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Flashcards in cardio Deck (223)
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1

located in the right atrium & contains clusters of pacemaker (P) cells

SA node

2

what is the setup for lead ii

right front leg (-) compared to left hind leg (+)

3

paper speed Multiply by 10 to determine bpm

25

4

Multiply by 20 to determine bpm

50

5

atrial depolarization

P wave

6

ventricular repolarization

T wave

7

ventricular depolarization

R wave

8

time between the end of
ventricular depolarization & the beginning of repolarization, normally isoelectric

ST interval

9

normal ms for QRS complex for dogs and for cats

dog <60ms, cat <40ms

10

what species is sinus arrhythmia normal for

brachycephalics

11

what is sinus arrhythmia

shorter on inspiration
longer on expiration

12

ECG with variable p wave amplitudes

wandering pacemaker

13

what are the 3 mechanisms of arrhythmia formation

1. disturbances of impulse formation
2. disturbances of impulse transmission
3. both

14

breeds that get SSS

miniature schnauzer, West Highland white terrier, dachshund, cocker spaniel

15

T/F
small breeds get A. FIB more commonly

FALSE - large breeds

16

cause of atrial standstill

hyperkalemia

17

what class drug is lidocaine

type 1 - sodium blocker

18

what class drug is atenolol

2 - beta blockers

19

sotalol is what type of drug

class 3 - potassium blocker

20

class 4 drug that is most common

diltiazem - ca channel blocker

21

first choice drug for supraventricular tachycardia

diltiazem

22

first choice drug for atrial fibrillation

diltiazem

23

first choice drug for VT

lidocaine - IV unstable patients

sotalol per os if stable

24

T/F
rhythm control is most common for tx of A fib

FALSE - rate control is

25

what is rate control

Slow conduction in the AVN to reduce the # of impulses reaching the ventricles

26

drug used for rate control

diltiazem

27

T/F
rate control Restores AV synchrony

FALSE - rhythm control does

28

what is the purpose of the atropine response test

To differentiate bradyarrhythmias caused by high vagal tone from bradyarrhythmias caused by structural heart disease

29

what does a positive atropine response test indicate

-- you will see sinus tachycardia, no pauses and no AV block

• Bradyarrhythmia was likely due to high vagal tone

30

what does a negative atropine response indicate

STRUCTURAL HEART DZ

31

what arrhythmias can be treated with a pacemakers

AVB: Atrioventricular Blocks (AVBs)
▪ High grade 2nd degree AV Block ▪ 3rd Deg AV Block

Sick Sinus Syndrome (the bradycardia requires Pacemaker)

PRIMARY Atrial standstill

32

a syndrome in which the heart is unable to meet the metabolic needs of tissues despite adequate venous return (VR)

heart failure

33

refers specifically to cardiac malfunction resulting in markedly increased
pulmonary venous and/or systemic venous pressures

CHF

34

backward HF patients are ___

wet -- due to effusion/edema

35

forward HF patients are ___

cold -- hypoperfusion

36

specifically to severe ventricular dysfunction resulting in poor tissue perfusion & arterial hypotension

low output heart failure

37

T/F
increased ventricular filling pressures will lead to pulmonary congestion and edema

TRUE

38

T/F
low output HF is always before CHF

FALSE -- other way

39

The amount of stretching of ventricular myocytes prior to contraction

preload

40

Determined by the quantity of blood that fills the ventricle (ie, end-diastolic volume)

preload

41

when preload increases contractility _____

increases

42

The tension acting on ventricular myocytes after the onset of myocyte shortening

afterload

43

what happens to stroke volume if the afterload increases

SV will decrease

44

The inherent ability of cardiomyocytes to contract

inotropy - contractility

45

when contractility increases -- stroke volume ??

increases

46

what are the acute responses to lower co and bp

decreases PSNS and increases SNS
- increased vasoconstriction, contractility, HR

47

concentric hypertrophy

pressure overload

48

eccentric hypertrophy

volume overload

49

cleaves angiotensinogen into angiotensin 1

renin

50

converts ang 1 into ang 2

ACE - from the lungs

51

what does angiotensin II do

increase the blood pressure by increases vasocontriction and SNS tone

52

what is a chronic effect of low CO and BP

RAAS activated because renal blood flow is low and the kidney is like hey make more volume

