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VET 433c > Cardio/ Resp pt.3 > Flashcards

Cardio/ Resp pt.3 Flashcards

1
Q

4 types of antiarrhythmic drug classifications

A
  1. Na-channel Blockers
  2. Beta Blockers (B1)
  3. K-channel Blockers
  4. Ca-channel Blockers
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2
Q

Na-Channel Blockers

A
  • dec phase 0, phase 4 depolarization rate, and prolong action potential phase
  • mainly use type B (Lidocaine and Mexiletine)
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3
Q

Na-Channel Blockers (type B)

A
  • Lidocaine and Mexiletine
  • most important to us
  • works best on open channels (actively arrhythmic)
  • preference for ventricular
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4
Q

Beta-Blockers (antiarrhythmic)

A
  • negatively inotrope and chronotrope

- atenolol (B1)

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5
Q

K-Channel blockers (antiarrhythmic)

A
  • sotalol (can cross react with Beta blockers)
  • prolong effective refractory period
  • primary action is ventricle
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6
Q

Ca-Channel Blockers

A
  • effect greatest at sinus and AV nodes
  • Negative chronotrope, negative inotrope
  • diltiazem, verapamil
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7
Q

When to treat arrhythmias

A
  • patient is symptomatic
  • hemodynamically sig
  • complex rhythm
  • patients with high risk for sudden death
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8
Q

Treatment of ventricular arrhythmias (in hospital)

A
  • lidocaine (maybe CRI)
  • sotalol orally
  • procainamide (Na type A)
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9
Q

Treatment of ventricular arrhythmias (at home)

A
  • sotalol (K blocker)
  • mexiletine (Na type B)
  • atenolol (Beta Blocker)
  • fish oil supplementation
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10
Q

Treatment of supreventricular arrhythmias (in hospital)

A
  • vagal maneuver
  • diltiazem (Ca channel)
  • esmolol (beta blocker)
  • procainamide (Na type A)
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11
Q

Treatment of supreventricular arrhytmias (at home)

A
  • diltiazem
  • atenolol
  • digoxin
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12
Q

Treatment of a-fib

A
  • electrical cardioversion is temporary fix
  • diltiazem
  • digoxin
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13
Q

Treatment of Sick Sinus Syndrome

A
  • pacemaker is definitive therapy

Medical: methyxanthines (theophyline), beta agonists (terbutaline), anticholinergics

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14
Q

Treatment of AV Block

A
  • 1st and mobitz 1 –> treat underlying cause of vagal tone

- mobitz 2 and complete require emergency pacemaker

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15
Q

BOAS (brachycephalic obstructive airway syndrome)

A
  • considered to be 3 main primary components:
    1. Stenotic nares
    2. Elongated soft palate
    3. Hypoplastic trachea

Also includes secondary Everted Laryngeal Saccules

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16
Q

T/F: there are limitations to what surgery can achieve with BOAS

A

T

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17
Q

T/F: BOAS is a mechanical issue resulting in functional problems

A

T

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18
Q

Non-surgical anatomic aspects of BOAS

A
  • hypoplastic trachea (not collapsing)
  • Nasopharyngeal turbinates
  • redundant pharyngeal tissue
  • macroglossia
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19
Q

The most significant treatment ot a dynamically collapsing pharynx is _______

A

weight loss, 65% of dogs are overweight with it

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20
Q

Treatment of Stenotic Nares

A
  • wedge resection

- nares amputation (more painful and less good outcomes)

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21
Q

Laryngeal Collapse (stages)

A
  1. laryngeal saccule eversion
  2. corniculate process loses rigidity, medial displacement
  3. cuneiform process loses rigidity, medial displacement
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22
Q

Brachycephalic anesthesia

A
  • induction should be rapid
  • propofol or alfaxalone or iso for the shortest recovery possible
  • possible long intubation during recovery
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23
Q

Tracheal collapse anesthesia

A
  • extubate early to avoid airway irritation

- maintain with inhalent

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24
Q

Cardiac Biomarkers

A

NT-Pro BNP –> released in response to stress; false (+) can be a problem

Cardiac Troponin I –> important in myocarditis

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25
Q

Innocent Murmurs (characteristics)

A
  • should not exceed 3/6, persist past 16 wks, or be ass. w/ clinical signs
  • should all be systolic
  • may go away with change in posture
  • loud or continuous warrant further investigation
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26
Q

