Cardiology (1-9) Flashcards by Natalie Bubenheim

Q

in canine cardiac cases, what is a cough commonly due to?

A

left atrial enlargement

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Q

is it common for cats to cough with cardiac disease?

A

no

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Q

what clinical sign is commonly seen with congestive heart failure (CHF) in cats and dogs

A

dyspnoea

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Q

dyspnoea is commonly seen in left congestive heart failure (CHF) due to what?

A

pulmonary oedema

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Q

dyspnoea is commonly seen in right congestive heart failure (CHF) due to what?

A

pleural effusion

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Q

what is pleural effusion in cats commonly caused by?

A

left congestive heart failure (CHF)

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Q

what type of activity can prolonged hypoxia cause?

A

seizure-like activity

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Q

what blood test assesses myocardial damage?

A

troponin-1

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Q

what blood test assesses myocardial stretch?

A

Pro-BNP

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Q

name 6 factors that affect the quality of thoracic radiographs

A

phase of respiration
view
rotation
exposure factors
developing
obesity

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Q

what vertebrae do you measure the vertebral heart score (VHS) from?

A

T4

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Q

what should the vertebral heart score be?

A

less than or equal to 10.5

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Q

name 3 types of blood pressure measurements

A

direct
oscillometric
doppler

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Q

name the heart disease

chronic activation of the compensatory systems (RAAS, sympathetic system, vasopressin, endothelin, etc) leads to fluid retention and cardiac remodelling

A

congestive heart failure (CHF)

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Q

name the stage of heart failure - MMVD (myxomatous mitral valve disease)

genetic predisposition but no structural changes

A

stage A

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Q

name the stage of heart failure - MMVD (myxomatous mitral valve disease)

no clinical signs, murmur, no clinically significant cardiomegaly

A

Stage B1

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Q

name the stage of heart failure - MMVD (myxomatous mitral valve disease)

no clinical signs, murmur, cardiomegaly (EPIC)

A

Stage B2

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Q

name the stage of heart failure - MMVD (myxomatous mitral valve disease)

past or current clinical signs of congestive heart failure (CHF)

A

Stage C

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Q

name the stage of heart failure - MMVD (myxomatous mitral valve disease)

severe refractory CHF

A

Stage D

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Q

what drugs can be used to treat heart failure by decreasing preload?

A

diuretics

(furosemide, torasemide, spironolactone)

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Q

name 3 diuretics that can be used to decrease preload

A

Furosemide
Torasemide
Spironolactone

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Q

what drugs can be used to treat heart failure by decreasing afterload?

A

vasodilators

(ACEi, pimobendan)

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Q

name 4 types of vasodilators that can be used to decrease afterload

A

ACEi
inodilators
nitric oxide donors
Ca2+ channel blockers

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Q

name the 5 step approach to an acute case of left-sided CHF (congestive heart failure)

A

oxygen and cage rest
IV furosemide
IV pimobendan (licensed for dogs only)
sedation if distressed
thoracocentesis (cats)

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name the 3 step approach to an acute case of right-sided CHF (congestive heart failure)

1. thoracocentesis (dog) if dyspnoeic 2. abdominocentesis 3. treat underlying cause

what is the standard treatment for a chronic case of congestive heart failure (CHF) in dogs (4 drugs)

1. furosemide 2. pimobendan 3. ACEi 4. Spirinolactone

what is the standard treatment for a chronic case of congestive heart failure (CHF) in cats (3 parts)

1. furosemide 2. clopidogrel 3. +/- thoracocentesis

name the 3 categories of diuretics

1. loop diuretics 2. K+ sparing 3. hydrochlorthiazies

# name the diuretic potent diuretic; fast onset of action; inhibits K+/Na+/2Cl- pump in thick ascending loop of Henle; highly protein-bound, NOT filtered! needs to be secreted into tubule for its action

furosemide

what drug should be used with furosemide due to side effect of activating RAAS further

ACEi

name 6 side effects of furosemide

1. hypokalaemia, hyponatraemia 2. activates RAAS further 3. hypocalcaemia, hypomagnesaemia 4. metabolic alkalosis 5. excessive dehydration 6. can aggravate azotaemia

