Cardiovascular Lecture and Lab

Question 1

How does blood flow through the heart?

Answer 1

In superior vena cava, to right atrium, through the tricuspid valve, into the right ventricle, through the pulmonic vavle into pulmonary artery, to lung, to pulmonary vein, to left atrium, through mitral valve, to left ventricle, through aortic valve to the aorta and systemic circulation

Question 2

What are the AV valves?

Answer 2

Atrioventricular
-Tricuspid and Mitral

Question 3

What are the semilunar valves?

Answer 3

Pulmonary and aortic

Question 4

Which side of the heart is high pressure versus low?

Answer 4

High is left, low is right

Question 5

How does electricity flow though the heart?

Answer 5

SA node (sinus) (Depolarize atrium) -> AV node ->through septum and spirals back up and around (Depolarize ventricle)

Question 6

What does each part of the P-QRS-T wave represent?

Answer 6

P - Atrial Depolarization
QRS - Ventricle Depolarization
T- Ventricle Repolarization

Question 7

What does each heart phase and sound line up with?

Answer 7

S1: Lub: Closure of AV valves (Tricuspid and Mitral) - end diastole beginning of systole

S2: Dub: Closure of Semilunar (Pulmonary and Aorta) - end of systole beginning of diastole

S3: ventricular filling

S4: Atrial Contribution to ventricular filling

Question 8

What occurs electrically and physically during cycle?

Answer 8

Early Systole: Ventricles depolarize, S1-AV valve snap shut and ventricular presure rises (Make QRS)

Systole: Ventricle contract, push blood through semilunar valves into pulmonary artery and aorta, ventricle repolarize (T)

Late Systole: Pressure in ventricle drop, S2 -semilunar valve snap shut

Early Diastole: S3 - Passive ventricular filling

Mid-Late Diastole: Atrial Depolarization S4 - atrial contributing to ventricular filling
(would not hear in afib)

Question 9

What should be part of your cardiac examination?

Answer 9

Normal PE
BCS
Cardiopulmonary auscultation on both sides of chest
Palpation and observation - jug vein, peripheral arteries and distal limb (Feel mandibular and facial)

Question 10

When listening to the heart is systole or diastole the longer or shorter pause?

Answer 10

Systole: short pause
Diastole: long pause

Question 11

What should you observe and palpate during your cardio exam?

Answer 11

RR rate and effort
Jug vein pulsation
-Tell pressure RA and RV - extend 2/3 up neck in heart failure
-Hyperdynamic
-Palpate peripheral pulse and chest

Question 12

What occurs when there is cardiovascular disease?

Answer 12

Incidence valvular regurgitation and arrythmias
-Murmur - physiologic, AOR, MR, TR
-Arrhythmia - 2 AV, AF
-Fatal low

Question 13

What is heart failure?

Answer 13

Impaired emptying or filling
-Chronic or acute valvular regurgitation
-Myocarditis
-large Vessel rupture
-Congenital anomalies
-Pericarditis
-Severe lung disease

Question 14

What signs might you see based on heart failure location?

Answer 14

Right: Peripheral edema, cavitary effusion

Left Sided: Cough, pulmonary edema

Subclinical heart disease, exercise intolerance, cyanosis, failure to thrive, syncope and sudden death

Question 15

What is pathognomonic for Pulmonary Edema?

Answer 15

Foam out of the nostrils

Question 16

When are additional diagnostics needed?

Answer 16

Loud murmur (3/6 or higher) - athlete
Unexplained exercise intolerance
Irregular Rythm
Sustained tachycardia >60bpm
Muffled heart sound
Sign CHF

Question 17

What can radiographs be used to ascess?

Answer 17

Size of heart, pulmonary vessels and lung parenchyma

Question 18

When performing a base-apex ECG, where do you want your leads for a negative QRS?

Answer 18

White- Right point of shoulder (base)
Black - Left axilla (apex)
Red - anywhere on right (Right jug furrow)

Question 19

What is your ECG checklist of things to evaluate?

