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522 (dog & cat class) > Cardio > Flashcards

Cardio Flashcards

1
Q

A dog presents to your clinic for congestive heart failure. What clinical signs do you expect to see?

A
  • resp distress / dyspnea
  • tachypnea
  • tachycardia
  • heart murmur
  • crackles on lung fields
  • syncope
  • hx of frequent cough, worse at night
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2
Q

Bitey is a 12 yo Bichon mix that presents to your clinic in respiratory distress. He has a history of a frequent cough, a 5/6 heart murmur, crackles on all lung fields, a HR of 140 and a RR of 60.

What 2 things should you do now?

A

Stabilize! –> O2, anxiolytics (butorphanol)

POCUS –> heart and lungs

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3
Q

You have a dog presenting for congestive heart failure. You do a POCUS of the heart and lungs. What do you expect to see?

A

lots of B lines in the lungs

La:Ao >2

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4
Q

You have a dog presenting in respiratory distress. He has a 5/6 murmur and crackles on lungs. You stabilize him and do POCUS, revealing B lines and La:Ao >2. What is your diagnosis? What do you do now?

A

congestive heart failure

furosemide!

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5
Q

You have a dog presenting in respiratory distress. He has a 5/6 murmur and crackles on lungs. You stabilize him and do POCUS, revealing B lines and La:Ao >2. You diagnose him with CHF and give furosemide. He is stable and you decide to do rads. What do you expect to see?

A

lung: interstitial to alveolar pattern, perihilar to caudodorsal

heart: enlarged, left atrium enlarged specifically, vein and artery enlarged

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6
Q

What is MVD? What happens to the animal who gets it? Like timeline and symptoms and stuff. Who gets it?

A

myxomatous degeneration of left AV valve causing mitral regurg, causing left sided apex murmur

80% of canine acquired heart disease

small/toy breeds, inherited in Cavalier King Charles Spaniels

can take 4-6 years from development of murmur to CHF

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7
Q

Gorp is a 11 yo Maltese cross presenting for a left sided systolic heart murmur. Based on C/S and signalment, what is the diagnosis?

A

mitral valve disease/mitral regurgitation

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8
Q

tell me about the disease progression of MVD.

A

starts with just a left-sided systolic heart murmur (no CHF, for 4-6 years).

murmur progression = worsening of disease. can lead to coughing without CHF (due to bronchial compression secondary to enlarged heart)

goes to CHF: progressive cough, dyspnea, syncope, crackles on auscultation, tachypnea , tachycardia

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9
Q

tell me about the MVD stages

WHEN DO WE WANT TO TREAT?????

A

A: breeds at risk. No structural disease. Cavalier King Charles spaniels are automatically stage A

B1: asymptomatic, no rad/echo evidence of disease - mild remodelling, mild murmur present

B2: asymptomatic, mild-mod heart murmur, rad/echo evidence of left sided enlargement

C: current or past C/S of CHF caused by MVD

D: end-stage MVD, C/S of HF are refractory to standard treatment

WE WANT TO TREAT AT STAGE B2 (i.e before symptoms of CHF!!!!)

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10
Q

what are the ways to diagnose MVD?

A
  • thoracic rads (3 view): not always sensitive –> can see left atrial enlargement as disease progresses
  • brain natriuretic peptide (BNP): not specific to MVD, but (-) result of this = most likely no cardiac disease

echocardiography = gold standard:” sensitive + specific –> La:Ao

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11
Q

What is the recommended treatment for MVD stage A

A

no therapy, yearly exam

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12
Q

What is the recommended treatment for MVD stage B1

A

no therapy, exam q 6-12 mo, BP, labs, early echocardiograms, thoracic rads

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13
Q

What is the recommended treatment for MVD stage B2

A

Pimobendan

Ace inhibitors (benazepril, enalapril) can be added

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14
Q

what is the treatment for MVD post-CHF? AKA stage C-D

A
  • pimobendan
  • ACEi (benazeprile, enalapril)
  • furosemide (taper to lowest effective dose)
  • diet lower in Na, weight control

labwork and PE 1 week after start, then 1 mo, then every 3 mo (with thoracic rads). make sure to check renal Vals and K+

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15
Q

Why should you monitor the kidneys in patients post-CHF and those using diuretics?

A

cardio-renal syndrome: less perfusion to kidneys leads to decreased kidney function and possible renal failure (furosemide will dehydrate you and lower GFR)

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16
Q

tell me about MVD post-CHF prognosis

A
  • pimobendan and ACEi treatment increases survival after CHF
  • increasing dosage of furosemide deceases survival
  • ruptured cordae tendinae decreases survival
  • asymptomatic phases of MVD: 4-6 years before progressing to CHF
  • post CHF: 1-2 years survival
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17
Q

What is pulmonary arterial hypertension? How do you diagnose? How do you treat?

A

often a consequence of MVD, commonly secondary to chronic lower airway disease (ex. chronic bronchitis, pulmonary fibrosis)

dx: large right ventricle, large right atrium, large pulmonary artery, echocardiography

tx: Sildanefil (viagra)

18
Q

Cutter is a 7yo Doberman with a 3-day history of cough that’s worse at night. He has a history of exercise intolerance. Cutter is presenting for breathing hard today. on PE, his temperature is 37.9, P: 186, RR: 42 and dyspneic. There are crackles bilaterally, his mm are cyanotic, and CRT 2 sec. What should you do next?