# name the diuretic weak diuretic, end DCT; competitive antagonist of aldosterone R; slow onset of action (days); improved absorption with food; effects on myocardial fibrosis

spironolactone

# name the diuretic weak diuretic, end DCT; inhibits Na+ channel in DCT; combined with hydrochlorthiazide

amiloride

# name the diuretic inhibit the Na+/Cl- cotransporter in DCT; better diuretic than K+ sparing; oral formulation (8-12h duration); slow onset of action (12h); side effects: hypokalaemia, hyponatraemia, hypochloraemia

hydrochlorothiazide

# name the vasodilator blocks conversion to Angiotensin II (RAAS activated in CHF)

ACEi

name 2 ACEi drugs that can be used to decrease afterload in CHF

1. Benazepril 2. Enalapril

# name the vasodilator inodilator - positive inotrope (calcium sensitiser); phosphodiesterase III inhibitor (peripheral vasodilation); phosphodiesterase V inhibitor (pulmonary hypertension)

pimobendan

# name the vasodilator acute management of LCHF in dogs; glyceryl trinitrate (Percutol cream) & Sodium Nitroprusside; mediates vasodilation through cGMP

nitric oxide donors

# name the drug used for inotropic support in patients with acute HF, septic shock; used to support myocardial function during GA; synthetic beta1 adrenergic agonist; can induce arrhythmias caused by intracellular calcium overload

Dobutamine

# name the drug weak positive inotropy (use in DCM in dogs); negative chronotropy (antiarrhythmic in dogs); from Digitalis purpurea (foxglove); blocks Na+/K+ ATPase leading to incr. intracellular Na+

Digoxin

name the 3 most common congenital cardiac diseases in dogs

1. subaortic stenosis 2. pulmonic stenosis 3. patent ductus arteriosus

name the 2 more common congenital cadiac diseases in cats

1. ventricular septal defects 2. atrioventricular valve dysplasia

name 5 dog breeds that are predisposed to subaortic stenosis

1. boxers 2. newfoundland 3. GSD 4. golden retrievers 5. rottweiler

name 3 clinical findings on physical exam that indicate subaortic stenosis

1. sytolic murmur 2. PMI left heart base 3. poor pulse quality

what should be used to diagnose subaortic stenosis

echocardiography

what breed is most commonly predisposed to pulmonic stenosis

bull dogs | (but also several breeds)

name 1 clinical finding on physical exam that may indicate pulmonic stenosis

1. systolic murmur (left heart base)

what should be used to diagnose pulmonic stenosis in a dog

echocardiography

what 2 signs of pulmonic stenosis may be seen on radiographs

1. right-sided enlargement 2. post-stenotic dilatation

what direction of shunting is the most common in patent ductus arteriosus (PDA)

left to right shunting

name 3 clinical findings on physical examination that may indicate a PDA

1. continuous "machinery" murmur 2. "water-hammer"/bounding pulse 3. PMI left base

what 2 signs of PDA are usually seen on radiographs

1. left-sided enlargement 2. pulmonary overcirculation

what is the treatment for a PDA

closure of the PDA

what dog breed is most predisposed to mitral valve dysplasia

english bull terriers

what sign of mitral valve dysplasia may be seen on radiographs

left-sided enlargement

name 2 signs of mitral valve dysplasia that may be seen on electrocardiography

1. left atrial enlargement 2. left ventricular enlargement

what does mitral valve dysplasia lead to

left-sided congestive heart failure

what does tricuspid valve dysplasia lead to

right-sided congestive heart failure

what breed is the mose predisposed to tricuspid valve dysplasia

labradors

what sign of tricuspid valve dysplasia may be seen on radiographs

right-sided enlargement

name 2 signs of tricuspid valve dysplasia that may be shown on electrocardiography

1. right-sided enlargement 2. splintered QRS

what direction of shunting is most common in a ventricular septal defect

left to right shunting

what breed is the most predisposed to ventricular septal defect

english springer spaniel (and cats!)

name 2 signs of ventricular septal defect that may be seen on radiographs

1. left (+/- right) enlargement 2. pulmonary overcirculation

is the systolic murmur louder with a smaller or bigger ventricular septal defect

louder with smaller hole

what 3 things does stenisus cause

1. pressure overload 2. concentric hypertrophy 3. forward and backward failure

what 3 things do leaks and holes in the heart cause?

