Cardiology Flashcards
Skipped/very minimal questions on echocardiographic variables unless in consensus or acronym study (209 cards)
1
Q
Diuretics reduce preload or afterload?
A
Preload
2
Q
What does furosemide do to the fractional excretion of sodium?
A
Increases it
3
Q
Maximum dosage of furesomide/day?
A
12 mg/kg/d
4
Q
Lasix-induced AKI in a CHF patient indicates that IVF are needed to correct dehydration. T/F?
A
False most of the time- CHF patients generally have maldistribution of fluids in venous circulation, and so IVF may actually worsen these. Ideal recommendation is to alleviate diuretic and also address heart failure with other modalities.
5
Q
Mechanism of action of dobutamine?
A
B1 agonist (both inotropic and lusitropic effects)
6
Q
What is a junctional escape rhythm?
A
escape rhythm originating from the N region of the AV node
7
Q
T waves can be positive or negative in healthy dogs. T/F?
A
True
8
Q
What is affected in a wandering pacemaker ECG?
A
Variations of P-wave morphology. Not pathologic.
9
Q
Three ECG characteristics of a-fib
A
- Supraventricular complexes
- irregularly irregular rhythm
- no p-waves. F-waves are seen
10
Q
A-fib and concurrent bundle branch block can look like what other rhythm disturbance? What are ways to distinguish the two?
A
Can look like v-tach. Can distinguish using vagal maneuver (v-tach will not slow); evaluate for regular R-R intervals (v-tach should still have regular R-R)
11
Q
A-fib can be associated with what other concurrent morbidities?
A
Hypothyroidism, anesthesia (esp with opiates), rapid pericardiocentesis, GI dz, volume overload (causing atrial stretch), giant-breed dog, structural cardiac disease (like DCM)
12
Q
Recommended meds for a-fib?
A
Digoxin and diltiazem
13
Q
What is the diagnosis and treatment of a Torsade de Points ECG?
A
Follows prolongation of Q-T interval and R on T. Rapid (>180 beats/min) ventricular rhythm has QRS complexes that are more regular than in VF but that are continuously changing in amplitude
and polarity. Treatment is discontinuing anti-arrhythmics and starting IV infusion of mag sulfate.
14
Q
Causes of high grade 2nd degree Mobitz type 2 and 3rd degree AV block?
A
Functional (hyperkalemia, digitalis intoxication, a2 agonist); structural - inflammatory vs degenerative
15
Q
How are 3rd degree AV blocks in cats different vs dogs?
A
most cats (61%) have underlying structural heart disease which will not be reversed with pacemaker, and survival without pacemaker can be long even without presenting signs. (HR in cats is generally similar to what it is at home - around 80-140)
16
Q
Cats are more likely to develop what type of bundle branch block?
A
Left anterior fascicle block (produces tall R wave in lead 1 but deep S wave in lead 2)
17
Q
LBBB almost always is associated
with left ventricular enlargement. T/F?
A
True
18
Q
Why are arrhythmias secondary to hypokalemia not responsive to class I antiarrhythmics (lidocaine, mexiletine, quinidine)?
A
Because they affect Na concentrations and depend on a normal K
19
Q
What does hypocalcemia do to the threshold of action potential?
A
Decreases it.
20
Q
What does hyperkalemia do to the resting potential?
A
Increases it (as in less negative)
21
Q
What is the second most common site of ATE in cats with underlying
cardiac disease?
A
Right subclavian artery (right forelimb sign)
Top site is aortic bifurcation
22
Q
What biochemical abnormalities are consistent with reperfusion injury?
A
Rapid development of life-threatening hyperkalemia and severe metabolic
acidosis
23
Q
What are echocardiographic measurements that spark prophylactic anti-thrombotics in cats?
A
echocardiographic measurements of an end-systolic left atrial diameter
>1.7 cm or left atrium-to-aortic ratio (LA/Ao) >2.0
24
Q
Two dog breeds in which DCM can be diagnosed before 1 year of age:
A
Portuguese Water Dog and Toy
Manchester Terrier
25
What is the first gene mutation in Doberman Pinschers that has been associated with DCM? Is this gene assocatiated with complete penetrance?
pyruvate dehydrogenase kinase 4 (PDK4) - incomplete penetrance, meaning not all dogs with the mutation will develop
disease and the expression of disease is variable
26
What is the cut-off for arrhythmias on a Holter that indicates a Doberman is at risk for development of DCM?
greater than 50 ventricular premature complexes (VPCs) per 24 hours, or with
couplets or triplets are suspect for the development of DCM
27
The use of pimobendan can help extend the time to CHF in Dobermans with occult DCM. T/F?
True (PROTECT study)
28
ARVC affected Boxers frequently have what ECG abnormality?
Left bundle branch block
29
Antiarrhythmic medications generally used for ARVC Boxers?