Young Dogs w/ Left Basilar Murmur

A
  • SAS (large breed)
  • PS (terriers)
  • physiologic murmur (stress, excitement)
  • relative aortic or pulmonic stenosis
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27
Q

Old, Small Dogs w/ Left Apical Systolic Murmur

A
  • 99% MMVD
  • Echo might not be necessary; take chest rads and systolic bp
  • NT pro BNP not useful
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28
Q

Middle Aged, Large Breed Left Apical Systolic Murmur

A
  • most likely DCM, possible early MMVP

- DCM requires echo diagnosis

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29
Q

Innocent Cat Murmurs

A
  • up to 75% of cats have them
  • requires an echo
  • consider VSD in young cats
    Diagnostic Testing:
    –> VPCs support HCM
    –> chest rads (cardiomegaly w/ LA enlargement)
    –> NTProBNP - HCM
    –> echo is gold standard
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30
Q

D. Immitis Life Cycle

A
  • Adults produce microfilaria
  • mosquito phase: MF ingested by mosquito and moves from L1-3
  • Tissue (SQ) phase: L3 (infective) transmitted, L3-4 (suscpetible to HW preventatives)
  • Blood Stream phase: L4 migrate to vasculature (resistant to treatment) -> L5 -> L5 migrate to pulm. artery -> mature to adult worms (6-7 months post infection)
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31
Q

What is the importance of Wolbachia sp on HW?

A

Larval molts are dependent on Wolbachia sp (intracellular gram (-) bacteria living w/in the worm

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32
Q

Key differences between canine and feline HWD (6 things)

A

Cats have:

  • unnatural host, innate resistance
  • incr abberant migration
  • much smaller worm burden
  • brief microfilaria
  • marked pulmonary reaction ( v sensitive)
  • lack of safe adulticidal therapy
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33
Q

Heartworm (pathophysiology)

A
  • severity relates to # and infection duration
  • live in the pulmonary artery
  • vascular +/- lung pathology occurs prior to L5 larvae ( before ability to detect)
  • inflammatory pulmonary edema (non-cardiogenic)
  • HARD in cats
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34
Q

T/F: heartworm causes cardiogenic edema

A

F; it causes an inflammatory edema

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35
Q

T/F: HARD (heartworm ass resp ds) refers to Larvae contributing to resp. signs despite resisting mature infection

A

T

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36
Q

Heartworm: Antigen vs antibody testing

A

Ag: (+) = HW (+); IDs adult females only

Antibody: ideal for cats d/t low worm count

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37
Q

T/F: What is the next step after a HW (Antigen +) reading?

A
  • do a blood smear or run it again to confirm it
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38
Q

Heartworm (treatment)

A
  1. Microfilariacide
  2. Wolbachia-cide
    - - wait 2-3 months –
  3. Adulticide (Melarsomine) –> not in cats
  4. Rest
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39
Q

What is caval syndrome

A

HW (+) and hemoglubinuria

it refers to such a severe infection that HWs now live in the right atrium and hemolyze the passing RBCs

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40
Q

Hypoventilation

A
  • an elevated PCO2

- either due to primary trauma or secondary to drugs

41
Q

Treatment of Hypoventilation

A
  • O2 therapy
  • Treat underlying cause
  • +/- positive pressure ventilation
42
Q

Management of Unstable Respiratory Distress Patient

A
  • O2
  • minimize stress
  • +/- physical exam
  • +/- thoracic ultrasound
  • consider empiric therapy
43
Q

Causes of Increased Respiratory Rate and Effort (8 causes)

A
  1. Upper airway dz
  2. Lower airway dz
  3. Pulmonary parenchymal dz
  4. Pleural space dz
  5. thoracic wall dz
  6. abdominal enlargement
  7. pulmonary embolism
    8 “look alikes”
44
Q

Upper Airway Disease (Recognition)

A
  • Noise (mainly on inspiration)
  • Stridor
  • Stertor
45
Q

Upper Airway Dz (management/ treatment)

A
  • reduce force of inspiration via sedation or active cooling
  • treat primary disease
  • if severe, then intubate and begin diagnostics
  • may require a temporary tracheostomy if dz is severe or will take long time to resolve
46
Q

Lower Airway dz (recognition)

A
  • resp distress
  • cyanosis
  • effort on exhalation
  • +/- wheezes and crackles
47
Q

Lower Airway dz (ER diagnosis)

A
  • history and PE
  • rads (bronchial pattern, hyperinflitation)
  • response to therapy
48
Q

Lower Airway dz (treatment)