53

increases water and sodium resorption

aldosterone

54

triggers aldosterone

ang II

55

T/F
aldosterone desreases blood volume

FALSE - increases

56

T/F
the first sign of L-CHF in cats is a cough

false - they rarely cough

57

3 goals of HF therapy

1. relieve congestion
2. improve cardiac out put
3. prevent progression

58

how can congestion be relieved in HF

decrease ventricular filling pressure
diuretics - furosemide
venodilators to lower preload
increase forward flow - thoracocentesis

59

emergency dose furosemide in dog

2-4 mg/kg IV

60

emergency dose furosemide in cat

1-3mg/kgIV

61

Inhibit the Na/K/2Cl
cotransporter in the thick loop of Henle and helps excrete water

furosemide -- loop diuretic

62

K sparing and Cardioprotective weak diuretic

spironolactone

63

moa of ace inhibitors

dont let ang 1 go to ang ii

64

what are enalapril and benazepril

ACE i

65

drug of choice for hypertension in dog

ACEi - benazepril

66

nitroprusside is ____

vasodilator

67

Hydralazine is drug of choice for ______

hypertensive cats

68

drug of choice for hypertensive cats

Hydralazine

69

Hydralazine, amlodipine and Sildenafil are all what type of drug

vasodilator

70

positive inotrope and vasodilator used in HF

pimobendan

71

Suppress VPCs & vent tachy with this anti-arrhythmic positive inortope

digoxin

72

used in severe HF and cardiogenic shock - strong beta 1 receptor agonist

dobutamine

73

diltiazam ER dosage

Acute ER- 0.1mg/kg IV SLOW over 5 min

74

lidocaine emergency dose in dogs and cats

DOGS: 2 mg/kg IV SLOW over 2-3 min

CATS: 0.2 mg/kg IV SLOW

75

Chronic management vent tachy & other complex vent tachy

sotalol

76

T/F
vasodilators increase the afterload on the ventricles

false -- decrease

77

T/F
in HF patients should should restrict protein in the diet

FALSE -- PATIENTS will get CACHEXIA: loss of lean body mass (muscle not fat)

78

T/F
drug class of choice for a stressed patient is beta blockers

FALSE -- only use on stalble patients at home, not emergency cases

79

if split S2 is pathological what is it due to

it is due to pulmonary hypertension

80

what side of the heart is the tricuspid valve

RIGHT

81

what valve is at the apex beat

mitral

82

what are the valves doing at S1

AV closing while semilunar opening

83

What are the Valves doing at S2

Semilunar closing while AV opening

84

which is a higher pitch: S1 or S2

S2

85

this arrhythmia is usually due to hyperkalemia

atrial standstill -- no p waves

86

first step with cranial trauma

treat shock first

87

what type of shunt is seen in PDA

L-R

88

what type of shunt is seen in reversed PDA

R - L

89

what type of hypertophy is seen in PDA

vol overload -- eccentric

90

bichon or other toy breed dog with a continuous heart murmur

PDA

91

how do you treat PDA

surgical ligation

92

poodle with split S2 or no murmur, and cyanotic to paralysis hind legs

reversed PDA - not correctable

93

what is PDA

Ductus arteriosus remains patent after birth

94

what is SAS

Subaortic Stenosis -- when fibrous tissue builds in the subvalvular region

95

T/F
subaortic stenosis is not always present at birth

TRUE

96

Where is the obstruction with SAS

it obstructs blood flow from the LV to the aorta

97

type of overload and hypertrophy in SASA

pressure -- stenosis!!!!
concentric hypertrophy

98

what type of dogs typically get SAS

large and giant breed dogs

99

murmur with sas

Left basilar systolic murmur

100

you have a small breed puppy with a bounding femoral pulse and normal HR

PDA

101

SAS dogs are also at risk for what

sudden death due to vtach
endocarditis

102

Treatment for subaortic stenosis

not curable -- give cardioprotective drugs
give atenolol beta blocker to lower myocardial o2 demand

103

stenosis that obstructs blood flow from the right ventricle to the pulmonary artery

pulmonic stenosis

104

T/F
pulmonic stenosis is most common in cats

false - dogs

105

pulmonic stenosis overload and hypertophy

stenosis is always pressure
and RIGHT concentric!