Sotalol and/or mexiletine
30
Most common auscultatory finding in R to L shunting PDA?
accentuated and split second heart sound
31
R to L shunting PDA dogs generally suffer complications secondary to what condition?
Hyperviscosity / sudden death. (CHF is uncommon)
32
ASD generally leads to right heart failure or left heart failure?
Right heart (or pulmonary hypertension)
33
For a VSD, a higher velocity of blood through the defect is more associated with a smaller or larger defect?
Smaller defect
34
Bull Terriers are associated with what kind of congenital heart disease?
Mitral and VALVULAR aortic stenosis [only breed known to have valvular form]
35
A splinted QRS complex is distinctive for what congenital abnormality in dogs and cats?
Tricuspid valve dysplasia
36
English Bulldogs and Boxers have what type of pulmonic stenosis and what other clinically relevant associated anomaly?
Subvalvular; anomalous development of coronary arteries
37
Newfoundlands are well-studied for what congenital cardiovascular anomaly?
SAS
38
Atenolol in severe SAS dog extended survival time compared to dogs without atenolol. T/F?
False - no difference. (Ettinger quoted JVIM 2014 study)
39
Features of tetralogy of Fallot
Pulmonic stenosis, VSD, right-ward positioned aorta, secondary RV hypertrophy
40
Two dog breeds more commonly known for Tetralogy?
Keeshond, English Bulldog
41
Rapid elevation of left atrial pressures with no corresponding left atrial enlargement and severe mitral regurgitation is consistent with
Mitral valve chordae tendinae rupture
42
How to calculate right ventricle pressure from right atrial pressure?
Adding an estimate of the RA pressure to the calculated pressure gradient
over the AV valve. Estimate of RA pressure is 5 mm Hg in the absence of RA dilatation, 10 mm Hg in the
presence of RA dilatation but no sign of right-sided CHF, and 15 mm Hg in dogs with right-sided CHF
43
Most frequent presenting complaint in dogs with infective endocarditis?
Lameness
44
Absence of fever is more common with endocarditis of which valve?
Aortic (and may be attributable to Bartonella?)
45
In positive blood cultures, what % should be positive after 72h?
90%
46
Microorganisms known to cause IE in dogs?
Staph, strep, Pseudomonas, bartonella, E coli, Corynebacterium, Erysipelothrix
47
Major criteria for diagnosis of infective endocarditis in dogs?
Vegetative/erosive lesion on valve; new valvular insufficiency (without SAS); positive blood culture (2 or more positives or 3 if common contaminant)
48
Recommended treatment for bacterial endocarditis?
Antibiotic (bactericidal - gram + and - spectrum) - parenteral (ideally IV) for first 1-2 weeks, and then SQ and then oral. Total treatment for at least 6 weeks. If Bartonella - monitor serology 1 mo after initiating tx.
49
First mutation noted in Maine Coons associated with HCM?
MyBPC3 Myosin Binding Protein C sarcomeric gene (Ragdolls can also have a mutation here)
50
Most common cause of ventricular arrhythmia in cat?
Myocardial disease (specifically HCM)
51
Two breeds that have shorter survival with HCM than other cats with HCM?
Ragdolls and Maine Coons
52
Unlike HCM, most cats with RCM are clinical for CHF at time of diagnosis. t/f/
true (same with DCM)
53
Why are cats prone to taurine deficiency?
low tissue concentrations of
cysteine-sulfinic acid decarboxylase (required enzyme for synthesis); also taurine is only amino acid used for bile acid conjungation
54
Taurine supplementation is generally recommended for feline DCM regardless of concentration. T/F?
True
55
Feline myocardial disease associated with shortest survival time?
Feline DCM
56
A subclinical cat with obstructive HCM can benefit from which beta-blocker?
Atenolol (beta-1 specific) [not as frequently prescribed for non-obstructive HCM as studies have not shown it to have a beneficial effect - now some clinicians do RAAS inhibitors or diltiazem]
57
What is pulsus paradoxus?
Abnormally decreased BP during inspiration. Fall of systolic arterial blood pressure >10 mm Hg during the inspiratory phase of normal breathing. With pericardial effusion, greater right ventricular filling during inspiration increases the pressure within the pericardial sac and pushes the interventricular septum leftward, both of which reduce the left ventricular chamber size, reducing left ventricular filling.
58
Most common cause of pericardial effusion in dogs?
Cancer (generally HSA - and if HSA, generally right atrium)
59
Which side heart failure is typically present in chronic pericardial effusion (if heart failure is present)?
Right sided heart failure
60
What % of idiopathic pericarditis cases have recurrent effusion?
50%
61
Most common cause of pericardial effusion in cats?
CHF
62
Which of the macrocyclic lactones does not have spectrum against rounds and hookworms in dogs?
