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MY 2016 RUSVM SAM 1 > Cardiac exam & Heart failure/Cardiovascular Conditions > Flashcards

Cardiac exam & Heart failure/Cardiovascular Conditions Flashcards

(69 cards)

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1
Q

What is the normal aortic BP

A

Systolic 120 Diastolic 80 written 120/80

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2
Q

What maintains aortic BP during diastole

A

Elastic muscle fibers stretch reflex

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3
Q

What creates the BP during systole

A

The contraction of the LV

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4
Q

What activates the SNS to maintain BP

A

baroreceptors

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5
Q

What is the Frank Starling relationship

A

increase in stretch (preload) = increase in force of contraction of muscle fibers

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6
Q

What is RAAS

A

Renin-angiotensin-aldosterone system

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7
Q

What is RAAS responsible for

A

Angiotensin II causes veno/arterioconstiction Aldosterone increases Na retention which leads to H2O retention which increases circulatory volume

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8
Q

What effect does the SNS have on CV system

A

veno/arterioconstriction +ve inotropy & chronotropy

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9
Q

How does the heart compensate for and increase in preload

A

hypertrophy

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10
Q

What is heart failure

A

Cardiac output is insufficient to meet body needs

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11
Q

When does heart failure occur

A

When heart disease is severe

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12
Q

What are the 2 major problems that are caused by heart disease

A

Volume overload Pressure overload

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13
Q

How does the heart compensate for a volume overload

A

eccentric hypertrophy enlargement of the ventricular volume (capacity)

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14
Q

Give an example of a condition that causes volume overload

A

myxomatous AV valve dz (endocardiosis)

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15
Q

What is the sequelae of eccentric hypertophy

A

there is a systolic emptying problem which leads to an increased afterload. Not all the blood leaves the ventricles after contraction

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16
Q

If an animal has an aortic/pulmonic (talking about the valves here) stenosis what type of overload would be caused

A

pressure overload

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17
Q

what type of hypertrophy would you see as a result of pressure overload in the ventricles

A

concentric hypertrophy

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18
Q

What are the sequelae of concentric hypertrophy

A

there is a diastolic filling problem which leads to an increased preload. Not enough space for the normal amount of blood that should fill the ventricles

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19
Q

In either case of hypertrophy how does the body try to maintain CO what changes in each type of hypertrophy

A

CO = SV * HR eccentric hypertrophy the stroke volume increases more concentric hypertrophy the heart rate increases more

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20
Q

What are the cardiac related CS of LCHF why

A

Left-sided congestive heart failure: hypotension pale mm incr. CRT incr. rate decr. pulses weakness syncope azotemia The left side pumps oxygenated blood to the body via the aorta. in failure (loss of effective pump) no blood is circulation which creates a relative hypovolemia that the body tries to compensate for.

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21
Q

Why is azotemia seen in LCHF

A

Because there is decr volume of blood flowing to kidneys therefore buildup of waste products

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22
Q

What are the pulmonary related CS of LCHF why

A

lung edema dyspnea coughing orthopnea tachypnea ex. intolerance cyanosis If there is a backup of blood in the LV there will be backup into the LA which will cause backup into lungs via pulmonary veins leading to fluid accumulation and decr in oxygen exchange

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23
Q

What are the CS of RCHF why

A

Ascites hepato-splenomegaly pleural effusion distension of veins hypotension If there is a backup of blood in the RV there will be backup into RA which will cause blood to remain in “great veins” beyond even their enormous reserve capability.

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24
Q

what is the hypotension in RCHF related to

A

The relative loss of circulating blood volume due to sequestration in extravascular compartment in addition to lack of an effective pump

