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Year 3 Cardiology > Diagnosis and treatment > Flashcards

Diagnosis and treatment Flashcards

(96 cards)

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1
Q

What are some ddx for an irregularly irregular heartbeat?

A 
pericardial effusion
DCM
arrhythmias
bacterial endocarditis
neoplasia
DMVD
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2
Q

What can be used to treat atrial fibrillation and what can affect outcome?

A

electrical cardioversion under GA

  • worse prognosis if have underlying structural disease / pathology
  • can use lidocaine / quinidine to help prolong sinus rhythm
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3
Q

What breed is more likely to get mitral insufficiency?

A

handbag dogs

cavalier king charles

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4
Q

what breed is more likely to dilated cardiomyopathy?

A

irish wolfhound

doberman

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5
Q

what can white mm be from?

A
  • poor peripheral circulation
  • vasoconstriction
  • reduced Hb levels
  • cold
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6
Q

what causes cyanotic mm?

A
  • adequate Hb but inadequate oxygenation

- blood shunting or oxygenation problem

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7
Q

what does S1 represent?

A

start of systole

closure of AV valves

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8
Q

where do you listen for S1?

A

left apex

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9
Q

what does S2 represent?

A

end of systole

-closure of pulmonary and aortic valves

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10
Q

where do you listen for S2?

A

left base

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11
Q

what is S3?

A

end of passive V filling

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12
Q

what is s4?

A

active V filling

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13
Q

what is a gallop rhythm?

A

in small animals when hear S3/S4 as v not filling properly

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14
Q

what does S1/S2 splitting mean?

A

asynchronous valve closure

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15
Q

what causes murmurs?

A

turbulent flow (increased velocity, increased volume, reduced viscosity, regurgitation)

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16
Q

where do you listen for the heart base?

A

cranial L

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17
Q

where do you listen for the heart apex?

A

caudal L

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18
Q

where do you listen for aortic and pulmonary valves?

A

heart base

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19
Q

where do you listen for mitral valve

A

heart apex

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20
Q

where do you listen for tricuspid valve

A

cranial R

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21
Q

what murmur is heard continuously?

A

PDA

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22
Q

what condition causes 2 murmurs?

A

VSD

  • blood hitting RV free wall - R cranial systolic
  • blood leaving PA - L cranial systolic
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23
Q

when would you hear a mitral / tricuspid insufficiency murmur?

A

systole

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24
Q

when would you hear a murmur associated with aortic / pulmonary stenosis?