Selamectin (apparently in Canada selamectin is labeled for use in hooks)
63
Which macrocyclic lactones can be used for slow-kill?
imidocloprid-moxidectin; selamectin; ivermectin (NOT milbemycin oxime or sustained release injectable moxi by itself)
64
When are corticosteroids indicated for canine heartworm?
pulmonary parenchymal complications (eosinophilic pneumonitis, eosinophilic granulomas, and PTE), to treat or prevent adverse reactions to microfilaricides, and
possibly to minimize tissue reaction to melarsomine.
65
Difference between eosinophilic pneumonitis and eosinophilic granulomatosis secondary to heartworm infection?
Both very responsive to steroids, but granulomatosis more likely to be more recurrent and may require second-agent. Granulomatosis has more nodular signs on CXR.
66
Development of clinical signs from heartworm-associated respiratory disease in cats can be avoided if the heartworms are not allowed to mature. T/F?
False
67
Primary lymphedema generally affects fore or hindlimbs? When does it generally present?
Hindlimbs; generally young. Generally bilateral but one side may be more affected.
68
Compression is generally effective for primary or secondary lymphedema?
Secondary
69
Which two breeds have higher cardiac troponins than other dogs?
Boxer and Greyhounds JVIM 2016 review
70
A significant increase in cardiac troponins have been identified in which cardiac myopathies?
HCM (JVIM 2016 review)
71
What is sensitivity/specificity of snap pro-BNP in determining cardiac vs noncardiac cause of pleural effusion in cats?
sens 95.2% and spec 87.5% - JVIM 2016
72
Plasma NT-proBNP in healthy Huntaways and herding dogs after work can exceed the upper limit of the reference range. T/F?
True - JVIM 2018
73
A relative increase in NT-proBNP in a cat on oral steroids is not likely secondary to steroid administration. T/F?
False. Steroids can cause increase NT-proBNP and heart size (specifically left ventricular internal diameter) - JVIM 2020
74
High proBNP (>100 pmol/L) detected all cats with HCM regardless of left atrial enlargement. T/F?
False. Detected all cats with LA enlargement but not without LA enlargement (Se was around 69% and specificity was 100%).
75
What was Se/Sp of proBNP ELISA for cats with murmur in detecting cardiac disease?
sensitivity of 71% and a specificity of 92% (i.e. positive means likely heart disease but neg doesn't reliably exclude it) - JVIM 2021
76
What was Se/Sp of cTnI cutoff of 0.625 ng/mL for infective endocarditis?
100% specificity (95% CI 90%-100%) and 52% sensitivity (95% CI 33%-70%) - JVIM 2021
77
What was MST of medium/large sized dog that presents in heart failure from MMVD with afib?
142d (significantly shorter than those without which was around 234 d). Controlling rate also had longer time than those whose rate was not controlled. JVIM 2016
78
What was the most significant echocardiographic indicator of cardiac-related death in 1 year with MMVD?
Tei Index (JVIM 2016) (this is myocardial performance index - parameter for left ventricular function)
79
Leptin was higher/lower in dogs with CVD compared to healthy dogs.
Higher (JVIM 2016)
80
What % of dogs had an increase in peak tricuspid regurgitation following sedation?
78% JVIM 2017
81
Which of the following decreased when dogs with cardiomegaly due to MMVD were given sacubitril/valsartan (Entresto)? potassium, arterial pressure, urinary aldosterone to creatinine ratio, NT-proBNP
urinary aldosterone to creatinine ratio JVIM 2018
82
VLAS over what number was a useful predictor of LA enlargement?
2.3 (JAVMA 2018); but highest specificity (96%) was found with VLAS equal or greater than 3 [sensitivity 40%] - JAVMA 2020
83
Stage B2 criteria for MMVD?
Murmur intensity ≥3/6
La:Ao ≥1.6
Left ventricular internal diameter in diastole, normalized for body weight (LVIDDN) ≥1.7
Breed-adjusted radiographic VHS >10.5 (or in absence of echo “general breed” VHS ≥11.5) or evidence of accelerating interval change
Newer index of radiographic left atrial enlargement, VLAS ≥3 likely identified Stage B2
(Consensus/EPIC)
84
Difference in nitroprusside vs nitroglycerin?
nitroprusside is a potent arterial and venous vasodilator, while nitroglycerin is more of a venodilator. Nitroglycerin - topical. Nitroprusside- IV
85
Stage D criteria for MMVD?
More than 8 mg/kg/d furosemide (ACVIM consensus MMVD)
86
Afterload reduction would involve arterial or venous dilation and is specifically recommended in which stage MMVD?
Arterial; Stage D (ACVIM consensus MMVD)
87
What was effectiveness of administration of synthetic brain natriuretic peptide in dogs with CHF?
Not effective (JVIM 2019)
88
Circulating trimethylamine N-oxide (TMAO) was higher in dogs with CHF than dogs with preclinical MMVD and normal dogs. T/F?
True JVIM 2019
89
Was plasma ANP or cardiac troponin better for detecting dogs with subclinical CVD?