A

ECG= look for Afib
POCUS: lungs for B lines, heart for mushroom view and La:Ao

19
Q

you have a Doberman who presents to your clinic for resp distress. You stabilize him and take rads when stable. You find this. What are your top 2 differentials? How would you tell the difference?

A
  1. DCM
  2. pericardial effusion

Do POCUS

20
Q

What is dilated cardiomyopathy? who is affected? what causes it?

A

acquired myocardial disease. left ventricle more often affected but can affect both ventricles

cause unknown in most cases: but GRAIN FREE DIETS, taurine deficiencies are important

large/medium breed dogs … DOBERMANS esp!!!

21
Q

You have a dog that has DCM. what C/S do you expect to see?

A
  • gallop, soft systolic murmur
  • new murmur or arrhythmia (Afib)
  • pulse deficits (pulsis paradoxis)
  • jug distension/pulses, ascites
  • weight loss, cool extremities
  • exercise intolerance
  • syncope
  • sudden death (esp Dobermans)
22
Q

how do you diagnose DCM?

A
  • echocardiography = gold standard
  • ECG, Rads, biomarkers (BNP) not sensitive or specific
23
Q

You have a 5yo Doberman patient on a grain free all fish diet with a newly diagnosed heart murmur. He is asymptomatic otherwise. You diagnose dilated cardiomyopathy. How do you proceed?

A
  1. Pimobendan + ACEi
  2. get him off that grain free all fish diet (all fish = taurine deficient)
24
Q

You have a 7yo Great Dane with DCM who just recently got diagnosed with CHF. He is stable now. How should you continue to treat him?

A
  • pimobendan
  • diuretics (furosemide)
  • ACEi
  • low salt diet
25
Q

tell me about the prognosis for DCM

A

worse prognosis: young, pleural effusion, pulmonary edema, ascites, AFib

better px: pimobendan treatment

overall, guarded to poor (90-300 days from time of DCM diagnosis) (dobermans have sudden death 30% of the time)

26
Q

You have a 7yo DSH named Witten who presents to your clinic for lethargy and anorexia for 24h. He has been less active for the last 2 weeks. on PE, you find T: 37.2, HR: 240, RR: 70, BP 106 mmHg, nasal flaring, dyspneic, orthopneic stance. Harsh lung sounds on thoracic auscultation. How can you differentiate heart failure from other feline respiratory distress?

A
  • POCUS (lung and heart)
  • thoracic rads when stable
  • pulse ox
  • ECG
27
Q

You have a cat presenting for respiratory distress and are worried about CHF. You do a POCUS of the heart and go into “mushroom” view. This is what you see. What are your top 2 differentials and how do you differentiate between the two?

A
  • HCM
  • hypovolemia

both show a thickened wall and small lumen.

Look at the La:Ao. Hypovolemia will have a small ratio and HCM will have a big ratio

28
Q

should you give pimobendan to a cat?

A

no

29
Q

true or false: you can see pleural effusion in cats with CHF

A

true

30
Q

You have a cat that comes in with CHF in resp distress. what do you do?

A
  1. stabilize: O2 and butorphanol (anxiolytic)
  2. POCUS (and rads when stable) to diagnose CHF (HCM most likely)
  3. furosemide
31
Q

you have a cat that comes in with CHF with pleural effusion. Should you perform thoracocentesis?

A

only if pleural effusion is significant enough to be part of the cause for dyspnea

we want to avoid stress

32
Q

What is hypertrophic cardiomyopathy? who gets it?

A

most common acquired heart disease in cats

left concentric hypertrophy, myocardial disease (decrease luminal vol –> dilation of L atrium –> CHF)

genetic: rag doll, maine coone, American shorthair, British shorthair, bengal, Siberian, rex, DSH…

middle aged to older

33
Q

do cats always get a heart murmur with HCM?

A

no!!! up to 30-50% of cats with HCM don’t have murmurs

34
Q

what are the C/S of HCM?

A

often nothing prior to CHF!!!!

can be a gallop prior to CHF, or sometimes mitral regurg

once in CHF: crackles, dyspnea, quiet lung sounds, open-mouth breathing, pleural effusion, aortic thromboembolism

35
Q

how do you diagnose HCM?

A

echocardiograph = gold standard

thoracic rads and POCUS

TT4*: hyperthyroidism can cause HCM and it’s reversible when you treat the hyperthyroidism

36
Q

true or false: HCM stages are the same as MVD stages for dogs

A

true

37
Q

how do you treat HCM?

A

same stages as dogs… but DO NOT USE PIMOBENDAN!!!

ACEi at stage B2

when there’s CHF: O2, anxiolytic, furosemide

chronic therapy after CHF: furosemide, ACEI, ± beta blockers

38
Q

what is the prognosis for HCM?

A

asymptomatic 3-4 years
after CHF: 1-2 years
if ATE, very poor prognosis with very short survival

left atrial size and age decreases prognosis

39
Q

You have a 5yo Boxer named Tammy who presents for the complaint of “seizures”. She’s actually experiencing syncope multiple times a day. PE is normal. What is going on? How do you find out for sure?

A

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

ECG = gold standard, VPCs BUT these can be intermittent, so you need a holter monitor (12 hour read)

40
Q

what is arrhythmogenic right ventricular cardiomyopathy? who gets it? what happens? what is the usual chief complaint?

A

mainly an electrical disease. Boxers, 6-10 yr old

syncope

VPC’s on ECG, but these are intermittent so you need a 12hr ECG (Holter monitor)

522 (dog & cat class) (31 decks)

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