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25
which is more commonly seen in animals R or L CHF
Left
26
What are the clinical stages of heart failure
I - dz but NO CS II - CS w/normal to strenuous exercise III - CS w/ any activity IV - at rest
27
What stage of HF has dz but no CS
One
28
What stage of HF has CS with normal to strenuous exercise
Two
29
What stage of HF has CS with any activity
Three
30
What stage of HF has CS at rest
Four
31
How do you do a CV system exam
TPR MM Thoracic palpation Auscultation
32
what are the changes you might see in TPR if HF is present Why
decr. T incr. RR decr. P less circ bv will decr. T less oxygen in blood, body will try to get more pulses are difference between systolic & diastolic pressures if the pump is ineffective then less difference will be felt.
33
why are MM pale
decr circ BV
34
Why do you palpate the thorax
to locate the apical beat for good auscultation
35
what are you listening to when you auscultate
you listen for normal or abnormal sounds http: //multimedia.3m.com/mws/media/346089O/heart-and-lung-sounds-soundfile.wav?fn=Normal%20Split%20S1.wav http: //multimedia.3m.com/mws/media/346098O/heart-and-lung-sounds-soundfile.wav?fn=Early%20Systolic%20Murmur.wav
36
what happens if you hear abnormal heart sounds
you send for cardiac ultrasound!
37
What are normal heart sounds
Lub-Dub
38
What are some types of abnormal heart sounds
gallops clicks murmurs
39
what are gallops sounds
S3 & S4 which are normal in LA but abn in SA
40
what are clicks
when the valves are slow to close due to chordae tendinae being stretched so you hear it as a separate sound Lub-click-Dub
41
What causes murmurs
murmurs are the sounds of turbulent blood flow due to narrowing of a vessel, valvular insufficiency, incr. blood flow or decr. blood viscosity
42
What are things you'd use to describe a murmur
where is occurs in cardiac cycle: systolic or diastolic where it is loudest: apex or base intensity on a scale of 1 to 6 with 6 being most severe grade of murmur
43
what use are radiographs with HF
Really good at seeing lung status in CHF Size & shape of pulmonary vessels evidence of pleural edema somewhat good at determining whether heart is enlarged esp for DCM and where
44
What is the best modality to evaluate HF
Echocardiogram!
45
Where does blood flowing into left atrium (LA) come from?
the lungs specifically the pulmonary veins
46
Blood flows into atria during _________ which is the _______ phase of cardiac cycle?
diastole, resting
47
Blood flows from LA to left ventricle (LV) through the ______ or ____ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ _____ during which phase?
mitral (human term), left atrioventricular valve diastolye
48
What is the mechanical means to cause the blood flow into the heart during diastole?
negative pressure created during inspiration
49
At end of passive filling phase the atria contract which results in?
last little bit of blood squeezed into LV to ↑ volume to allow for ↑ contraction due to Frank-Starling relationship
50
Why doesn't blood flow backwards into LA when LV contracts?
Due to closure of LAV valve
51
Why doesn't LAV valve prolapse back into atrium during ventricular contraction?
Chordae tendinae holding it in place.
52
what is another name for myxomatous AV valve dz?
endocardiosis
53
what type of overload does endocardiosis lead to? what part of cardiac cycle problem? afterload or preload? what type of hypertrophy?
volume overload systolic emptying problem (↑ afterload) eccentric hypertrophy
54
what type of overload does aortic/pulmonic stenosis lead to? what part of cardiac cycle problem? afterload or preload? what type of hypertrophy?
pressure overload diastolic filling problem (↑ preload) concentric hypertrophy
55
CS of LCHF Front side vs back side
Front side = signs as a direct result of heart failure hypotension syncope ex intolerance mm: pale, cyanotic CRT ↑ ↑ HR ↓ pulses weakness azotemia Back side = signs due to consequences of direct CS of heart failure lung edema dyspnea coughing orthophnea tachypnea ex intolerance cyanosis
56
CS of RCHF
Front side vs back side much less common than LCHF Front side: Syncope weakness ex. intolerance azotemia Back side: ascites hepato-plenomegaly pleural effusion distension of veins hypotension
57
Which spp coughs more with CHF dogs or cats?
dogs
58
Clinical stages of heart failure
1: dz but no CS 2: CS w/ normal or strenuous exercise 3: CS w/ any activity 4: CS at rest
59
What changes in TPR may be seen w/ pt w/ CHF
T: may be ↓ d/t ↓perfusion R: RR may be ↑ d/t hypoxia P: rate ↑, rhythym reg or irreg, quality ±↓
60
what are MM supposed to be?
pink, moist
61
ddx of pale MM
anemia shock heart failure
62
ddx of cyanotic mm
heart failure R→L shunts
63
ddx of bright red mm
sepsis R→L shunts erythrocytosis
64
ddx of yellow mm
liver problem pernicious anemia
65
what is felt on thoracic palpation
apical beat -mitral valve if displaced caudally from right behind elbow think ddx of what can displace heart caudally
66
what is normally heard on thoracic auscultation? What do the sounds represent?
normal heart sounds -LubDub Lub=closure of AV valves, start of systole Dub=closure of aortic/pulmonic valves, start of diastole
67
What are the abnormal sounds that can be heard on auscultation
gallops = S3 +S4 sounds (normal in LA abn in SA) -S3= filling of ventricles (lubdubdub) -S4= contraction of atria (dublubdub) clicks= mitral valve dz (lubclickdub) murmurs= turbulance of blood flow, ↑ blood flow (hyperthyroidism), ↓viscosity (anemia)
68
How to describe murmurs
functional (physiological) vs pathological timing in cardiac cycle -systolic vs diastolic pansystolic vs holosystolic -lubwooshdub = holosystolic -wooshwooshwoosh = pansystolic continuous aka washing machine Location & radiation of murmur -base vs apex Intensity of murmur -grade 1-6 what dz has characteristic washing machine murmur PDA
69
grades of murmur intensity
Grade 1: very soft, over sm area Grade 2: Grade 3: Grade 6: very loud, off the chest wall, over the entire thorax, palpable thrill

MY 2016 RUSVM SAM 1 (12 decks)

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