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Cardiology Flashcards

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1
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A
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2
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3
Q

What is heart failure (HF)?

A

Inability of the heart to adequately eject and/or receive blood, leading to compromised tissue perfusion and/or vascular congestion.

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4
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What are the classifications of heart failure by mechanism?

A
  • Systolic failure: Impaired contractility (e.g., DCM)
  • Diastolic failure: Impaired filling or compliance (e.g., HCM, RCM)
  • High-output failure: Excessive demand (e.g., anemia, thyrotoxicosis)
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5
Q

What are the functional categories of heart failure?

A
  • Impeded filling: Tamponade, HCM, RCM, valve stenosis
  • Increased afterload: Systemic or pulmonary hypertension, outflow tract obstruction
  • Impaired systolic ejection: DCM, myocardial ischemia
  • Volume overload: Valve insufficiency, congenital shunts
  • Arrhythmias: SVTs, bradyarrhythmias
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6
Q

What role does the Sympathetic Nervous System (SNS) play in heart failure?

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Early: Increases HR, contractility, preload via NE/Epi; Chronic: β1-receptor downregulation, arrhythmogenic, maladaptive remodeling.

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7
Q

What is the function of Angiotensin II in heart failure?

A
  • Vasoconstriction
  • Aldosterone & vasopressin release
  • Myocardial hypertrophy
  • Activates MAPKs → fibrosis and remodeling
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8
Q

What are the effects of Arginine Vasopressin (AVP) in heart failure?

A
  • Vasoconstriction via V1A receptors
  • Aquaporin-2–mediated water retention via V2 receptors
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9
Q

What are Natriuretic Peptides (ANP, BNP, CNP) and their role in heart failure?

A

Released in response to atrial/ventricular stretch; Promote natriuresis, diuresis, RAAS inhibition.

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10
Q

What are the types of cardiac remodeling?

A
  • Concentric: Response to pressure overload
  • Eccentric: Response to volume overload
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11
Q

What is Laplace’s Law in relation to wall stress?

A

Wall Stress ∝ Pressure × Radius² × Wall Thickness.

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12
Q

What mediates myocardial fibrosis?

A
  • Angiotensin II
  • Aldosterone
  • TGF-β1
  • Endothelin-1
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13
Q

What are some cellular changes in heart failure?

A
  • ↓ SERCA expression/activity
  • Altered ryanodine receptor function
  • ↓ ATP due to mitochondrial dysfunction
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14
Q

What are the key studies related to heart failure diagnostics?

A
  • Plasma NE levels correlate with CHF severity in dogs
  • NT-proBNP in cats shows strong diagnostic correlation with HCM and CHF.
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15
Q

What are clinical signs of left-sided CHF?

A
  • Pulmonary edema
  • Dyspnea
  • Cough
  • PCWP >25 mmHg
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16
Q

What are clinical signs of right-sided CHF?

A
  • Ascites
  • Hepatomegaly
  • Jugular distension
  • CVP >15 mmHg
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17
Q

What are the management principles for heart failure?

A
  • Identify and stage the underlying disease
  • Stabilize the patient
  • Use evidence-based medications
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18
Q

What drugs are used to reduce preload in heart failure?

A
  • Furosemide
  • Torsemide
  • Spironolactone
  • Hydrochlorothiazide
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19
Q

What drugs are used to enhance contractility in heart failure?

A
  • Dobutamine
  • Pimobendan
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20
Q

What are common arrhythmias in veterinary medicine?

A
  • Atrial Fibrillation
  • Supraventricular Tachycardia
  • Ventricular Premature Complexes
  • Ventricular Tachycardia
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21
Q

What is the mechanism of atrial fibrillation?

A

Irregularly irregular rhythm with absence of P waves.

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22
Q

What is the classification of arrhythmias based on impulse formation?

A
  • Abnormal impulse formation
  • Abnormal impulse conduction
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23
Q

What are the signs of forward failure in heart failure?

A
  • Exercise intolerance
  • Weakness
  • Lethargy
  • Hypothermia
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24
Q

What is the purpose of using NT-proBNP in heart failure diagnosis?

A

↑ in CHF; low values argue against HF.