Plasma ANP - JAVMA 2020
90
A JVIM 2020 study found that performing VLAS was not superior to VHS or VHS+ VLAS. T/F?
True - JVIM 2020.
91
A VHS score of > 11.7 was how specific of left heart enlargement on echo?
97% JVIM 2020
92
Between Miniature Schnauzers and Yorkies- which breed tended to have a higher prevalence of MMVD? Which breed tended to be younger at diagnosis?
Miniature Schnauzers for both. (JAVMA 2021), Study also found other things that kind of make sense, that yorkies are more likely to have cough (airway collapse) and schnauzers more likely to have syncope (sick sinus)
93
What was overall prevalence of a-fib in dogs with MMVD?
2.7% (JVIM 2020)
94
How to do modified VLAS? What is cut-off that provides >90% sens/spec for left atrial enlargement? [this method was reported to be superior to VHS and VLAS)
MVLAS—an initial line (yellow)—is drawn from the centre of the most ventral aspect of the carina to the intersection between the most caudal aspect of the left atrium and the dorsal border of the caudal vena cava. A second additional line (red) is then drawn from the most distal border of the left atrium towards the first line, intersecting it perpendicularly. Two separate straight lines corresponding to the lengths of the first 2 lines (yellow + red) were then drawn from the cranial edge of the T4 vertebral body extending in a caudal direction, ventral and parallel to the vertebral canal.
cut-off value of ≥3.4 vertebrae using M-VLAS provided 92.7% sensitivity and 93.1% specificity (JVIM 2021)
95
Ratios of what lymphocytes were lower in Stage C and D dogs compared to B2?
CD3+CD4+/CD3+CD8+ (JVIM 2021)
96
Maltese and CKCS may have similar SERT gene single nucleotide polymorphisms (SNPs) contributing to pathophys of MMVD. T/F?
false - maltese do but these were not in found with CKCS (JVIM 2021)
97
Approximately what % of dogs with rhythm abnormalities changed (progressed or regressed) following pacemaker implantation?
More than 1/3 (JVIM 2016)
98
Mean derived Holter HR above what bpm was associated with decreased survival?
125 bpm (JVIM 2018)
99
How does sotalol work?
The negative inotropic effect that sotalol has on dogs is mild. T/F?
Class III (KChannel blocker/prolongs action potential duration)
True - JVIM 2018
100
What breed is most commonly affected by AV accessory pathways and what type of cardiomyopathy can it produce?
Labrador retriever, DCM (recommendation to Holter because you may miss this tachyarrhythmia - generally suprentricular) - JVIM 2018
101
What % of dogs with orthodromic atrioventricular reciprocating tachycardia converted to sinus rhythm with lidocaine?
84.4% (JVIM 2019)
102
Prevalence of sudden death in dogs with a-fib?
15% - JVIM 2021 (predictors - younger age, LA size, and history of syncope; NOT associated with ventricular arrhythmias)
103
Monotherapy with which of the following medications significantly prolonged time to onset of CHF or sudden death in Irish Wolfhounds with preclinical cardiomyopathy? Benazepril, methyldigoxin, pimobendan
Pimobendan (JVIM 2016)
104
What was best variable to predict sudden cardiac death in Dobermans with DCM?
Left ventricular overload on echo (LVEDV>91.3 ml/m2) - JVIM 2016. Ventricular tachycardia, increased troponin and VPC >260 bpm were additional important variables to predict sudden cardiac death
105
What was Se/Sp of hs-cTnI concentration >0.113 to identify Dobies with or without DCM?
se 81.2% and Sp 73.2% JVIM 2019
106
Other than PDK4, what other gene variant has been identified with DCM?
TTN (titin). Not all Dobies have variant with one of these though, which was the point of the study - JAVMA 2020
107
Measurement of the left ventricular free wall over what mm is consistent with HCM in cats? Is this diastole or systole?
6 mm in diastole (JFMS 2016)
108
Asymptomatic cats with HCM likely have similar rates of arrhythmia as normal cats on holter. T/F?
True JFMS 2017
109
What are some characteristics of cats that have CHF from transient myocardial thickening as opposed to HCM?
TMTS are generally younger when in heart failure and have some kind of antecedent event (like general anesthesia). Better prognosis for TMT. (JFMS 2017)
110
Which group had the lowest SDMA in cats? Diabetics, control cats, HCM, renal cats?
Diabetics had lowest. Control = HCM. Renal had highest. JVIM 2018
111
What is the specificity of a cardiac troponin I > 0.163ng/m in distinguishing HCM with no left atrial enlargement vs normal cats?
100%. (sensitivity was 62% though) - JVIM 2018; higher cTI = higher severity- cTnI of 0.234ng/ml had a sens 95% and spec 77.8% for assessing heart failure.