106

murmur heard with pulmonic stenosis

L basialr systolic

107

ventricular septal defects are common in what animals

cats and spaniels

108

T/F
with VSD the larger the defect the louder the murmur

false - smaller defect = louder murmur

109

VSD blood flow

from LV to RV

110

VSD hypertophy

vol overload - left sided eccentrci

111

how can we tell the severity of the VSD

doppler

112

VSD tx

either banding sx or cardioprotective drugs

113

tricuspid valve dysplasia hypertrophy

vol overload and right sided eccentric hypertrophy

114

what murmur is heard in TVD

RIGHT apical systolic Murmur

115

TVD is common in what animals

cats and labs

116

most common issue with mitral valve dysplasia

mitral regurg

117

what side is the mitral vavle

left

118

what side chf can be seen with mitral valve dysplasia

left

119

T/F
in mitral valve dysplasia there is RV outflow tract obstruction

FALSE - left ventricle bc the mitral vavle is on the left

120

when stenosis is present during MVD what is seen

the LA is dilated & the LV is small -- you could use a thoracic radiograph to see this but an echo is still best ddx

121

Atrioventricular septal defects are common mostly in what animal

cats

122

T/F
Atrioventricular septal defects have a really good prognosis if you give drugs

FALSE - they will die sorry... CHF and sudden death likely

123

what are the four parts of Tertalogy of fallot


1. Pulmonic stenosis
2. Secondary concentric
hypertrophy of the right
ventricle
3. Overriding aorta
4. Ventricular septal def

124

MOST common cause of
cyanotic heart disease in cats & dogs

tetralogy of falloy

125

what type of shunt is seen in ToF

Right to left -- reason for the cyanosis (remember reversed PDA is the same )

126

Vascular ring anomaly (VRA) characterized by persistence of the right fourth aortic arch during fetal development

persistent right aortic arch - megaesophagus

127

low grade systolic murmur that will go away by 6 months old

innocent

128

in degenerative valve disease this valve gets the most effected

mitral

129

what breed is genetically predisposed to DVD

king charles spaniels

130

what murmur would you hear if there is degenerative valve disease ?

LEFT apical systolic murmur due to the mitral regurg

131

T/F
thoracic rads are good for R-CHF

no ...
left

132

dog with genetic predisposition to DVD but is not showing signs is what stage

A -- just monitor

133

dog that is asymptomatic but may have signs of a structural heart disease like a murmur or history of a murmur and there is not sign on the echo or radiographs of cardiogenic remodeling

B1

134

dog that is asymptomatic but may have signs of a structural heart disease like a murmur or history of a murmur and there is valve regurg seen on dx tests

B2

135

patients with past or current clinical signs of heart failure associated with structural heart
disease are what stage DVD

C

136

DVD stage: patients with end-stage disease with clinical signs of heart failure caused by degenerative
valve disease that are refractory to ‘‘standard therapy”

D - for death

137

diastolic dysfunction heart disorder in cats where the ventricle wall stiffness increased a lot

HCM

138

what cats get HCM

rag doll
maine coon
DSH

139

kitty cat with a left sided murmur, gallop heart beat, high BNP on test results, and dyspnea

HCM

140

what is a severe complication in HCM

ATE - saddle thrombus, cold back legs

141

diastolic dysfunction in cats but the ventricle walls do not increase in thickness they are just not compliant

RCM

142

RCM/HCM antithrombic drug?

clopidogrel

143

dilated cardiomyopathy is common in what type of dogs

big dogs
dobermans
Cocker, Portuguese, Manchester, dane

144

what is the dysfunction in DCM

Primary ventricular systolic dysfunction

145

what type of hypertophy is in dilated cardiomyopayhy

eccentric due to volume overlaod

146

in cats what should you check for to monitor for DCM

taurine and BNP ?

