Diagnostic Approach To Patients With CV Disease Flashcards
(166 cards)
1
Q
cardiac output equation
A
cardiac output = heart rate x stroke volume
2
Q
blood pressure equation
A
blood pressure = total peripheral resistance x cardiac output
3
Q
cardiac output must equal
A
venous return
4
Q
define heart failure
A
a complex syndrome initiated by the inability of the heart to maintain a normal output at normal filling pressures
5
Q
forward heart failure
A
inadequate output at normal filling pressures. leads to underperfusion
6
Q
backward heart failure
A
adequate output with inadequate filling pressure. leading to congestion
7
Q
forward and backward heart failure
A
inadequate output at abnormal filling pressures
8
Q
congestive heart failure is initiated by
A
underfilling of arterial circulation
9
Q
normal autonomic dominance of heart function
A
parasympatheic
10
Q
3 hormone systems involved in heart failure
A
- RAAS
- ADH
- natriuretic peptides
11
Q
what causes renin release
A
- renal underperfusion
- sympathetic stimulation
- decreased chloride to renal tubule
12
Q
renin causes
A
angiotensinogen to angiotensin 1
13
Q
angiotensin 1 is converted to angiotensin 2 by
A
ACE
14
Q
angiotensin 2 is a
A
- potent vasoconstrictor
- stimulates aldosterone release
- causes cardiac growth
15
Q
where is aldosterone released from
A
zona glomerulosa of adrenal cortex
16
Q
aldosterone actions
A
sodium and water retention by the collecting ducts of renal tubule
17
Q
ADH causes
A
- free water retention leading to dilutional hyponatraemia
- vasoconstriction
18
Q
when in heart failure is ADH seen
A
late or severe heart failure
19
Q
2 natriuretic peptides
A
- atrial
- brain
20
Q
where are natriuretic peptides made
A
atrial myocardium
21
Q
causes release of natriuretic peptides
A
increased cardiac wall stress
22
Q
natriuretic peptides cause (2)
A
- vasorelaxation
- increase sodium loss
23
Q
3 causes of cardiac hypertrophy
A
- adrenergic stimulation
- angiotensin 2
- increased intracellular calcium
24
Q
types of cardiac hypertrophy
A
- concentric
- ecentric
25
type of hypertrophy caused by increased pressure loads
concentric
26
type of hypertrophy caused by increased volume
eccentric
27
concentric hypertrophy define
- increased thickness of walls
| - decreased lumen size
28
eccentric hypertrophy define
- normal wall thickness
| - increased lumen size
29
cardiac hypertrophy leads to increased demand of
oxygen
30
lack of oxygen to cardiac myocytes causes
ischaemia, regional hypoxia and myocardial dysfunction
31
4 ways in which oedema can form
- increased vascular permeability
- increased vascular hydrostatic pressure
- decreased oncotic pressure
- decreased lymphatic drainage
32
5 diseases of vasculature
- vasculitis
- thrombosis or embolism
- degenerative vascular disease
- malformation of vasculature
- hypertension
33
thrombosis occurs when
blood clot forms in circulation
34
4 predisposing factors to thrombosis formation
- blood stasis
- increased coagulation
- decreased fibrinolysis
- endothelial damage
35
malformations to vasculature can be (2)
- acquired
| - congenital
36
large breed middle aged dogs are likely to have (heart)
myocardial disease
37
small breed older dogs are likely to have (heart)
primary valve disease
38
larger horses are likely to have (heart)
atrial fibrilation
39
ponies likely to have (heart)
septal defects
40
female dogs are likely to have (heart)
patent ductus arteriosus
41
male dogs are likely to have (heart)
dilated cardiomyopathy
42
8 cardiac disease clinical signs
- dyspnoea
- cough
- lethargy
- exercise intolerance
- ascites
- peripheral oedema
- syncope
- collapse
43
define syncopy
fainting
44
clinical signs of venous congestion
- jugular pulse/distension
| - obvious ventral abdominal veins
45
what valve is on the right sied
tricuspid
46
what valves are on the left
- pulmonic
- aortic
- mitral
(PAM)
47
S1 heart sound is made due to
- start of systole
| - closure of mitral and tricuspid (atrioventricular) valves
48
S2 heart sounds made due to
- end of systole
| - closure of pulmonic and aortic valves
49
s3 heart sounds made due to
passive filling of the ventricle
50
S4 heart sounds made due to
active filling of ventricle due to atrial contraction
51
presence of a diastolic heart sounds in small animals indicates
ventricle not filling normally
| gallop rhythm
52
heart murmur indicates
presence of turbulent flow
53
murmurs are described based on (6) (also what are most important)
- timing/duration
- intensity
- location
- radiation
- pitch
- shape
(first three are most important)
54
valves near the heart base are
outflow valves - aortic and pulmonic
55
valves on left near apex
mitral
56
valve near apex on right
tricuspid
57
PDA murmurs location
dorsal to left heart base
58
ventricular septal defect murmur location