Although JVIM 2019 said > 0.06 is sensitive (91.7%) and specific (95.4%) for healthy cats as screening for HCM so.... The JVIM 2019 also used serum and not plasma and they said their study was better lol.
112
Restrictive cardiomyopathy generally has normal normal left ventricular (LV) wall thickness. T/F?
True JFMS 2018
113
What variable was most significantly associated with survival time in cats with restrictive cardiomyopathy?
Left atrial enlargement JVIM 2019
114
Levels of insulin, IGF-1, and glucose were higher in cats with asymptomatic HCM than normal cats. T/F?
True - JVIM 2020
115
What acute phase protein was an independent prognostic factors for CHF in multivariate analysis?
alpha-1-acid glycoprotein concentration JVIM 2020
116
Summation of VitD was lower or higher in cats with cardiomyopathy compared to normal cats?
Lower JVIM 2020
117
HCM cats with systolic anterior motion of the mitral valve had higher concentrations of troponin and NTproBNP than HCM cats of similar echocardiographic variables but no SAM? T/F?
True - which may make sense as SAM is associated with more severe left ventricular concentric hypertrophy in cats JVIM 2020
118
A test diet containing what improved echocardiographic variables + cardiac troponins in cats with subclinical HCM?
reduced starch, supplemented EPA + DHA JVIM 2020
119
Is pimobendan well tolerated in cats with obstructive cardiomyopathy?
Yes JVIM 2020
120
Common ddx to be ruled out in cats with mild/moderate LV wall thickening besides HCM?
Hyperthyroidism, hypertension, acromegaly, dehydration, transient myocardial thickening (JFMS 2021 review)
121
What parameters were correlated with increased risk of progression/cardiac related death in cats with preclinical HCM?
Increased left atrial size, higher NTproBNP, increased rate of LA size increase between examinations (JVIM 2021)
122
What % of cats with HCM had IGF-1> 1000?
6.7% JVIM 2021
123
In a prospective, double-blind, randomized, nonpivotal, exploratory field study, was there a benefit of pimobendan in preventing dose escalation of furosemide over 180d in cats with HCM and CHF?
No - JVIM 2021
124
What is the main difference between Stage B1 and Stage B2 in cat cardiomyopathy?
Left atrial enlargement - both are subclinical. B1 - normal/mild; B2 - moderate/severe; ACVIM consensus
125
In cats- type of cardiomyopathy does not matter as much as stage of heart disease in terms of management. T/F?
True - ACVIM consensus
126
Dogs and cats with tetralogy of fallot had a shorter survival time if no or low grade murmur was noted. T/F?
True - MST of 3.4 mo compared to 16.4 mo (JAVMA 2016)
127
What is rate of recurrence in dogs (Labs) with tricuspid stenosis that received balloon valvuloplasty?
2/5 (JVIM 2017)
128
A normal proBNP cannot rule out congenital heart disease in a puppy. T/F?
True. Generally puppies with murmurs had much higher proBNP but some pups with severe PS had normal BNPs. JVIM 2017
129
Adult dogs with PDA and pulmonary hypertension will not tolerate PDA correction.T/F?
False - they can still be corrected. JVIM 2017
130
Dogs with vascular ring anomalies may regurgitate after surgery, however this is not associated with post-op esophageal dilation. T/F? What % may not respond to surgery?
True; 1/5 (20%) - JAVMA 2019 review
131
German Shepherds are commonly over-represented with what cardiac congenital abnormality?
PDA; they apparently also can get type III PDAs which are tube-like and need surgical ligation, but most of them have type II which can be corrected interventionally (with ACDO) - JVIM 2019
132
What was the most common clinical sign and the only predictor of survival in dogs with bidirectional and continuous right-to-left shunting patent ductus arteriosus ?
Hindlimb collapse (in 50%); cats had variable signs. Dogs treated with sildenafil survived longer. JVIM 2021 R-CHF had a shorter median survival time (58 days vs 1839 days, MST overall was 626d.
133
A stable respiratory rate under what value breaths per minute is consistent with stable CHF?
30 brpm (VetJ 2016)
134
Cats with larger % decrease in NT-proBNP from admission to discharge had longer survival time. T/F?
True JVIM 2017
135
What was the MST of dogs that had CHF that needed management of >4 mg/kg/d of furosemide?
281 days JVIM 2018
136
A group of dogs that responded (decreased NTproBNP) to prespecified therapy escalation for CHF had what criteria (of NTproBNP and Cr)?
> 1500 NTproBNP and Cr < 3 (JVIM 2018)
137
A Positive NT-proBNP was how sensitive/specific for CHF in a cat in respiratory distress?
93.9% sens, 72.2% spec JVIM 2018
138
What % of dogs with CHF were cachexic from cardiac disease?