1. volume overload 2. eccentric hypertrophy 3. backward failure

what is the most common cardiac disease in dogs?

myxomatous mitral valve disease (MMVD)

# name the cardiac disease the basic, thin, mitral valve structure is disrupted and distorted by expansion of the matrix of the spongiosa; the valve leaks leading to a systolic murmur

myxomatous mitral valve disease (MMVD)

how does age affect myxomatous mitral valve disease (MMVD)

severity and leak increases with age

as preload increases, which part of the heart enlarges?

left atrium

which part of the heart enlarges with eccentric hypertrophy?

left ventricle

a leakly mitral valve causes volume overload which eventually leads to what kind of heart failure?

left-sided congestive heart failure

# backward or forward heart failure signs? 1. cough 2. dyspnoea 3. abdominal distension

backward failure signs

# backward or forward heart failure signs? 1. exercise intolerance 2. lethargy 3. syncope

forward failure signs

which comes first in myxomatous mitral valve disease (MMVD), backward or forward failure signs?

backward failure signs

name 2 biomarkers from blood samples that can aid management and diagnosis of congestive heart failure

1. Troponin-I 2. NT-proBNP

# name the biomarker released according to atrial stretch and ventricular wall stress

pro-BNP

what diagnostic is required in order to diagnose left-sided congestive heart failure?

chest radiograph

acute presentations of congestive heart failure in a dog with MMVD is often due to the rupture of what structure?

chordae tendinae rupture | (less likely: left atrial rupture)

name the 4 drugs/therapies used to treat acute congestive heart failure

1. Furosemide IV 2. Oxygen 3. Nitroglycerine ointment 4. Pimobendan | (reach for phone, then have a pee)

if you have to choose, what are the 2 most important drugs for treating congestive heart failure

furosemide + pimobendan

name two predictors of congestive heart failure; increase in the 4 months before stage C of failure

1. incr. HR 2. incr. RR | (BW decreases by 3%)

the valves on which side of the heart are affected by bacterial endocarditis?

left side

name the 2 commonest sites of bacterial endocarditis in dogs & cats

1. mitral valve 2. aortic valve | (left side of heart)

name 4 non-specific signs of malaise that dogs with bacterial endocarditis typically present with

1. pyrexia 2. joint stiffness 3. new murmur 4. diastolic murmure over left heart base

what is the treatment for bacterial endocarditis?

supportive care and antibiotics

what 3 signs should be seen in a chest radiograph to diagnose CHF (congestive heart failure) in dogs with MMVD (myxomatous mitral valve disease)?

1. left atrial/auricular enlargement 2. pulmonary venous congestion 3. peri-hilar pulmonary oedema

what chemotherapy drug can cause secondary DCM (dilated cardiomyopathy)

Doxorubicin

name 3 nutritional causes of secondary DCM (dilated cardiomyopathy)

1. taurine deficiency 2. carnitine deficiency 3. "BEG" diets

what is the main histopathological feature of DCM (dilated cardiomyopathy)

wavy myocardial fibres

what value should always be measured to aid in diagnosis, prognosis and management of DCM (dilated cardiomyopathy)

T4/TSH

what makes the definitive diagnosis of DCM (dilated cardiomyopathy)

echocardiography

is echocardiography necessary to diagnose myxomatous mitral valve disease (MMVD)?

no, can diagnose with just stethoscope

what drug can be used to incr. contractility and prolong pre-clinical period of DCM (dilated cardiomyopathy) | (does not cure it)

Pimobendan | (PROTECT study)

what drug can be used to treat atrial fibrillation?

digoxin

name 2 postitive inotropes that can be used in acute management of DCM (dilated cardiomyopathy)

1. pimobendan 2. dobutamine

name the 4 drugs that should be used for chronic management of DCM (dilated cardiomyopathy) with congestion

1. furosemide 2. pimobendan 3. ACE inhibitor 4. Spironolactone

name 3 dog breeds that must be warned of sudden death with DCM (dilated cardiomyopathy)

1. Dobermans 2. Boxers 3. Great Danes

what is the most common cardiac disease in cats?

hypertrophic cardiomyopathy (HCM)

# name the subtye of HCM when dynamic left ventricular outflow tract obstruction occurs with HCM (hypertrophic cardiomyopathy)

HOCM (hypertrophic obstructive cardiomyopathy)

what type of heart failure does HCM (hypertrophic cardiomyopathy) in cats lead to?

left-sided congestive heart failure

what heart sound in a cat usually suggests cardiac disease?

gallop sound | (murmur does not always mean cardiac disease in cats)

what diagnostic exam is superior to radiography in dyspnoeic cats?