147

what are the genetic mutations in doberman for DCM

PDK4 & NCSU DCM 2 mutation

148

asymptomatic stage of DCM

occult

149

symptomatic stage of DCM

overt

150

what arrythmias are common in DCM


-A fib/ V-tach/VPCs common -Sudden death

151

T/F
Dogs cannot die from DCM

FALSE - sudden death is common and may be the first sign in some dogs -- from V tach

152

what type of murmur would you hear in DCM

LEFT apical systolic murmur

153

what type of heart failure is in DCM

low output HF

154

what is the cure for DCM

nothing ... but you can give
Benazepril & pimobenden to slow the progression

diltiazem and digoxin if dog is in a fib

155

Arrhythmogenic Right ventricular cardiomyopathy is a mutation in what gene

striatin

156

T/F
Arrhythmogenic Right ventricular cardiomyopathy is diastolic dysfunction

FALSE -- systolic

157

T/F
Arrhythmogenic Right ventricular cardiomyopathy is common in the right ventricle

true..... look at the name???

158

Arrhythmogenic Right ventricular cardiomyopathy most commonly affects this breed of dog

BOXER

159

owner comes in like hey my boxer is tired AF

Arrhythmogenic Right ventricular cardiomyopathy

160

histologic findings of Arrhythmogenic Right ventricular cardiomyopathy

fatty infiltration, myocyte vacuolization, myocyte loss

161

what is a good way to monitor a boxer for Arrhythmogenic Right ventricular cardiomyopathy

24 hour holter monitor looking for Electrocardiogram: VPCs originating from right ventricle are upright and lead II (>1000 VPCs)

162

drug of choice for Arrhythmogenic Right ventricular cardiomyopathy

sotalol -- mexiletine if that doesnt work

there can still be sudden death

if it has type 3 with all the problems:
ARVC + systolic dys (type 3):
-ace inhib
-pimobendan
- furosemide/ spirolactone

163

MOST common pericardial disorder dog/cat

pericardial effusion

164

when IPP > ICP

diastolic filling pressure will decrease
CARDIAC TAMPONADE --- this is an emergency

165

what is the first step when you detect cardiac tamponade

pericardiocentesis

166

you have a doggo with a lot of pericardial effusion and you wanna get that fluid to go away, you also have detected cardiac tamponade so you grab furosemide to help get rid of the effusion

FALSEEEEE -- diuretics are not ok with tamponade plz no

167

what is seen on the ECG with pericardial efffusion

alternans- tall short tall short

168

T/F
lactate decreases in pericardial effusion

false - increased

169

test to confirm dx of PE

FAST

170

what is the cause of degenerative mitral valve disease

unknown

171

Dog w/ CHF due to ______ have arteriosclerosis of intramural coronary arteries & myocardial fibrosis

degenerative mitral valve disease

172

what do you use to treat stage B2 and stage C of DMVD

ACE inhibitor (enalapril)/ pimobendan
and maybe some spironolactone a few weeks later

173

characterized by moderate or severe left atrial enlargement*

left sided cardiomegaly

174

what should the sleeping RRR be at home

<30
if greater than 30 start being concenred

175

know the rib method

sydney texted it

176

heart murmur caused by tricuspid valve regurg

Right sided CHF (think about it- you move to the right of the chest to hear tricuspid!) o +/-leftapicalsystoilcmurmur

177

occursbecausepapillarymusclehypertrophyleadstodisplacementof
chordae tendineae into the LV outflow tract (LVOT)

SAM -- systolic anterior motion of the mitral valve

178

why do some cats with HCM not have a murmur

the blood is flowing normally unless there is SAM or DLVOTO -- no turbulence = no murmur

179

what do cats with ATE need for treatment

ANALGESIA - this is painful
antithrombotic - heparin or clopagril
supprtive tx

180

4 causes of physiologic murmurs in cats

• Dynamic right ventricular outflow tract obstruction (DRVOTO)
• Anemia
• Hyperthyroidism
• Fever