48% - JVIM 2019
Cachexia associated with shorter survival time
139
Which of the following was associated with cats with cachexia and CHF? Longer survival time; pleural effusion; decreased BUN; higher HCT
Pleural effusion (JVIM 2019) [cachexic cats survived shorter, higher BUN, and lower HCT]
140
How to calculate corrected chloride? Is chloride more likely to be lower or higher in Stage DCHF dogs vs other (stage C or nonCHF dogs)?
c[Cl−]− = (mid-reference range [Na+]/measured [Na+]) × m[Cl−]; chloride is more likely to be lower (b/c Lasix vs dilution vs both] - JVIM 2021
141
Dogs with DCM and eating nontraditional diets can improve echocardiographic variables and survival time with diet change. T/F?
True - improvement in left ventricle size in diastole and with LA:Ao ratio. JVIM 2021
142
Point-of-care lung ultrasound has not been shown to correlate with improvement of CHF in hospital. T/F?
False - it does correlate (JVIM 2021)
143
What is most common electrolyte abnormality in CHF dogs? What % of dogs had this?
hypochloremia, 24% (JVIM 2021). This study noted a negative correlation with chloride concentration and furosemide dose.
144
Pimobendan prolonged preclinical period in Stg B2 MMVD by how long according to EPIC?
15 mo (EPIC JVIM 2016)
145
Torsemide can be given how frequently according to the TEST study?
q24h (TEST JVIM 2017)
146
Dogs with pimobendan and MMVD had less severe CHF than those off pimobendan. T/F?
False - they were indistinguishable (pimobendan extends CHF but does not change CHF quality) - EPIC JVIM 2018
147
What is the likelihood that a cat with HCM or HOCM will develop CHF or ATE (or both)?
30.5% (REVEAL JVIM 2018) - 27.9% of cats died from those episodes
148
Which variable was the earliest to change before development of CHF in dogs with MMVD? Which was variable changed most dramatically before development of CHF?
Heart rate (HR), clinic respiratory rate (RR) or home-measured resting respiratory rate (RRR), rectal temperature (RT), body weight (BW), and vertebral heart sum (VHS)
VHS; RR or RRR (EPIC JVIM 2020)
149
What was hazard ratio (aka how much more or less likely) for dogs with MMVD on once a day torsemide to experience death, euthanasia, or premature study withdrawal compared to q12 furosemide?
hazard ratio, 0.36; CARPODIEM JVIM 2020
150
Did ramipril improve survival time in dogs with CHF secondary to MMVD? What was overall survival time for all dogs in this group?
No; 214 d (with ramipril - 187d; without - 227d; no significant diff) - VALVE JVIM 2020
151
Based on MINE Scores, what was median survival time for a MINE score of 13? (MINE is a scoring system for MMVD)
A MINE score of 13-14 = 157 days
A MINE score over 8 is predictive of cardiac death.
mild (score: 4-5), moderate (score: 6-7), severe (score: 8-12), late stage (score: 13-14).
mild (2344 days), moderate (1882 days), severe (623 days), and late stage (157 days)
MINE JVIM 2021
152
A combination product of spironolactone + ACE-i was not inferior to benazepril for mild, moderate or severe CHF caused by MMVD in dogs. T/F?
False- was SUPERIOR to benaze - BESST JVIM 2021
153
What is another echocardiographic variable that can be measured for pulmonary hypertension if no tricuspid regurg is available?
Right pulmonary artery distensibility (RPAD) correlated strongly with TR pressure gradient >50 mmHg
RPAD <29.5% gave sensitivity of 84% and spec of 95%
JVIM 2016
154
What% of dogs with respiratory-associated pumonary hypertension died or euthanized within 1 mo from diagnosis?
32% - JVIM 2020
155
6 categories of pulmonary hypertension in dogs
1. pulmonary arterial hypertension (drugs, shunt, idiopathic, vasculitis, heritable, veno-occlusive disease)
2. left sided heart disease (most common)
3. respiratory disease (interstitial, obstructive, hypoxic)
4. PTE
5. parasitic (dirofilaria and angiostrongylus)
6. multiple categories/unclear/compressive (like neoplastic or granuloma) [Consensus on PH]
156
Which was associated with worse prognosis in dogs with pulmonary hypertension? age, PH secondary to LHD versus other causes, right heart failure, syncope?
Right heart failure
Right atrial area, RV function (TAPSE < 3.23 mm/kg0.284 ), and right heart failure offer clinically relevant prognostic information in dogs with PH
JVIM 2020
157
What % of dogs on Palladia developed BP > 160?
37% JVIM 2016
158
Cats with a higher BP (>200) may require a higher dose of amlodipine. T/F?
True - like 1.25 mg instead of 0.625 JVIM 2016
159
Median Doppler BP in healthy cats?
120 mmHg (but higher BPs with age, nervousness, hx of being stray, male cats, neutering) -JVIM 2017
160
The increased BP/SDMA/albuminuria is not secondary to higher basal RAAS activation in cats. T/F?
True - JVIM 2017
161
Is coccygeal or radial artery better for Doppler measurement in an old, sarcopenic cat?
