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PCP EOY - CVRS > Cardiac > Flashcards

Cardiac Flashcards

1
Q

heart failure

A

cardiac output and tissue perfusion maintained at expense of increased cardiac filling pressures

heart can no longer meet metabolic needs

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2
Q

compensations for heart failure

A

cytokines
aldosterone system
RAAS
sympathetic nervous system

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3
Q

cardiac causes of heart failure

A

mitral valve disease
DCM
HCM
pericardial effusion
restrictive cardiomyopathy
patent ductus arteriosus
mitral/tricuspid valve dysplasia
pulmonic stenosis

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4
Q

classifications of heart failure

A

A - no heart failure, at risk breed
B1 - no heart failure, murmur but no enlargement
B2 - no heart failure, murmur and cardiomegaly
C - presence or history of heart failure
D - refractory heart failure

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5
Q

diagnosis of heart failure

A

thoracic radiography
echocardiography
NT- proBNP levels

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6
Q

signs of heart failure

A

cough
dyspnoea
increased sleeping respiratory rate
exercise intolerance

gallop and arrythmia - poor prognostic indicators

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7
Q

normal vertebral heart score

A

13.25

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8
Q

non cardiac sources of NT-proBNP

A

systemic hypertension
hyperthyroidism
renal failure

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9
Q

ECG - B mode

A

moving image of heart

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10
Q

ECG - M mode

A

sending one beam only so only see structure associated with that beam

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11
Q

ECG - views

A

right parasternal long axis - large left ventricle view, see all chambers

right parasternal short axis - mushroom - LV in mushroom bit, RV crescent moon shap

base parasternal short axis - mercedes sign - aorta view

Right sided -
subjective assessment of chamber size and systolic function
evaluate mitral and tricuspid valves
measure chamber size

measurements taken over 3 cycles and averaged

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12
Q

ECG - transducer

A

generates sound

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13
Q

ECG - frequency

A

number of cycles per second

high frequency = better resolution but shallower depth

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14
Q

ECG - acoustic impedance

A

resistance of a medium to the flow of sound - bone is high, air is low

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15
Q

ECG - attenuation

A

weakening of a sound travelling through a medium

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16
Q

ECG - controls

A

depth - adjusts field of view
gain - power - higher gain –> whiter image
sector width - angle of sector shown, smaller sector –> higher resolutation
focus - at depth level of interest

hyperechoic - white
hypoechoic - black

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17
Q

ECG - fractional shortening

A

allometric scale for m-mode cardiac measurements

= (LV diameter during diastole - LV diameter during systole)/LV diameter during diastole

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18
Q

ECG - cornell measurement

A

scaling for size of heart to body weight

19
Q

ECG - E-point to septal separation

A

minimum difference between e point of mitral valve and the septum in m mode

20
Q

acquired heart disease in dogs

A

mitral valve disease
DCM
pericardial effusion

21
Q

cquired heart disease in cats

A

HCM
HOCM (hypertrophic obstructive cardiomyopathy)
restrictive cardiomyopathy
DCM

22
Q

indications for ECG

A

murmur
breathlessness, cough, or collapse
arrythmia
gallop rhythm
investigation of pericardial disease
unexplained pyrexia
breed screening for preclinical DCM
pre-chemo assessment

23
Q

key indicators in history of heart disease - farm

A

syncope
exercise intolerence
murmur
lethargy
anorexia
mouth breathing
fluid thrill
dyspnoea
crackles
jugular pulsation
cyanosis
cough

young - more likely congenital
adult - more likely acquired

24
Q

clinical signs heart disease - farm

A

often non-specific/absent
exercise intolerance and weakness
syncope/pre-syncope
cyanosis
coughing
paresis
neurologic signs

25
Q

clinical signs heart failure - farm

A

tachypnoea/dyspnoea
weight loss
swollen abdomen
peripheral oedema
other heart disease signs

26
Q

mm - colour and CRT

A

cyanosis - right to left shunt

central - body wide cyanosis
differential - head membranes normal, caudal pale
peripheral - affecting only certain regions

slow CRT - poor CO

27
Q

jugular

A

pulsation - should only be visible 1/3 up neck

tricuspid regurgitation - backflow up vena cava

collapse right atrium - pericardial effusion, back up of blood up jugular

distension - elevated systemic venous pressure

right sided heart failure

pericardial disease

cranial vena cava obstruction - neoplasia or thrombus

hypervolemia

28
Q

auscultation

A

murmur
gallop
arrhytmia
HR
lung fields
muffled sounds
crackles

29
Q

palpation

A

apex beat - shouldn’t be prominent on right
thrill
percussion for fluid/air
compression - reduced compressibility in cats with heart disease

30
Q

gallop sounds

A

additional sound for S3 (early diastolic filling - systolic dysfunction) or S4 (atrial contraction - forced atrial ejection)

31
Q

abdominal examination

A

palpation - ascites, splenomegaly, hepatomegaly, pain

hepatojugular reflux - push up behind last ribs, if heart under too much pressure see blood flow back up jugular

32
Q

arterial pulse

A

femoral - does pulse rate match HR, pulse quality

pulsus alternans - alternating stong and weak pulses - myocardial failure

pulses paradoxus - decreased pulse quality on inspiration - pericardial effusion

33
Q

heart murmurs

A

turbulent blood flow
can be innocent or due to leaking valve (stenosis)

additional sound, longer than normal sounds

systole - between lub and dub
diastole - after dub

low grade murmur in puppies and kittens - resolves on it’s own

34
Q

heart murmur grading

A
  1. barely audible
  2. audible but quieter than heart sounds
  3. clearly audible and as loud as heart sounds
  4. louder than heart sounds
  5. thrill present on palpation
  6. audible with stethoscope off chest
35
Q

apical systolic murmur

A

left side - mitral regurgitation
DCM or MMVD
can radiate to right side if loud enough

right side - tricuspid regurgitation
tricuspid valve dysplasia, pulmonary hypotension or valve degeneration

36
Q

basillar systolic murmur

A

under axilla
harsh sound
radiates to thoracic inlet and sometimes up carotid
hard to notice unless severe

37
Q

innocent/functional murmur

A

innocent - puppies and kittens - systolic, left, heart base, resolves on its own

functional - side effect of another disease

38
Q

ventricular septum defect

A

left to right murmur
louder if hole is smaller (so louder is more severe)

39
Q

atrial septal defect

A

murmuer at left heart base

40
Q

diastolic murmurs

A

aortic regurgitation - quiet, at heart base - early mitral valve closure

pulmonic regurgitation - left base, uncommon, pulmonary hypertension

mitral stenosis - left apex, rare, mid-diastole

continuous - patent ductus arteriosus

41
Q

investigating heart murmurs

A

blood pressure

CBC
biochem
electrolytes
NT-proBNP
cardiac troponin

ECG

thoracic imagine

42
Q

treatment in heart failure

A

oxygen
ultrasound at point of care
furosemide - IV or IM
blood pressure monitoring
bloods
when stable - ECG and radiographs

43
Q

indications to investigate murmur

A

murmur present at rest
loud murmur
remaining loud through rest of systole
other signs
murmur radiates out from main point
continuous or diastolic element to murmur

PCP EOY - CVRS (3 decks)

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