A
  • minimize stress
  • Oxygen
  • +/- Sedation
  • ID exacerbating factor
  • bronchodilators (terbutaline, albuterol)
  • Allergy/ inflammation control
49
Q

Pulmonary Ebolism (presumtive diagnosis)

A
  • acute resp distress and hypoxemia
  • heartworm
  • any prothrombotic dz
50
Q

PE (treatment)

A
  • O2
  • anticoagulation (heparin, aspirin)
  • thrombolysis - therapy
  • resolve underlying disease
51
Q

Pneumothorax etiology

A
  • Traumatic

- Spontaneous

52
Q

Tension Pneumothorax

A
  • one way valve effect that causes pleural pressure > atmospheric pressure
  • rapid deterioration to cardiovascular collapse
53
Q

Pleural space disease (recognition)

A
  • increased resp rate and effort
  • discontinuous breathing pattern
  • abnormal auscultation
  • thoracic ultrasound
  • trauma patient
54
Q

Pleural Space Disease (treatment)

A
  • O2 therapy
  • +/- Sedation
  • Evacuate pleural space (tap or chest tube)
  • treat primary disease
55
Q

Indications for Chest Tube placement

A
  • pyothorax
  • pneumothorax
  • post op thoracotomy
56
Q

T/F: we aim to keep the tip of the chest tube in the cranioventral thorax

A

T

57
Q

Flail Chest

A
  • rib fractures of several adjoining ribs causing a free floating chest wall
  • Assess for pneumothorax and hemothorax and pulmonary contusions
58
Q

Flail Chest (treatment)

A
  • O2
  • stabilize flail segment
  • Thoracocentesis
  • Analgesia
  • (surgical stabilization)
59
Q

Indications for thoracocentesis

A
  • closed pneumothorax

- any form of pleural space disease

60
Q

Hypoxemia

A
  • PaO2 < 80mmHg

- severe is PaO2 < 60mmHg

61
Q

Hypoxemia (causes)

A
  1. Low inspired O2
  2. Hypoventilation ( on room air)
  3. Venous Admixture (low V/Q, no V/Q, anatomic shunts, diffusion defects)
62
Q

Pulm. parenchymal dz (causes)

A
  • pneumonia
  • edema
  • hemorrhage
  • neoplasia
63
Q

Pulm. Parenchymal dz (recognition)

A
  • History and PE (+/- crackles)
  • inadequate oxygenation
  • thoracic rads and ER ultrasound
64
Q

Pulm. Parenchymal dz (treatment)

A
  • O2
  • Sedation (big maybe)
  • +/- positive pressure ventilation
65
Q

Pneumonia (treatment)

A
  • abx
  • fluids
  • humidification
66
Q

Pulmonary edema (treatment)

A
  • cardiogenic vs non-cardiogenic

- furosemide for both probs

67
Q

Acute Respiratory Distress Syndome (ARDS)

A
  • result of a systemic inflammatory insult to the lung
  • Diagnostic criteria (acute onset, severe hypoxemia, diffuse alveolar infiltrates
  • Treat like pulm. parenchymal dz
68
Q

Pulm. Hemorrhage (causes)

A
  • contusions
  • coagulopathy
  • neoplasia
69
Q

Indications for pos pressure ventilation

A
  • severe hypoxemia despite therapy
  • severe hypoventilation despite therapy
  • excessive breathing effort
70
Q

Nasal Mites

A 
- pneumoyssoides caninum
CS: serous nasal discharge, (reverse) sneezing
Dx: visualization of the mites
Tx: ivermectin, selamectin
- probably spread via direct contact
71
Q

Nasopharyngeal Polyps

A
  • inflammatory fibrous tissue obstructing the nasal cavity, pharynx, or ear canal
  • Cats&raquo_space; dogs
  • young animals
72
Q

T/F: nasopharyngeal polyps can present with many different clinical signs such as aural, ear canal, nasal, or pharyngeal depending on the infiltrating location

A

T

- also nasopharynx so think stertor

73
Q

Nasopharyngeal Stenosis

A
  • tissue occluding the choanae (most often scarring)
  • congenital or acquired (rhintis, nasal regurg)
    CS: stertor, lack of nasal airflow
    Dx: CT + caudal rhinoscopy
    Tx: balloon dilation, stents
74
Q

T/F: the larynx is abducted by the circoarytenoideus and is solely innervated by the recurrent larygeal nerve (vagus)

A

maybe T;

also has sensory inervation by the ext. branch of the cranial laryngeal n.