181

Differential Diagnoses –LV Concentric Hypertrophy

Aorticstenosis
Systemic hypertension
Hyperthyroidism
Acromegaly
lymphoma

182

why are these important
Differential Diagnoses –LV Concentric Hypertrophy

must rule all out before saying it is HCM

183

main drug in HF to increase contractility

pimobendan

184

the dilation in DCM occurs secondary to ??

systolic dysfunction

185

drugs given to treat the occult stage of DCM

Benazepril & pimobendane (B-blocker theoretically beneficial)

186

prognosis for occult DCM, and the prognosis once HF develops

for occult - this is asymptomatic and they could have 4-5 years until heart failure develops
once develops it is poor to guarded and they could die from sudden death

187

boxers get this most

ARVC

188

what does the heart look like grossly in ARVC

normal

189

most common arrhythmia associated with ARVC

ventricular tachycardia

190

normally the first choice anti-arryhthmic drug to treat ARVC

sotalol - this is a class 3 potassium channel blocker
it also will not affect the GI so no upset tummy

191

allows pericardial sac to stretch with slow fluid accumulation

fibroelastic properties

192

s long as the_____ <

intrapericardial pressure (IPP) is < intracardiac pressure (ICP)

193

most common location of heart affected by Hemangiosarcoma

right atrium/auricle most common

194

number one cause in dogs of pericardial effusion

neoplasia -- hemngiosarcome

195

features of PPDH on thoracic radiograph

Enlarged cardia silhouette, different opacities, globoid

196

order of conduction through the heart

SA
AV
Bundle HIs
Bundle branches
purkinje fibers

197

head tilt towards lesion, no CP deficits, HORIZ nystagmus slow toward, fast away. CN7,8

peripheral vestibular dz

198

ipsilateral, CP deficits, cranial nerve def. VERT/HORIZ nystagmus, toxic, hypoTh, CN2,3

central vestibular dz

199

when vesstibular dz is Lesion on Left, CP deficits on Right

paradoxical

200

T/F
cat with cerebellar hypoplasia will have CP deficits and lower reflexes

FALSE -- just ataxia

201

Tx acute seizures
Tx seizures long

diazepam - acute stop
phenobarb always

202

drug to help drain brain edema

mannitol

203

– focal hemorrhage and edema, possible CP deficits

contusion

204

4 differentials for wide QRS

1. Hyperkalemia
2. Bundle Branch Blocks
3. Ventricular Tachycardia
4. Ventricular Premature Complex

205

hypercalcemia arrythmias

raises AP threshold, bradycardia, shorter QT, VPCs

206

hypocalcemia arrhythmias

more in skeletal muscle, lowers AP threshold, longer QT

207

hypokalemia arrythmias

prolongs repolarization, VPCs, APCs, lowers RMP

208

hyperkalemia arrhythmias

tented T waves, wide QRS, long PR interval, absent P wave, V-fib, PEA/EMD

209

High end diastolic pressure in the RV - what side HF

R- CHF

210

lowered forward stroke volume = what side HF

L - CHF

211

T/F
L-CHf results in hypertension

false - hypotension

212

T/F
When an electrical impulse moves toward the positive pole, there will be an upward deflection on the ECG

TRUE

213

AV association

Same impulse depolarizes; P for every QRS complex

214

T/F
Both hyperkalemia and hypercalcemia can give you tachycardia

FALSE -- both would give a bradycardia

215

Tx for AIVR

none

216

3 drugs that will increase contractility of heart

pimobendan
digoxin
dobutamine

these all have positive inotope effedcts

do not use in stenosis problems -- contractility is already too high

217

VSD murmur

systolic right murmur

this is a L-R shunt

218

DCM is _____ dysfunction and _____ contractility

systolic
decreased

219

ECG findings expected with DCM

a fib
VPCS

220

type of hypertrophy in HCM

LV concentric

221

most common cause of PE in cats

R-CHF

222

what breed commonly gets Chemodectoma

bulldogs

223

bartonella primarily affects this valve

aortic valve