Cardiology

Question 1

Define heart failure:

Answer 1

Heart disease which is severe enough to overwhelm the compensatory mechanisms of the cardiovascular system

Question 2

Which is a good vein to check for venous pressure and how might you do it?

Answer 2

The jugular - lift the liver to increase the pressure at the back of the dog and watch the jugular pulses.

Question 3

Which disease makes up 80% of all canine cardiac disease?

Answer 3

Chronic valvular heart disease (mainly mitral)

Question 4

What type of heart disease are large dogs particularly prone to?

Answer 4

Cardiomyopathies.

Question 5

What is the predominant heart disease found in cats?

Answer 5

Cardiomyopathies (mainly hypertrophic).

Question 6

What is a haemic murmur and in what age group are you likely to see it?

Answer 6

See in puppies and kittens - they have a lower haematocrit than adults, therefore their blood is less viscous and breaks into turbulence at lower velocity.

Question 7

Is it possible to induce a murmur in a small animal?

Answer 7

Yes, by putting too much pressure on the chest during examination.

Question 8

Does increased tallness of the heart tell us more about the left or right side?

Answer 8

The left.

Question 9

What form does canine cardiomyopathy usually take?

Answer 9

Dilated

Question 10

What is stage A heart disease?

Answer 10

Patient that is at high risk of developing heart disease but does not yet actually have any (a healthy Cavalier King Charles)

Question 11

What is stage B heart disease?

Answer 11

Patient has evidence of structural heart disease but no clinical signs of heart failure.

Question 12

What is stage C heart disease?

Answer 12

Patient with past or current clinical signs of heart failure associated with structural heart disease.

Question 13

What is stage D heart disease?

Answer 13

Patient with end stage cardiac disease - clinical signs of heart failure are refractory to ‘standard therapy’.

Question 14

How would you describe the appearance of the nodule in chronic valvular heart disease?

Answer 14

Smooth, rounded, firm nodules.

Question 15

Chronic valvular heart disease leads to “valvular ______”

Answer 15

Insufficiency / regurgitation / leakage

Question 16

Volume overload in the heart leads to what type of hypertrophy?

Answer 16

Eccentric hypertrophy

Question 17

Pressure overload in the heart leads to what type of hypertrophy?

Answer 17

Concentric hypertrophy

Question 18

True or false:

Enlargement and damage to the heart makes spontaneous depolarisations more likely?

Answer 18

True

Question 19

What changes do you see in sympathetic and parasympathetic tone in chronic valvular heart disease?

Answer 19

Increased sympathetic tome and decreased parasympathetic tone.

Question 20

In what type of heart failure might pleural effusion be seen?

Answer 20

Biventricular failure.

Question 21

Mitral regurgitation and developing left heart failure could predispose to right heart failure, especially if there were the beginnings of degenerative lesions on the tricuspid valve. How?

Answer 21

Left heart failure causes more pressure in the lungs and therefore the right side now has to work harder.

Question 22

Will you hear sinus arrhythmia with tachycardia?

Answer 22

No - an irregularity associated with a fast heart rate is likely to be pathological.

Question 23

Which part of the cardiac cycle is diastole?

Answer 23

Relaxation - heart refilling with blood.

Question 24

Which part of the cardiac cycle is systole?

Answer 24

Contraction - heart is emptying.

Question 25

What does increased diastolic pressure do to pulse strength?

Answer 25

Decreases pulse strength

Question 26

What is the most common scenario in which you will hear a gallop sound?

Answer 26

In a cat with hypertrophic cardiomyopathy

Question 27

What happens if you give frusemide on its own? What should it be given with?

Answer 27

It will active RASS - you should give it with an ace inhibitor.

Question 28

What should you do one week after starting an animal on ACEI?

Answer 28

Check that the drug has not raised serum creatinine substantially.

Question 29

What is the effect of nitroglycerine ointment?

Answer 29

Vasodilator

Question 30

Whic main location do septic emboli from infective edocarditis travel to?

Answer 30

The kidneys and cause infarcts

Question 31

What is the pathological consequence of immune complexes formed in infective endocarditis?

Answer 31

Lodge in basement membranes in various locations and set up inflammatory responses - joints (polyarthritis) and glomeruli (leakage of albumin).

Question 32

What is the incidence of infective endocarditis?

Answer 32

Uncommon to rare in dogs. Very rare in cats.

Question 33

What is a prerequisite of infective endocarditis?

Answer 33

Blood-borne infection.

Question 34

What are the most common bacteria found in cases of infective endocarditis?

Answer 34

Staphylococcus, streptococcus, E. coli, pseudomonas aeruginosa.

Question 35

What antibiotic classes wou;d be best indicated for treatment of infective endocarditis?

Answer 35

beta lactam + aminoglycoside combination OR a fluoroquinolone

Question 36

Why might a murmur caused by cardiomyopathy in a dog be quite soft?

Answer 36

The murmur is softer due to weaker muscle contractions.

Question 37

Treatment principles for canine cardiomyopathies:

Answer 37

A diuretic to relieve congestion. A positive inotrope to support ventricular function. An ACEI to oppose RAAS, reduce salt and water retention and mildly vasodilate. Anti-arrhhythmic drugs as necessary.

Question 38

What is the first sign of digoxin toxicity?

Answer 38

Anorexia / vomiting

Question 39

What is the most common presentation of cardiomyopathy in cats?

Answer 39

Hypertrophic

Question 40

What is a common sequela of hypertrophic cardiomyopathy in cats?

Answer 40

Caudal aortic saddle thrombus

Question 41

Do you perform thoracocentesis in front of or behind the rib?

Answer 41

In front of the rib

Question 42

Why might you sedate an animal in acute congestive heaart failure?

Answer 42

To calm them down which can improve the efficacy of breathing.

Question 43

What is the most common congenital cardiovascular defect in dogs?

Answer 43

Patent ductus arteriosus

Question 44

What is differential cyanosis and when will you see it?

Answer 44

Patent ductus arteriosus with right to left (reversed) shunt causes differential cyanosis. The gums are receiving fully oxygenated blood so they are pink but the vulval/prepuce mucous membranes will be purple due to deoxygenated blood mixing in the aorta.

Question 45

What 4 things make up 'Tetralogy of Fallot'?

Answer 45

1. Pulmonic stenosis 2. Secondary right ventricular hypertrophy 3. Ventricular septal defect 4. Overriding aorta