Coccygeal JAVMA 2017
162
Rare adverse effect associated with spironolactone in cats?
Facial dermatitis and excoriations (ACVIM consensus hypertension)
163
Why is lowering the BP excessively detrimental in some chronically hypertensive patients?
Autoregulatory vascular beds in brain and kidneys may have adapted to higher perfusion pressure 🡪 acute marked BP reduction may result in hypoperfusion (ACVIM consensus hypertension)
164
How to determine cuff measurement for BP?
width of the cuff should be 30%-40% of the circumference of the extremity at the site of cuff placement (ACVIM consensus hypertension)
165
Incidence of hypertension in a population of older cats from the UK?
19% - JVIM 2018
also this study showed that if you measure BP in a cat and control hypertension before clinical signs their survival is better
166
In obese cats, coccygeal BP may be higher or lower than radial measurements?
Higher (18 mmHg) - JFMS 2018
167
In a study evaluating Doppler BP compared to arterial BP monitoring to evaluate hypotension in anesthetized dogs, Doppler was superior/not inferior/inferior?
Inferior - considered unreliable - JAVMA 2018
168
Dogs with acepromazine are how much more likely to develop hypotension compared to dexmedetomidine?
2.61x (JAVMA 2019)
169
What are the effects of the ACE2 system and its produced peptides?
vasodilatory, natriuretic, diuretic, antifibrotic, and antiremodeling
9-amino acid peptide called angiotensin 1-9 (Ang1-9) and a 7-amino acid peptide called angiotensin 1-7 (Ang1-7)
These are increased in dogs with CHF. JVIM 2019
170
What % of cats had mmHg < 150 after 28d after 2 mg/kg telmisartan SID if BP was > 160 but < 200
52% - JVIM 2019
171
What was average decrease in BP on telmisartan (1.5 mg/kg BID for 14d then 2 mg/kg SD) after 28d in cats?
-23.9 mmHg - JVIM 2019
172
Hypochloridemia is more common in stage D or Stage C CHF dogs
Stage D - JVIM 2020
173
What % of dogs with ACE gene polymorphism-positive showed aldosterone break through with ACE-i compared to polymorphism negative dogs?
54 to 38%. (my takeaway is that there is still aldosterone breakthrough in dogs with ace-i) - JVIM 2020
174
Prevalence of hypertension in dogs with hyperadrenocorticism? What factors made hypertension more likely?
Prevalence of SH 82%; prevalence severe SH 46%.
THROMBOCYTOSIS (all dogs with thrombocytosis were hypertensive); HYPOKALEMIA (all dogs with hypokalemia were hypertensive); proteinuria - JVIM 2020
175
Which of the following combinations had the best theoretical angiotensin peptide profile? ACE-i, ARB, ACE-i + rhACE2, ARB + rhACE2
ARB + rhACE2 (JVIM 2021)
Another JVIM 2021 also supported this as a good combo in cats (but only looked at telmisartan with and without rhACE2)
176
Among Birman, Norwegian, and DSH breeds, which had lower BP?
Birman (JVIM 2021)
177
Systolic BP in cats was improved measuring in carrier than on a table. T/F?
False - it was the same. However, higher mean arterial pressure (MAP), diastolic BP (DBP), and PR were found when measurements were performed with cat placed on table, rather than in carrier. JVIM 2021
178
Efficacy of ACE-i + telmisartan was better at improving proteinuria than either of them on their own. T/F? How about for blood pressure?
True for proteinuria. However, BP with ACE-i + telmisartan was lower than ACE-i but was not significantly different than that achieved with telmisartan. JVIM 2021
179
Background treatment of benazepril + spironolactone in dogs made diuretic braking effect of furosemide CRI less likely. T/F?
False - it did not. (JVIM 2021)
180
What was predictive of 2-year survival in dogs in a study evaluating ACE-i efficacy on dogs with cardiac disease?
12h dose frequency of ACEI (hazard ratio [HR], 0.30) and higher serum potassium concentration (HR, 0.39) -JVIM 2021
181
What was estimated prevalence of cats with heartworms in US?
0.4% - retrovirus + increased likelihood of infection - JAVMA 2017
182
Milbemycin-oxime was well-tolerated by dogs with heartworm microfilaremia and was a good microfilaricidal. T/F?
False - was incompletely microfilaricidal (but yes was well tolerated) - JAVMA 2018
183
Cats with lower airway signs were more likely to be heartworm positive than cats with no signs. T/F?
False - no significant difference - JFMS 2017
Most significant risk for HW+ was outdoor access
184
What are first screening tests for angiostrongylus in dogs? What are secondary tests that can confirm negative in a highly suspect dog?
ELISA antigen and Baerman. Follow up tests are qPCR on BAL and ELISA antibody. JVIM 2018
185
Heartworm beagles treated with imidacloprid/moxidectin and doxycycline had better radiographic and echocardiographic scores compared to nontreated heartworm beagles on day 28. T/F?