T-POCUS | (stress can cause sudden death in cats with heart disease)

name the 2 drugs used to treat HCM (hypertrophic cardiomyopathy) in cats with chronic congestive heart failure

1. furosemide/torasemide 2. clopidogrel

# name the form of restrictive cardiomyopathy normal LV wall thickness; fibrosis of myocardium

myocardial form

# name the form of restrictive cardiomyopathy thick endocardial scar that may bridge LV lumen

endomyocardial form

# name the feline emergency Presentation: acute onset, severe pain; paresis of hindlimbs, cyanotic pads, cold limbs, no pulse; up to 66% CHF - dyspnoea

feline aortic thromboembolism

what type of pain relief should be given to a cat with feline aortic thromboembolism

IV opioids

in the FAT cat study, what drug was able to outperform aspirin as an anti-thrombotic agent?

clopidogrel

# name the disease inflammation of the heart muscle

myocarditis

name 4 causes of myocarditis

1. infectious 2. neoplasia 3. toxins 4. immune-mediated

what value will be highly elevated in a patient with myocarditis

troponin (cTnl)

is heart failure typically systolic or diastolic in dogs?

systolic

is heart failure typically systolic or diastolic in cats?

diastolic

name the 2 main causes of pericardial disease

1. idiopathic 2. neoplastic

what breeds commonly have idiopathic pericardial disease?

1. golden retrievers 2. giant breeds

name 5 neoplastic causes of pericardial disease

1. right atrial haemangiosarcoma 2. chemodectoma 3. thyroid carcinoma 4. mesothelioma 5. lymphoma

what diagnostic gives the definitive diagnosis of pericardial disease?

echocardiography

name 5 key diagnostic findings of pericardial disease that can be seen with echocardiography

1. black fluid stopping at heart base 2. pleural effusion 3. neoplasm 4. ascites 5. distended caudal vc & hepatic vv

why is congestive heart failure (CHF) therapy contra-indicated in pericardial disease treatment?

filling is already compromised

name 3 treatment options for pericardial disease

1. pericardiocentesis 2. sub-total pericardiectomy 3. balloon pericardiotomy (palliative)

what side of heart failure does pericardial effusion cause

right-sided heart failure

what is the best therapy for canine pericardial disease

pericardiocentesis

where do adult Angiostrongylus vasorum live in dogs?

in pulmonary arteries

name 3 respiratory signs in a dog with Angiostrongylus vasorum

1. coughing 2. haemoptysis 3. dyspnoea

name 3 post mortem findings that diagnose Angiostrongylus vasorum

1. nematodes in airways and vessels 2. R ventricular hypertrophy 3. thromboembolic lesion

name 2 definitive diagnostic tests for Angiostrongylus vasorum

1. ELISA antigen test (Angio Detect test) 2. Baermann analysis (faecal test)

name 3 haematology signs of Angiostrongylus vasorum

1. eosinophilia 2. thrombocytopenia 3. anaemia

name 4 treatment options for Angiostrongylus vasorum

1. Fenbendazole 2. Milbemycin 3. Moxidectin spot-on 4. Selamectin spot-on

which lungworm is more common in north UK

Crenosoma vulpis

# name the parasite the spaghetti worm; large, white-ish worm; females 30cm, males 23cm w/ spirally coiled tail; mosquito is intermediate host

Dirofilaria immitis

what is the primary clinical sign of Dirofilaria immitis

coughing

name 5 haematology signs of Dirofilaria immitis

1. eosinophilia 2. neutrophilia 3. basophilia 4. anaemia 5. lymphopenia

what is the definitive diagnostic test for Dirofilaria immitis

Heartworm antigen test (female only antigen)

name 3 treatments for Dirofilaria immitis in dogs

1. doxycycline 2. larvaicidal 3. melarsomine hydrochloride

in what case is direct removal of Dirofilaria immitis (heartworm) performed?