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25
What are the effects of nitric oxide (NO) deficiency in heart failure?
Contributes to endothelial dysfunction and impaired vasodilation.
26
What are Ventricular Premature Complexes (VPCs)?
Wide QRS, no preceding P wave. May be benign or pathologic. ## Footnote Holter: >300 PVCs/day or runs of VT = concerning
27
How is Ventricular Tachycardia (VT) defined?
3 VPCs in a row; may be monomorphic or polymorphic. Emergency if sustained or hemodynamically significant. ## Footnote Tx: lidocaine (IV), sotalol, mexiletine, amiodarone
28
What are common types of bradyarrhythmias?
Sinus arrest, AV block, sick sinus syndrome. ## Footnote Common in Miniature Schnauzers (SSS) and Cocker Spaniels (3° AVB)
29
What is the role of Holter Monitoring?
24-hour ECG → detects intermittent or exercise-related arrhythmias.
30
What is the gold standard for diagnosing congenital heart diseases?
Echocardiography.
31
What is a Patent Ductus Arteriosus (PDA)?
Persistent fetal connection between aorta and pulmonary artery. ## Footnote Small breed predisposition: Maltese, Poodle, Sheltie.
32
What is the most common congenital heart defect in cats?
Ventricular Septal Defect (VSD).
33
What are the common breeds predisposed to Pulmonic Stenosis (PS)?
Bulldogs, Boxers, Terriers.
34
What does the clinical sign of a continuous 'machinery' murmur indicate?
Patent Ductus Arteriosus (PDA).
35
What is the most common acquired heart disease in adult dogs?
Myxomatous Mitral Valve Disease (MMVD).
36
What characterizes Stage B1 of MMVD according to ACVIM?
Murmur present, no cardiomegaly.
37
What are the common clinical signs of Myxomatous Mitral Valve Disease?
Exercise intolerance, tachypnea, cough, syncope, dyspnea.
38
What is the treatment for Stage C/D MMVD?
Furosemide/Torsemide, Pimobendan, ACE inhibitors, Spironolactone.
39
What are common organisms causing Infective Endocarditis (IE)?
Streptococcus spp., Staphylococcus spp., Bartonella spp., E. coli.
40
What is the pathogenesis of Infective Endocarditis?
Endothelial injury → platelet-fibrin thrombus → bacterial adherence.
41
What is the Modified Duke Criteria used for?
Diagnosis of Infective Endocarditis.
42
What is a key diagnostic finding in echocardiography for MMVD?
Leaflet thickening, prolapse, mitral regurgitation jet.
43
What is the prognosis for untreated MMVD in Stage B1/B2?
Can live years without CHF.
44
What is the treatment for Ventricular Tachycardia (VT) if sustained?
IV lidocaine or procainamide.
45
Fill in the blank: Antiarrhythmic Class I includes _______.
Sodium channel blockers (lidocaine, mexiletine).
46
True or False: Atrial Septal Defect (ASD) is often asymptomatic unless large.
True.
47
What are the clinical signs of Tetralogy of Fallot (ToF)?
Cyanosis, exercise intolerance, polycythemia.
48
What are the essential tools for diagnosing congenital heart diseases?
Thoracic radiographs, ECG, echocardiography.
49
What are myocardial diseases?
Intrinsic disorders of cardiac muscle distinct from valvular diseases, pericardial disease, and endocarditis ## Footnote Myocardial diseases primarily involve the cardiomyocytes and interstitium.
50
What is the most common type of myocardial disease in dogs?
Dilated Cardiomyopathy (DCM) ## Footnote DCM is the second most common acquired heart disease in dogs.
51
What defines Dilated Cardiomyopathy (DCM)?
Systolic dysfunction, left ventricular ± biventricular dilation, and often presents with eccentric hypertrophy ## Footnote DCM is characterized by a decrease in contractility.
52
What is the prevalence of DCM in referral populations?
~0.5–1% ## Footnote This statistic indicates that DCM is relatively rare in specialized veterinary populations.
53
Which breeds are at high risk for DCM?
* Doberman Pinscher (DP) * Great Dane * Irish Wolfhound (IW) * Boxer * Newfoundland * Cocker Spaniel * Saint Bernard * Portuguese Water Dog ## Footnote These breeds show a higher incidence of DCM.
54
What are common clinical signs of left-sided CHF in DCM?
* Tachypnea * Dyspnea * Cough ## Footnote These signs indicate heart failure and impaired pulmonary function.
55
What diagnostic tool is the gold standard for diagnosing DCM?
Echocardiography ## Footnote It assesses ejection fraction and chamber dilation.
56
What is the role of NT-proBNP in DCM diagnostics?
It is a biomarker with sensitivity of 70–80% and specificity of ~90% for detecting DCM ## Footnote NT-proBNP levels can be elevated in preclinical DCM.
57
What is the prognosis for dogs in the preclinical phase of DCM?
May last years ## Footnote Prognosis varies based on breed and clinical signs.
58
What characterizes Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?
RV myocyte loss and fibrofatty replacement leading to ventricular arrhythmias, syncope, and sudden death ## Footnote ARVC is more common in Boxers and English Bulldogs.
59
What are the most common clinical signs of ARVC?
* Asymptomatic * Syncope * Exercise intolerance * CHF ## Footnote Many cases may remain undetected until severe symptoms occur.
60
What is the typical age range for dogs affected by ARVC?