False - no difference. JVIM 2020
186
What % of dogs with intracardiac heartworms had caval syndrome? What are the signs associated with caval syndrome?
25%; anemia + pigmenturia + clinical signs JVIM 2021
Pigmenturia was the second most common clinical finding (31/72; 43%) after lethargy (44%)
Estimated intracardiac heartworm burden was low in 14 of 72 (19%) and high in 58 of 72 (81%) dogs
187
What ophthalmologic agent for glaucoma can be safely used to decrease HR in cats?
Timolol (nonselective beta agonist) JVIM 2016
188
Cats with the A31P mutation in the MYBPC3 gene have a lower or higher likelihood of platelet activation (What breed has this mutation)?
Higher likelihood; Maine Coon - believed to contribute to hypercoagulable status in HCM. Clopidogrel is effective at attenuating platelet activation and aggregation JVIM 2016
189
What was se/sp for CXR to detect heart-base masses in dogs?
Sensitivity was 40%, specificity was 97% JAVMA 2016
190
Which of the following is the best evaluation for feline hypertension?
Plasma N-Terminal Probrain Natriuretic Peptide, Vascular Endothelial Growth Factor, and Cardiac Troponin I, Indirect Doppler + fundoscopy
Indirect doppler + fundoscopy (none of the other biomarkers are useful clinically despite a positive significant correlation) JVIM 2017
191
POC BNP ELISA (150-200 as cut-off) was how sensitive and specific for detecting cats with heart disease?
sens of 65.4% and spec of 100%
192
Which of the following was lower in obese dogs? Cardiac hypertrophy; Adiponectin; IL-8
Adiponectin (JVIM 2017)
193
A minimal difference of what temperature (Celsius) using infrared thermography has 100% specificity and high sensitivity for femoral arterio thromboembolism dx?
2.4 C (JFMS 2018)
194
Does IM sedation with dexmed + bupe affect LA/Ao or wall thickness in cats?
No - JFMS 2018
195
Which of the following is clinically altered if trazodone administered to healthy cats? Echocardiographic variables, HR, systolic blood pressure
Systolic blood pressure - decreased JFMS 2019
196
Which pathogens were more commonly found on myocardial biopsy? (esp in unclassified myocardial and rhythm disorders compared to congenital heart disease)
canine distemper, coronavirus, parvovirus, Bartonella spp
JAVMA 2019
197
Is benazepril clinically beneficial in cats with heart disease?
No lol JVIM 2019
198
What are characteristics of Irish Wolfhound cardiomyopathy? What are positive predictors (2) of whether or not this will develop?
left atrial enlargement, left ventricular dilatation, and systolic dysfunction; positive predictors are a-fib and male JVIM 2020
199
Most common (top 3) causes in dogs with aortic thrombosis in study looking at 100 cases? What % did not have underlying etiology? What was correlated with survival to discharge?
PLN (32%), neoplasia (22%), exogenous steroids (13%); 23% had no underlying etiology; ambulation status was significantly correlated with survival to discharge JVIM 2020
200
blood transfusion should not be attempted in animals with volume overload. T/F?
False - well tolerated (although study looked at packed reds and whole blood). More looking at TACO I guess JVIM2021
201
BOTH dogs eating grain-free and diets with FDA listed ingredients of concern (peas, lentils, potatoes in top 10 ingredients) had higher values of which of the following compared to dogs eating grain-inclusive or diets without ingredients of concern? VPCs, high sensitivity cardiac troponins, NT-proBNP, taurine concentrations
hs-cTnI (VPCs were higher in dogs eating diets with peas/lentils/potatoes; NTproBNPs were the same; dogs eating GF diets had higher plasma taurines; whole blood taurine concentrations were the same) JVIM 2021
202
Breeds generally predisposed to sick sinus syndrome?
Miniature Schnauzer, Cocker Spaniels, Westies (Dachshunds, Boxer)
203
When to treat ventricular tachyarrhythmias?
V-tach (>180), symptomatic (collapsing, weak), hypotensive, multiform
204
Trypanosomi cruzi serology cross-reacts with what other vector-borne disease?
Leishmaniasis
205
When are melarsomine injections administered (considering Day 0 as when dog was heartworm antigen positive) on a 3 injection protocol?
Day 60, Day 90, Day 91
206
Macrocyclic lactones are appropriate to give to MDR1 mutants at preventative dosages. T/F?
True
207
Congenital heart defects in dogs consistent with systolic left heart base murmur?
Pulmonic or subaortic stenosis; ASD
208
Which side of heart is generally impacted in a VSD?
Left side (pulmonary overcirculation)
209
What are diets linked to nutritional DCMs in dogs?
High-legume/high "pulse" diets (all exclusively dry diets); weak evidence for exotic meats; not necessarily grain-free or taurine-deficient per se