caval syndrome

what treatment for Dirofilaria immitis can be used in dogs but is toxic to cats

melarsomine

name 4 preventative treatments for Dirofilaria immitis

1. ivermectin 2. selamectin 3. milbemycin oxime 4. moxidectin

what is the preventative protocol for Dirofilaria after a trip duration <1 month

single treatment when back in UK

what is the preventative protocol for Dirofilaria after a trip duration >1 month

first treatment w/in 30 days of arrival at destination, then monthly thereafter & for 30 days after return to UK

list the 3 types of cells of the heart in order of most to least automaticity

1. SA node (60-160/min) 2. AV node (40-60/min) 3. Perkinje cells (20-40/min)

where is electrical activity of the heart generated?

sinoatrial node

name the 6 parts of the conduction system of the heart in order

1. sino-atrial node (SA) 2. special tracts (ST) 3. Atrial ventricular node (AV) 4. bundle of His (H) 5. Purkinje fibres (PF) 6. ventricular muscle (VM)

name the 6 key anatomical elements that contriibute to the ECG

1. spontaneous SA node 2. atrial myocardiu 3. insulating annulus fibrosus 4. slowly conducting atrioventricular (AV) node 5. rapidly conducting purkinje fibres 6. ventricular myocardium

what is a normal beat on an ECG called?

sinus beat

what does the P wave represent on an ECG?

atrial depolarisation

what does the PQ interval represent on an ECG?

delay at AV node

what does the QRS complex represent on an ECG?

ventricalar depolarisation

what does the T wave represent on an ECG?

ventricular repolarisation

what 3 things soes an ECG tell you about?

1. rate 2. rhythm 3. conduction

how should the animal be positioned to record an ECG?

R lateral recumbency

what 4 things should be labelled on ECG tracings

1. name/number 2. date 3. paper speeds 4. callibration mark

where does the red lead of an ECG go? | (UK)

Right fore (above point of elbow)

where does the yellow lead of an ECG go? | (UK)

Left fore (above point of elbow)

where does the green lead of an ECG go? | (UK)

Left hind (above the stifle)

where does the black lead of an ECG go? | (UK)

Right hind (above the stife)

this causes regular baseline oscillations at 50Hz on an ECG

AC interference

what type of oscillations do muscle tremors cause on an ECG?

coarse, disorganised oscillations

what does limb movement cause on an ECG?

single, well-defined deflections

how to determine the heart rate from an ECG at 25 mm/s

1. count number of QRS complexes in 15cm 2. multiply by 6 (6 seconds at 25mm/s)

how to determine the heart rate from an ECG at 50 mm/s

1. count the number of QRS complexes in 15cm 2. multiply by 20 (3 seconds at 50 mm/s)

if the impulse generating the QRS starts off above the annulus, how will the QRS complex look on ECG

tall and narrow

if the impulse generating the QRS starts off below the annulus, how will the QRS complex look on ECG?

wide and bizarre

what does a wide P wave on ECG indicate?

LA enlargement

what does a tall P wave on ECG indicate?

RA enlargement

what does a wide QRS complex on ECG indicate?

LV enlargment or LVBBB

what does a tall QRS complex on ECG indicate?

LV dilation/hypertrophy

what does a small QRS complex on ECG indicate?

effusions, obesity, hypothyroidism

what does alternating R waves in QRS complex on ECG indicate?

pericardial effusion

what does a deep S wave on ECG indicate?

RV enlargement or left anterior fascicular block

what does a wide S wave on ECG indicate?

