Ch. 6 Cardiovascular Emergencies

Question 1

What are the medical problems that may have a cardiac cause?

Answer 1

Dyspnoea
Weakness/syncope/collapse
Coughing (dogs)
Abdominal Enlargement
Paresis
Cyanosis

Question 2

What should one ask with paroxysmal events?

Broad concepts

Answer 2

Pro-dromal behavioural changes
Occuring at rest/excercise
Careful description of the event:
 - Flaccid
 - Rigid?
 - Tonic/clonic movements
Autonomic signs?
Time to recover 
Etc.

Question 3

What are the goals of assessment using POCUS for the cardiac patient?

Answer 3

RPSLA = mitral flail, LV size, contractility & chamber filling
RPSSA = LA:Ao, contractility, smoke in LA?
Pericardium - fluid?
Liver - hepatic venous congestion?

Question 4

What are the four types of acute heart failure and their likely causes and treatment?

Answer 4

Warm and dry = compensated
Warm and wet = CHF e.g. MVD, DCM, HCM, PE
Cold and dry = diuresis, arrhythmias,
Cold and wet = 
- systolic failure: DCM (dogs or cats)
- diastolic failure: HCM.

Question 5

Treatment for CHF?

Answer 5

Diuresis, positive inotropy, vasodilators

Question 6

Treatment for cold & dry failure?

Answer 6

Cautious fluids, treat arrhythmias, discontinue diuretics

Question 7

Treatment for systolic failure

Answer 7

Positive inotropes, arteriodilators

Question 8

Treatment for diastolic failure

Answer 8

Diuretics, venodilators

Question 9

What are the options for vasodilation?

Answer 9

Pimobendan
Sodium nitroprusside
ACEi
Hydralazine
Amlodopine

Question 10

What is pulsus paradoxus

Answer 10

In the normal animal, inspiration improves venoms return to the right side of the heart. With cardiac tamponade this increased filling of the right side will increase the pressure in the left ventricle thus reducing systolic function and leading to a lack of arterial pressure during inspiration which is known as pulses paradoxus.

Question 11

Important clinical signs of PCE

Answer 11

• Muffled heart sounds
• Weak pulses
• Distended jugular veins

Question 12

DDx for pericardial effusion

Answer 12

• Haemorrhagic effusion
	◦ Haemangiosarcoma*
	◦ Heart base tumour (chemodectoma)*
	◦ Mesothelioma
	◦ Idiopathic pericarditis*
	◦ Lymphoma (cats - also other neoplasia for cats)
	◦ Left atrial rupture
	◦ Coagulopathy
	◦ Trauma
• Transudate
	◦ CHF (cats)
	◦ Hypoalbuminaemia
	◦ Toxaemia (uraemia)
• Exudate
	◦ Migrating FB
	◦ Penetrating wound
	◦ Lepto, distemper
	◦ FIP/Toxo (cats)

Haemangiosarcoma carries the worst prognosis of the different tumours. Chemodectomas and mesotheliomas fare better and can be managed with surgery.

Idiopathic pericarditis is a diagnosis of exclusion. n.b. that bicavity effusion is not predictive of neoplastic vs. non-neoplastic causes.

CHF is the most common cause in cats and carries a guarded prognosis.

Question 13

Poor prognostic indicators for FATE

Answer 13

For survival to discharge

• Hypothermia <37.2
• Multiple HLs affected
• Abscence of any motor function
• Reduced HR

For Long term

• CHF will reduce long term survival
• 25-50% of cats will get recurrance
• can take days to weeks to improve

Question 14

Management of FATE

Answer 14

• Analgesia for at least 24-48h
• Anti-clotting therapy
◦ Anti-coagulant - no oral meds yet and IV meds assoc with complications
◦ Anti-plateley = clopidogrel/aspirin (can use both)
‣ Aspiring = COX1 inhibitor which bloc TXA2 needed for platelet recruitment/activation
‣ Clopidogrel = ADP receptor antagonist that prevents PLT aggregation
◦ Thrombolytic therapy - not used as high risk of RPI
◦ Supportive therapy as required
◦ Management of RPI
‣ Frequent HR monitoring
‣ Monitoring serum K
‣ can occur hours to days after event and is not uncommon