5–7 years ## Footnote This age range indicates onset during middle age.
61
What is the most common classification of feline cardiomyopathy?
Hypertrophic Cardiomyopathy (HCM) ## Footnote HCM is characterized by left ventricular hypertrophy in the absence of systemic causes.
62
What diagnostic finding is indicative of obstructive Hypertrophic Cardiomyopathy (OHCM)?
Systolic anterior motion (SAM) of the mitral valve ## Footnote SAM can lead to left ventricular outflow tract obstruction.
63
What are typical clinical signs associated with HCM in cats?
* CHF (dyspnea, tachypnea) * Arterial thromboembolism (ATE) * Sudden death ## Footnote These signs may vary in severity.
64
What defines Restrictive Cardiomyopathy (RCM)?
Impaired diastolic filling with normal wall thickness and systolic function ## Footnote RCM is often caused by endocardial or myocardial fibrosis.
65
What are common causes of Dilated Cardiomyopathy (DCM) in cats?
* Taurine deficiency * Doxorubicin toxicity * Tachycardia-induced myocardial failure * Genetic or idiopathic cases ## Footnote Taurine deficiency was previously common but is now rare due to awareness.
66
What is the prognosis for cats with DCM?
Poor overall, but dramatic recovery is possible if taurine-responsive ## Footnote Early detection and treatment can improve outcomes.
67
What is the most common cause of pericardial effusion in dogs?
Neoplasia ## Footnote Hemangiosarcoma is a frequent cause, especially in large breeds.
68
What are the clinical signs of cardiac tamponade in dogs?
* Lethargy * Exercise intolerance * Abdominal distension * Dyspnea * Syncope or collapse ## Footnote These symptoms arise from impaired cardiac filling.
69
What is the gold standard for diagnosing pericardial diseases?
Echocardiography ## Footnote It helps identify effusions, masses, and signs of tamponade.
70
What is the typical management for cardiac tamponade?
Pericardiocentesis for diagnostic and therapeutic purposes ## Footnote This procedure can relieve pressure on the heart.
71
What is electrical alternans in ECG?
QRS amplitude varies beat-to-beat
72
What does low voltage in ECG indicate?
May suggest pericardial effusion
73
What is the gold standard for echocardiography?
Evaluate for mass, look for LA rupture, and signs of tamponade
74
What is pericardiocentesis?
Diagnostic and therapeutic procedure for pericardial effusion
75
What are common characteristics of pericardial fluid in cytology?
Often hemorrhagic, non-clotting
76
What is the initial treatment for acute tamponade?
Emergency pericardiocentesis
77
What is the recommended approach for pericardiocentesis?
Right-sided, low-intercostal approach (4th–6th ICS)
78
What medications might be considered for recurrent idiopathic effusion?
NSAIDs, steroids (with caution)
79
What is the prognosis for HSA (Hemangiosarcoma)?
Poor prognosis; median survival 1–3 months
80
What is HARD in cats?
Heartworm-Associated Respiratory Disease from immature worm death
81
What is the causative agent of heartworm disease?
Dirofilaria immitis
82
What is the primary vector for heartworm transmission?
Mosquito (L3 stage transmitted)
83
What are common clinical signs of heartworm in dogs?
Cough, exercise intolerance, dyspnea
84
What is the best test for diagnosing heartworm in dogs?
Antigen testing
85
What is the treatment for stable dogs with heartworm?
Macrocyclic lactone, doxycycline, prednisone
86
What is a common complication of venous thromboembolism?
Pulmonary thromboembolism (PTE)
87
What are the components of Virchow’s Triad?
* Endothelial injury * Hypercoagulability * Stasis of blood flow
88
What is lymphangiectasia?
Dilation of intestinal lymphatics leading to protein-losing enteropathy
89
What condition can result from thoracic duct rupture?
Chylothorax or chyloabdomen
90
What are the treatment options for pulmonary thromboembolism?
* Anticoagulation (LMWH, rivaroxaban) * Thrombolytics (for severe cases) * Oxygen support
91
What are the clinical signs of venous thrombosis?
Pain, swelling, impaired function
92
What is the prognosis for idiopathic chylothorax?
Variable; may recur after surgery
93
What diagnostic imaging can be used for venous disorders?
* Radiographs * Ultrasound * CT angiography
94
What should be monitored during pericardiocentesis?
Monitor for arrhythmias or vasovagal collapse
95
What is the treatment for jugular vein thrombosis?
Anticoagulation and possible catheter removal
96
What is the role of the lymphatic system?
Removes excess interstitial fluid and returns filtered plasma to circulation
97
What are the risk factors for venous thromboembolism?
* Protein-losing nephropathy * Neoplasia * Immune-mediated hemolytic anemia
98
What can cause impaired drainage in the venous system?
Obstruction, compression, inflammation
99
What is the prognosis for neoplastic or infectious venous disease?
Depends on underlying cause
100
What are the signs of chylothorax on effusion analysis?
High triglyceride concentration, small lymphocytes predominate
101
What is a common diagnostic limitation in cats for heartworm?
Lower sensitivity; false negatives common

Ettingers (11 decks)

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