RBBB

what does a prolonged QT on ECG indicate?

electrolyte disturbances, hypothermia

what does an elevated/depressed ST on ECG indicate?

hypoxial, artifacts

where does supraventricular premature complex start off?

above annulus (tall & narrow QRS)

# name the type of arrhythmia 4 or more consecutive SVPCs; the R-R interval is regular

supraventricular tachycardia

# name the type of arrhythmia results from multiple re-entrant circuits above the annulus; narrow QRS tachycardia with no P waves and irregular R-R intervals

atrial fibrillation

where do ventricular premature complexes (VPCs) start off from? they are wide, bizarre and appear earlier than expected

below annulus

what is R-on-T on an ECG a risk factor for? (when there is no flat baseline between 2 complexes)

ventricular fibrillation

# name the type of arrhythmia 4 or more consecutive VPCs and is life-threatening

ventricular tachycardia

# name the type of arrhythmia quick, but not fast enough to be a ventricular tachycardia

accelerated idioventricular rhythm

# name the type of arrhythmia the PQ interval is long but the AV still conducts

1st degree AV block

# name the type of arrhythmia some P wavs are conducted, some are not

2nd degree AV block

what is Mobitz type 1 (2nd degree AV block) mediated by?

vagally mediated

what is Mobitz type 2 (2nd degree AV block) due to?

pathology

# name the type of 2nd degree AV block the PQ varies or lengthens before the block

Mobitz type 1

# name the type of 2nd degree AV block the PQ interval is constant when a P wave conducts

Mobitz type 2

# name the type of arrhythmia no P waves are conducted, and escape beats come from below the annulus; P waves are superimposed on QRS complexes

3rd degree AV block

# name the type of arrhythmia there is a pause in the P waves greater than 2 R-R intervals, but there are still P waves

sinus arrest

# name the type of arrhythmia there are no P waves at any point on the ECG tracing

atrial standstill

# name the type of arrhythmia a sinus rhythm with beat-to-beat variation in the height of the R waves; often due to pericardial effusion

electrical alternans

# name the type of arrhythmia sinus rhythm with a deep S wave on leads 1, 2, and 3

right ventricular enlargement pattern

# name the type of arrhythmia a sinus rhythm with a deep S wave on leads 2 and 3 but not lead 1 (usually in cats only)

left anterior fascicular block

# name the type of arrhythmia combines supraventricular tachyarrhythmias with bradydysrhythmias

sick sinus syndrome

# name the type of arrhythmia uncoordinated, incessant ventricular activity; looks like a scrawl and requires DC cardioversion

ventricular fibrillation

name the 2 reasons for treating an arrhythmia

1. haemodynamically significant 2. life threatening

name 5 drugs to treat tachyarrhythmias

1. lidocaine 2. beta blockade 3. sotalol 4. Ca channel blockers 5. Digoxin

name 3 ways to treat bradyarrhythmias

1. pacemaker 2. sympathomimetics 3. anti-cholinergics

# name the Vaughan William classification blocks Na+ channel; prolongs AP; ex: Quinidine, Procainamide; for ventricular arrhythmias

Class 1A

# name the Vaughan William classification blocks Na+ channel; shortens AP; ex: Lidocaine, Mexiletine; for ventricular arrhythmias

Class 1B

# name the Vaughan William classification blocks Na+ channels; no effect on AP; ex: Flecainamide; for ventricular arrhythmias

Class 1C

# name the Vaughan William classification beta-blockers; no effect on AP; ex: Atenolol, Propanolol, esmolol

Class II

# name the Vaughan William classification blocks K+ channels; marked prolongation of AP; ex: amiodorone solatol

Class III

# name the Vaughan William classification blocks Ca2+ channels; no effect on AP; ex: diltiazem, verapamil; for supraventricular arrhythmias

Class IV

# name the arrhythmic class membrane stabilising drugs; Na+ channel blockers; inhibit Na+ influx; needs normal K+ for activity

Class 1

# name the antiarrhythmic class 1B; affects phase 0, primarily in diseased tissue; used as local anaesthetic; rapid action; IV use; first choice for ventricular tachycardia!

lidocaine

# name the antiarrhythmic similar properties and effects to lidocaine, but ORAL; indicated for ventricular arrhythmias; difficult to obtain; good in combo with Solatol and Atenolol

Mexiletine

# name the antiarrhythmic class adrenergic beta-R blocker; negative chronotrope; negative ionotrope; indications: 1. pheochromocytoma 2. hyperthyroidism 3. pressure overload 4. arrhythmias (V and SV)