Answer 19

Heart Rate
Rhythm - RR interval (regular or irregular)
Relationship between P and QRS
Morphology complexes

Question 20

How should you calculate the HR on ECG?

Answer 20

Count small boxes (MM) between R-R complex and divide by paper speed. Then do 60 over your answer to get BPM.

Question 21

Why do we perform echocardiogram?

Answer 21

Allows us to assess chamber size, vascular architecture and competency and cardiac function

Question 22

What are some general rules for Echocardiogram?

Answer 22

Adult heart should fit on 30cm screen

L atrium 11-14cm depend on breed

RH should be 1/3 LH

Valve leaflets should be clean and crisp with synchronous motion

Question 23

How do you determine cardiac function on echo?

Answer 23

Fractional shortening - % decrease left ventricle when comparing diastole to systole

Question 24

What is color doppler used for on echo?

Answer 24

Intensity and shade color vary to depict velocity and direction of blood flow
-M mode allow timing of regurgitation

Blue - away
Red - toward
Green - laminar flow turbulent

Question 25

What are the most common forms of cardiac disease in the equine?

Answer 25

Cardiac malformations, acquired valvular disease and arrythmias

Question 26

What is left sided heart failure?

Answer 26

pulmonary edema due to heart disease

Question 27

What is right sided heart failure?

Answer 27

Peripheral edema, ascites, pleural effusion

Question 28

What are signs of heart disease?

Answer 28

Exercise Intolerance Cough (left sided) Tachypnea, Hyperpnea, respiratory Ventral Edema (right sided) Syncope Failure to thrive

Question 29

What should be included in a PE for suspect heart disease patient?

Answer 29

Exam in quiet area BCS RR rate and character assessed Color, CRT and hydration status Examine Jug vein (1/3 up neck normal) Arterial Pulse Precordial Palpation (PMI) Auscultation

Question 30

If the jugular vein fills higher than 1/3 way up the neck what may be the issue in the sense of heart physiology?

Answer 30

Increase in right ventricular diastolic pressure (filling)

Question 31

What is felt when you are feeling an arterial pulse?

Answer 31

ventricular ejection (influenced by stroke volume)

Question 32

What 2 things can be evaluated from the pulse?

Answer 32

Amplitude - strength of pulse (difference between systolic and diastolic) Character - subtle shape of arterial pressure pulse - rate it rises and falls

Question 33

When is there a right ventricular heave?

Answer 33

Substantial right ventricular hypertrophy

Question 34

When does a hyperdynamic precordium result?

Answer 34

When there is ventricular enlargement and preserved systolic function

Question 35

When does a precordium thrill occur?

Answer 35

Palpable vibration of chest wall that occurs when kinetic energy from high intensity murmurs are communicated through teh chest wall

Question 36

What are the normal heart sounds and what is occurring during them?

Answer 36

S1 - Lub - AV valves closing (Start of systole) S2 - Dub - Semilunar closing (End of Systole) S3 - Whoosh - Ventricular Filling (diastole) S4 - Atrial contraction (diastole)

Question 37

What does the radiograph provide diagnostically?

Answer 37

Global cardiac size Indirect assessment of performance - see pulmonary vessels and parynchema

Question 38

What is an electrocardiography?

Answer 38

record of electrical activity of heart and primary means by which to clarify a physical finding of arrythmia -Cant evaluate side in horse - why we don't need so many leads

Question 39

How is the single bipolar lead base-apex applied to the horse?

Answer 39

White - right point of shoulder Black - behind left shoulder Red - right side jugular

Question 40

What does each letter of the P QRS T wave represent?

Answer 40

P - Right atrium depolarize QRS - Ventricles depolarize T - Ventricle Repolarization R-R Interval - Evaluate Rhythm

Question 41

What is echocardiography?

Answer 41

Use of medical ultrasound to provide information regarding cardiac structure and function -No sedation needed -M mode and 2D -Tell size, myocardial function and pericardial space -See individual chambers and measure them -Doppler - see colors

Question 42

What do the colors represent on a doppler echocardiogram?

Answer 42

Blue - away Red - toward Green - turbulence