75
Q

Laryngeal Paralysis (causes)

A
  • Acquired: idiopathic, myopathic, trauma

- Congenital: dalmations, other large breed dogs

76
Q

Laryngeal Paralysis (History and PE)

A
  • stridor
  • hyperthermia
  • resp. distress
  • proprioceptive placing deficits
  • excercise intolerance
77
Q

Laryngeal Paralysis (Dx)

A

Imaging (rule out aspiration and mass)

Laryngoscopy (assess all upper airway structures and r/o airway collapse (small breed))

78
Q

Laryngeal Paralysis (tx)

A
  • requires surgical tie back
  • sedation, O2, tracheotomy, cooling
  • weight loss
  • elevated feeding (to prevent asp. pneumonia)
79
Q

Laryngeal neoplasia

A
  • stridor, +/- abn laryngeal palpation
  • inspiratory distress
    Dx: rads/ ultrasound
    Tx: radiation, chemo, surgery
    Lymphoma and SCC common
80
Q

T/F: the dorsal meatus is connected to the cribriform plate while the ventral meatus is connected to the nasophary nx

A

T

81
Q

Nasal Trauma or FB

A
  • Acute disease
  • paroxysmal sneezing (maybe reverse)
  • unilateral discharge or epistaxis
  • pawing or rubbing @ face
  • normal airflow
  • can lead to aspergillosus
82
Q

Acute Feline URI

A
  • FHV-1, FCV, chlamydia, bordetella, mycoplasma
  • incubation period 2-10 days
  • shedding: 1day to 3 weeks post infection
83
Q

Feline URI (CS)

A
  • fever, malaise, anorexia
  • serous or purulent discharge
  • ptyalism (inc saliva)
  • dehydration
  • FCV (oral ulcers, lameness)
84
Q

Feline URI (Dx)

A
  • based on clinical signs and titers
85
Q

Feline URI (tx and prevention)

A

Tx: supportive care, systemic abx, opthalmic ointment
Prevention: improve husbandry (reduce stress), vaccine to limit clinical signs

86
Q

Rhinoscopy

A
  • used to examine caudal nasopharynx and rostral nasal cavities
87
Q

Chronic Rhino-sinusitis

A
  • any age of cat
  • partial response to abx
  • diagnosis via exclusion
  • PE: usually healthy w/ normal airflow
88
Q

Chronic Rhino-sinusitis (Dx)

A

Rads: bi/ unilateral turbinate lysis, asymmetry, lysis of vomer, inc fluid

Rhinoscopy: destructive rhinitis, hyperemia, mucu-purulent discharge

89
Q

Chrnoic Rhino-sinusitis (Tx)

A
  • consider empiric therapy for bacterial, mucus, inflammation
  • culture/ sens. then treat for 7 days post clinical sign resolution
90
Q

Canine Lymphoplasmacytic rhinitis

A
  • large breed dogs
  • mucopurulent discharge
  • poor response to therapy
91
Q

Tooth Root Abscess or oronasal fistula

A
  • difficulty eating or opening mouth
  • anorexia or drooling
  • facial amss
  • painful
  • +/- evident dental disease
92
Q

Nasal Fungal Infections

A

Canine –> Aspergillus

Feline –> Cryptococcus neoformans, C. gatti, asp is rare

93
Q

Nasal Aspergillosus

A
  • young, large breed, dolicephalic dogs
  • profuse mucoid/ bloody discharge
  • depigmentation
  • increased airflow
  • head shy/ painful
94
Q

List 2 nasal conditions that might make an animal head shy/ painful

A
  1. tooth root abscess
  2. nasal aspergillosus
  3. nasal tumor
95
Q

Nasal Aspergillosus (tx)

A
  • clotrimazole
  • enilconazole

–> give big infusions

96
Q

Cryptococcus (Hx, CS, tx)

A
  • older cats
  • Hx: sneezing, nasal mass, facial deformity, skin mass
  • CS: ulcerative craterous skin lesions, blindness, mand. lymphadenopathy, loss of nasal airflow,
  • Tx: itraconazole, fluconazole until (-) titer
97
Q

Nasal Tumors

A
  • older dogs and cats
  • large breed dolicephalics
  • often met to local lymph nodes but slow progression of dz
  • CS: epistaxis or nasal discharge, pain, sneezing, facial deformity
98
Q

Aspergillosus vs Nasal Tumor

A
  • loss of airflow possible with nasal tumor

- CT differences

VET 433c (6 decks)

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