Class 2

name 2 selective beta1-blockers; for patients with asthma, diabetes

1. Atenolol 2. Esmolol

name 3 conditions where you must be careful using beta-blockers

1. risk of CHF 2. diabetes 3. asthma

# name the antiarrhythmic class III; half a beta-blocker + K+ blocker; for V and SV arrhythmias; prolongs action potential duration; can lead to QT prolongation at high doses; 1st choice for ARVC (boxers)

sotalol

# name the antiarrhythmic class III; K+ blocker but also effects class I, II, IV; for V and SV arrhythmias; very long half-life

amiodarone

name 4 possible side effects of amiodarone

1. hepatotoxic 2. hypothyroidism 3. pulmonary fibrosis 4. QT prolongation

# name the antiarrhythmic class Ca2+ channel blockers; mainly for SV arrhythmias; can induce vasodilation, bradycardia

Class IV

# name the antiarrhythmic class IV; well absorbed but first pass metabolism; oral form (admin TID, modified release BID); for acute SVT and atrial fibrillation

Diltiazem

# name the antiarrhythmic narrow therapeutic index; weak positive inotrope; parasympathomimetic activity; useful in atrial fibrillation; careful if V arrhythmias; long half life

Digoxin

name 5 reasons to reduce digoxin dose

1. hypoalbuminaemic 2. hypokalaemic 3. azotemic 4. cachexic 5. Doberman

name 3 GI signs that can be caused by digoxin toxicity

1. nausea 2. vomiting 3. anorexia

name 4 ECG signs of malignancy that indicate risk of ventricular fibrillation

1. Ron T 2. multifocal VPCs 3. very premature 4. couplets, triplets

name 3 criteria for a haemodynamically significant arrhythmia

1. HR > 180-200 bpm 2. hypotension 3. clinical signs

name the 4 parts of treatment for sustained ventricular tachycardia in order (emergency)

1. lidocaine IV 2. class III 3. beta blockers 4. cardiversion

name 3 types of effective drugs for management of narrow QRS tachycardia

1. beta-blockers (class III) 2. calcium blockers (class IV) 3. class III

what 2 drugs should be used to treat atrial fibrillation

Diltiazem + Digoxin

name 3 options for medical treatment of bradyarrhythmias

1. parasympatholytics 2. sympathomimetics 3. adenosine R

name 3 things that affect stroke volume

1. preload 2. afterload 3. contractility

the lower the cardiac reserve, the (lower or greater?) the exercise intolerance

greater

what is the relationship between oxygen delivery (DO2) & oxygen uptake (VO2) when cardiac reserve is exhausted?

DO2 < VO2

name 4 reasons that animals with cardiovascular disease are at increased risk from anaethesia

1. anaesthetics impair cardiopulmonary function 2. CV disease causes multiple secondary organ effects 3. CV disease alters drug pharmacokinetics 4. treatment may interact with anaesthetics

what 2 organs are most commonly secondarily affected by CV disease?

1. renal dysfunction 2. liver dysfunction

name 3 signs of renal dysfunction secondary to CV disease

1. hyperkalaemia 2. azotaemia 3. hypoalbuminaemia

name 3 signs of liver dysfunction secondary to CV disease

1. coagulation abnormalities 2. hypoglycaemia 3. delayed drug metabolism

name 9 ways to reduce anaesthetic risk in a dog/cat with CV disease

1. make an accurate diagnosis 2. understand pathophysiology 3. recognise secondary complication 4. recruit cardiovascular reserve 5. choose anesthetics that offset primary haemodynamic effects 6. reduce adverse haemodynamic effects of surgery 7. use adjunct drugs 8. titrate against clinical effect 9. adequate monitoring

name 3 ways to decr. cardiac work preoperatively for an animal with CV disease

1. vasodilators 2. rest 3. anxiolytics

name 3 ways to remove fluids preoperatively for an animal with CV disease

1. diuretics 2. pericardiocentesis 3. diets

which is safer for an animal with CV disease: gen. anaesthesia OR sedation?

gen. anaesthesia | (monitoring!)

name 5 negative effects of hypothermia during anaethesia in a patient with CV disease

1. depressed ventilation 2. incr. blood viscosity 3. 'left shift' OxyHb dissociation curve 4. arrhythmogenic 5. causes shivering

why should a patient with CV disease not be positioned in a severe 'head-up' position during anaesthesia?

reduces venous return

why should a patient with CV disease not be positioned in a severe 'head-down' position during anaesthesia?

1. impairs breathing 2. decr. cerebral perfusion