A

systole

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25
when do you hear a murmur associated with mitral and tricuspid stenosis?
diastole
26
when do you hear a murmur associated with aortic and pulmonary insufficiency?
diastole
27
what is a grade 1 murmur?
audible in perfect conditions
28
what is a grade 2 murmur?
audible as soon as stethescope over area of highest intensity
29
what is a grade 3 murmur?
as loud as normal heart sounds
30
what is a grade 4 murmur?
louder than normal heart sounds, no thrill palapabe
31
what is a grade 5 murmur?
thrill palpable over highest intensity area
32
what is a grade 6 murmur?
audible without a stethescope
33
When is echocardiography the test of choice?
when investigating structural cardiac disease
34
what can you see on an echo?
- chamber size, wall thickness, valve structure | - systolic, diastolic, valve, intracardiac pressure
35
what is m-mode?
linear point is orientated to make a depth against time graph
36
what is a 2d echo?
wedge shaped sector to produce a tomographic image
37
what is a spectral doppler?
velocity time graph of blood flow
38
what is a colour flow doppler and what do the colours represent?
- Blue = away from transducer - Red = towards transducer - Green = turbulent flow
39
what can you see with a right parasternal long axis view?
all 4 chambers, mitral and tricuspid valves, LV outflow tract
40
what can you see with a right parasternal short axis view?
mitral and aortic valves, pulmonary valve
41
what can you see with a left apical 4 chamber view?
all 4 chambers, mitral valve
42
What does fractional shortening measure and how is it calculated?
- determines LV systolic function | - FS% = (LVDd - LVDs)/ LVDd x100
43
what is normal cat and dog FS%?
``` cat = 30-50 % dog = 25-50% ``` -reduced with DCM
44
What can cause LA dilation?
- volume overload =mitral valve disease - diastolic dysfunction = hypertrophic CM - systolic dysfunction = dilated CM - L-R shunts
45
what can cause LV eccentric hypertrophy?
- volume overload = mitral valve disease | - systolic dysfunction = dilated CM
46
what can cause LV concentric hypertrophy?
- pressure overload = aortic stenosis - idiopathic = HCM - systemic hypertension
47
what can cause valve abnormalities?
- mitral valve disease - myxomatous - endocarditis - degenerative valve disease
48
what can cause RV hypertrophy?
- pressure overload = pulmonic stenosis | - pulmonary hypertension
49
signs of RS HF?
hepatomegaly peritoneal effusion pleural effusion
50
signs of LS HF?
pulmonary congestion | pulmonary oedema
51
how is pulmonary congestion seen on a radiograph?
- veins appear larger than arteries | - veins are ventral (lateral) and central (VD)
52
how is pulmonary oedema seen on radiography?
- air bronchogram | - dogs normally caudo-dorsal lobe
53
how can the trachea help us on radiography?
if pushed nearer to spine indicated enlarged heart
54
what dogs have more large rounded hearts?
- fat dogs - puppies - brachycephalic
55
what could general cardiac enlargement on rads mean?
``` cardiomyopathy mitral/tricuspid insufficiency training bradycardia pericardial effusion ```
56
When would we want to reduce preload?
- congestion - pulmonary oedema - ascites - peripheral oedema - pleural effusion - venous congestion -Heart failure
57
when would we want to reduce afterload?
- to decrease myocardial work - increase perfusion as less resistance -Mitral regurg
58
when would we want to improve systolic function?
DCM | mitral valve disease
59
when would we want to improve diastolic function?
hypertrophied muscle so not relaxing fully
60
when would we want to optimise cardiac rate and rhythm?
arrhythmias
61
what classes of drugs are used to reduce preload?
diuretics | venodilators
62
what loop diuretics are used and how do they work?
furosemid and thorasemide - block Na absorption in ascending limb of LoH - be careful of electrolyte disturbances, hypovolaemia, azotaemia
63
what DCT diuretic is used?
thiazides | -second or third line choice
64
what K sparing diuretic is used?
Spironolactone - blocks aldosterons - be careful of hyperK
65
What venodilators are used, when and how do they work?
- glyceryl trinitrate and nitroprusside - act like endogenous nitric oxide to relax smooth muscle - risk of hypotension - used in emergency management of acute heart failure
66
what would you give to manage an emergency of acute heart failure?
venodilators | -glyceryl trinitrate and nitroprusside
67
what class of drugs reduce afterload?
arteriodilators or balanced vasodilators
68
name 3 afterload reducing drugs
- ACE inhibitors - pimobendan - amlodipine
69
how do ACE inhibitors reduce afterload and what are the risks.?
- block angiotensin 2 so get vasodilation | - may get hypotension and renal underperfusion
70
how does pimobendan work and what are the risks?
- reduces afterload by inhibiting phosphodiesterase and calcium sensitising causing vasodilation - may affect heart rate and rhythm as an inotrope
71
what is used to treat preclinical DCM?
pimobendan
72
what is amlodipine and how does it work?
reduces afterload by antagonising calcium channels
73
name 3 inotropes
pimobendan digoxin dobutamine
74
what class of drugs is used to enhance systolic function?
inotropes
75
how does digoxin work and what are its risks?
- blocks Na/K ATPase , increases intracellular calcium and increases vagal tone - narrow therapeutic index - pro-arrhytmia - GI side effects - also decreases HR
76
what is digoxin used to treat?
-advanced heart failure AF supraventricular arrhytmias
77
how does dobutamine work and what are the risks?
- beta agonist - pro-arrhythmic - increases HR
78
what class of drugs is used to enhance diastolic function?
lusitropes or negative chronotropes
79
what are 2 lusitropes / negative chronotropes?
- Diltiazem = calcium channel antagonist | - beta-blockers = atenolol
80
how do you optimise cardiac rate and rhythm and what is the big issue?
- anti-arrhytmics | - none of them are licensed and are potentially hazardous
81
name 7 anti-arrhythmics?
``` quinidine lignocaine mexilitine sotalol verapamil dilitiazem digoxin ```
82
what anti-arrhytmic is used for converted AF in horses?
quinidine
83
What combination of drugs is used for MVD treatemtn?
pimobendan ACE i sprinonolactone
84
what drugs are used to treat DCM?
pimobendan | ACE i
85
What drug is used to treat HCM?
ACE i
86
What combination of drugs is used to treat heart failure?
``` frusemide spironolactone ACE i pimobendan (digoxin) ``` minimum = frusemide and pimobendan
87
best test to determine if in heart failure?
thoracic rads
88
what can you do with a patient in HF that is refractory to the treatment?
- increase frusemid dose - sequential nephron blockade with diuretics - vasodilators - digoxin - salt restriction
89
when would you worry about a congenital murmur in under 6mo?
- >III/VI - loud - diastolic - not at L heart base - other signs - gets louder with age
90
what is eccentric hypertrophy?
- volume loaded | - bigger lumen
91
what is concentric hypertrophy?
- pressure loaded | - smaller lumen
92
how does blood travel in a PDA?
Ao - PA - PV - LA - LV - AO
93
how does blood travel with a VSD?
LV - RV - PA - PV - LA - LV
94
how can you treat a PDA?
-closure by ligation or transcatheter approach
95
how can you differentiate between 2nd degree AV block and AF in a horse?
- exercise and if HR becomes regular then 2nd degree AV block - if exercise and still irregular then AF
96
What are the side effects of quinidine sulphate in horses?
``` hypotension V tach colic diarrhoea sudden death supra ventricular tachycardia ```

Year 3 Cardiology (4 decks)

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