pressure overload (increased resistance to chamber emptying)
Diastolic failure (impaired ventricular filling with normal systolic function)

Front 2

What TWO maladaptive mechanisms are important in development of heart failure?

Back 2

BARORECEPTORS: stimulated by reduced arterial filling, cause vasoconstriction and increase heart rate and contractility
RAAS: stimulated by renal underperfusion, causes vasoconstriction, cardiac remodelling and water and sodium retention

Front 3

What does hyponatraemia suggest in a patient with heart failure?

Back 3

This is a negative prognostic indicator.
ADH is released in severe/late heart failure causing water retention with hyponatraemia.

Front 4

What are the TWO types of cardiac hypertrophy?

Back 4

Concentric (thickened wall)
Eccentric (increased internal diameter)

Front 5

What would be the cause of a murmur dorsal to the left heart base in a neonate?

Back 5

Patent ductus arteriosus (continuous murmur)

Front 6

What is the most likely cause of a decrescendo murmur in a horse?

Back 6

Aortic regurgitation

Front 7

What is the most likely cause of a murmur that radiates cranially?

Back 7

Aortic stenosis

Front 8

What is the most likely cause of a murmur that radiates dorsally?

Back 8

Mitral regurgitation

Front 9

What are the TWO possible causes of a murmur that varies with stress in a cat?

Back 9

Physiological/incidental flow murmur
HCM

Front 10

What are the typical characteristics of a flow murmur?

Back 10

Do not exceed grade III/IV and resolve by 6 months

Front 11

What is Eisenmonger's physiology?

Back 11

A large left to right shunt leads to hypertension and reversal of the shunt

Front 12

What are the FOUR defects associated with tetralogy of Fallot?

Back 12

High septal defect
Pulmonic stenosis
Over-riding aorta
Right ventricular hypertrophy (often a consequence of the other three)

Front 13

What controversiality exists with use of positive inotropes in management of heart failure?

Back 13

They increase mortality but improve quality of life

Front 14

What TWO drugs are essential for treatment of myxomatous valve degeneration?
What TWO others may be added if required?
When should treatment be commenced?

Back 14

Furosemide and pimobendan
Add spironolactone and ACEI if required
Do not commence treatment until onset of clinical signs

Front 15

What TWO drugs are essential for treatment of dilated cardiomyopathy?
What TWO others may be added if required?
When should treatment be commenced?

Back 15

Furosemide and pimobendan
Add spironolactone and ACEI if required
ACEI may be useful from diagnosis
Do not commence other treatment until onset of clinical signs

Front 16

What is pulsus paradoxus? What condition might it suggest?

Back 16

Pulse intensity decreases on inspiration
Occurs with pericardial effusion

Front 17

What is electrical alternans?
What condition might it suggest?

Back 17

Variation in amplitude of QRS complex
Occurs with pericardial effusion

Front 18

What is the cause of feline dilated cardiomyopathy?
What is the prognosis?

Back 18

Taurine deficiency
Grave prognosis

Front 19

An aged oriental breed cat presents with an arrythmia and dyspnoea. What is the most likely diagnosis?
Explain the aetiology of the disease

Back 19

Restrictive cardiomyopathy
Endomyocardial or myocardial fibrosis causes marked diastolic impairment with normal systolic function. Left atrium is enlarged and ventricle normally sized.

Front 20

What FOUR interventions are required for management of feline acute heart failure?

Back 20

Oxygen
Butorphanol
Furosemide
Nitroglycerin

Front 21

How should aortic thromboembolisms be managed?

Back 21

Heparin to prevent thrombus extension (thrombolysis not attempted due to risk of reperfusion injury)
Prevent recurrence with aspirin, heparin or clopidogrel

Front 22

What causes an early-mid systolic crescendo-decrescendo murmur over the left heart base in the horse?

Back 22

Aortic flow murmur

Front 23

What causes an early diastolic 'whooping' murmur over the mitral/tricuspid valve in the horse?

Back 23

Ventricular flow murmur

Front 24

What causes a systolic plateau murmur that radiates caudodorsally in the horse?

Back 24

Mitral regurgitation

Front 25

What causes a diastolic decrescendo murmur that radiates caudodorsally and to the right in the horse?

Back 25

Aortic regurgitation

Front 26

What causes a systolic plateau murmur that radiates craniodorsally in the horse?

Back 26

Tricuspid regurgitation

Front 27

What is the consequence is the consequence of rupture of the chordae tendinae?

Back 27

Severe tricuspid/mitral regurgitation, causing sudden death or acute cardiac failure

Front 28

What causes a systolic plateau murmur over the tricuspid valve in the horse?

Back 28

A ventral septal defect causing a left to right shunt

Front 29

What causes a systolic crescendo-decrescendo murmur with wide radiation over the mitral valve in the horse?

Back 29

A ventral septal defect causing a right to left shunt

Front 30

What worms are responsible for verminous pneumonia (summer cold) in the horse?
Outline the lifecycle

Back 30

Strongyles (vulgaris, edentatus, equinus).
Eggs passed in faeces develop to infective-stage larvae. Once ingested, they exsheath and migrate extensively, eventually to lungs, before being swallowed and developing to maturity in the large intestine

Front 31

What worm infests equine connective tissue?
What is its route of infection?

Back 31

Onchocerca cervicalis - transmitted by Culicoides spp.
Onchocerca gutturosa/linealis - transmitted by Simulium spp.

Front 32

What are THREE factors predispose to development of atrial fibrillation?
What clinical signs does it cause?

Back 32

Large atrial size
Slow SA node rate
Variable refractory period
Causes exercise intolerance during vigorous work (85% of ventricular filling is passive)

Front 33

What is Cor Pulmonale?

Back 33

Also called high altitude disease/Brisket disease; right sided heart failure secondary to pulmonary hypertension

Front 34

What region of the lung is most affected by the caudodorsal lung lobes?

Back 34

Caudodorsal

Front 35

Describe the FOUR phases of the cardiac cycle

Back 35

Rapid filling phase (AV valves open_
Isovolumetric contraction phase (AV valves close)
Ejection phase (Semilunar valves open)
Isovolumetric relaxation phase (Semilunar valves close)

Front 36

How are end systolic volume, end diastolic volume and stroke volume related?

Back 36

End diastolic volume = Stroke volume (2/3) + End systolic volume (1/3)

Front 37

What is the role of the sinoatrial node?

Back 37

Slow, spontaneous depolarisation (no resting potential)

Front 38

What is the role of the atrioventricular node?

Back 38

Slow electrical conduction before acceleration through the Purkinje fibres and bundle of His

Front 39

What is the function of cardiac beta receptors?

Back 39

Beta1 adrenoceptors increase heart rate and contractility

Front 40

What classes of drugs are positive chronotropes? Give an example of each

Back 40

Muscarinic antagonists (atropine)
Beta agonists (dopamine/dobutamine)

Front 41

What classes of drugs are negative chronotropes? Give an example of each

Back 41

Muscarinic agonists (pilocarpine, bethanecol)
Alpha-2 agonists (xylazine)
Beta agonists (atenolol)

Front 42

What classes of drugs are positive inotropes? Give an example of each

Back 42

Beta agonists (dobutamine)
Methylxanthines (theophylline)
Cardiac glycosides (digoxin)
Phosphodiesterase inhibitors (pimobendan)

Front 43

What is the mechanism of action of cardiac glycosides?

Back 43

Inhibit Na/K pump, e.g. digoxin. Positive inotropes

Front 44

What sort of drug is pimobendan?

Back 44

Phosphodiesterase inhibitor - positive inotrope

Front 45

What classes of drug are negative inotropes? Give an example of each

Back 45

Beta antagonists (atenolol)
Na channel blockers (quinidine, lidocaine)
Ca channel blockers (diltiazem, verapamil)

Front 46

What is the Vaughan-Williams classification of anti-arrhythmic drugs? Give an example of each

Back 46

Class I: sodium channel blockers (quinidine, lidocaine)
Class II: beta-antagonists (atenolol, sotalol)
Class III: K channel blockers (amiodarone, sotalol)
Class IV: Ca channel blockers (verapamil, diltiazem)
Class V: other (digoxin)

Front 47

What is the Frank-Starling law?

Back 47

Intrinsic control of stroke volume: increased venous return increases ventricular stretch, resulting in increased myosin and actin overlap and therefore increased force of contraction

Front 48

How is blood pressure controlled?

Back 48

Baroreceptors in the aortic arch and carotid sinuses modify autonomic stimulation of the heart and vasculature via the medullary centre in the brain

Front 49

What are the TWO types of second-degree AV block?

Back 49

mobitz type 1 - progressive prolongation of the PR interval
mobitz type 2 - constant PR interval with skipped beats

Front 50

What are preload and afterload?

Back 50

Preload is to force caused by blood entering the right atrium (venous return)
Afterload is the force the heart must overcome in order to pump blood (aortic pressure)