diagonal from left apex to right sternal border
59
grades for heart murmur intensity (out of)
6
60
grade 1/6 heart murmur
heard after a long time with perfect coniditions
61
grade 2/6 heart murmur
heard as soon as you place stethoscope over point of maximal intensity
62
grade 3/6 heart murmur
clearly audible and as loud as the normal heart sounds
63
grade 4/6 heart murmur
louder than heart sounds but no palpable thrill. likely to radiate widely over thoracic cavity
64
grade 5/6 heart murmur
palpable thrill over point of maximal intensity at skin surface
65
grade 6/6/ heart murmur
can hear with stethoscope lifted of off chest wall
66
high pitch murmurs indicate
more likely to be ejection murmur
67
low pitch murmurs indicate
more likely to be regurgitant flow
68
when listening to heart murmur is it louder on
right or left
69
is murmur during
systole or diastole
70
diastolic murmur on left over the apex suggests
mitral stenosis
71
diastolic murmur on left over the heart base suggests
aortic or pulmonic insufficiency
72
diastolic murmur on right cranial suggests
aortic insufficiency or tricuspid stenosis
73
systolic murmur on the left over the apex suggests
mitral insufficiency
74
systolic murmur on left over the heart base suggests
aortic or pulmonic stenosis
75
systolic murmur on the right sternal border suggets
ventricular septal defect
76
systolic murmur on the right cranial suggests
tricuspid insufficiency or aortic stenosis
77
4 types of echocardiography
- M-Mode
- 2D echo
- spectral doppler
- colour flow doppler
78
M-mode echocardiography shows
linear point of source ultrasound that makes a graph showing depth against time
79
M-mode is used to sow
contractility
80
2D echo shows
2D image of wedge shape through the heart
81
spectral doppler shows
velocity-time graph of blood flow
82
colour flow doppler shows
- colour indicates direction of blood flow
| - Blue Away Red Towards (BART)
83
normal short axis left atria:aorta diameter in dogs
smaller than 1.6
84
normal short axis left atria:aorta diameter in cats
smaller than 1.5
85
long axis left atria diameter in cats
less than 1.6 cm
86
normal fractional shortening in dogs
25-50%
87
normal fractional shortening in cats
30-50%
88
if % fractional shortening is too low it is
hyopkinetic
89
if % fractional shortening is too high it is
hyperkinetic
90
pulmonary congestion can be seen on radiograph as
enlarged arteries and veins coming from heart in the thoracic cavity
91
right sided heart failure will show radiographically as (3)
- hepatomegaly
- pleural effusion
- peritoneal effusion
92
left sided heart failure will show radiographically as (2)
- pulmonary congestion
| - pulmonary oedema
93
pulmonary oedema in dogs usually affects the
caudal lung lobes
94
increased cardiac size can show (3)
- cardiac dilatation
- eccentric hypertrophy
- pericardial effusion
95
3 types of dog that normally have an enlarged rounded heart
- puppies
- fat dogs
- brachycephalic breeds
96
number of intercostal spaces usually occupied by the heart
3
97
a square broad heart silhouette is usually seen in what breed
retrievers
98
an upright straight caudal border heart shape is seen in what breeds
dobermans
99
tall slim cardiac silhouette is seen in what breeds
- setters
| - afghans
100
enlargement of the left ventricle shows as what on radiograph
- RL views - increased dorsal ventral dimension
| - DV/VD views - elongated cardiac silhouette
101
left atrial enlargement shows as what on radiograph
- RL view - increased dorsal ventral dimension with bulge at dorsocaudal point
- DV/VD view - focal bulge on mid left side of heart
102
right ventricular enlargement shows on radiograph as
- RL view - enlarged craniocaudal dimension with increased sternal contact
- DV/VD view - more curved right side border
103
right atrial enlargment on radiograph shows as
- RL view - increased craniocaudal dimension without increased sternal contact
- DV/VD view - more curved right side border
104
aortic flow murmurs are seen in what type of horse
fit horses
105
aortic flow murmurs timing
early to mid systolic
106
aortic flow murmur shape
crescendo - decrescendo
107
ventricular flow murmurs timing
early diastolic
108
ventricular flow murmurs point of max intensity
heart base or AV valves on left/right
109
ventricular flow murmurs are normal in (horse)
2-3 year old young thoroughbreds
110
% of horses in work with valve regurgitation
30%
111
severe mitral valve regurgitation can cause
pulmonary artery rupture causing collapse/sudden death
112
aortic regurgitation is seen in (horses)
older horses
113
most common equine valve pathology
degenerative valvular heart disease
114
bacteraemia can cause what in heart
bacterial endocarditis
115
treatment of bacterial endocarditis
broad spectrum antibiotics
116
prognosis of bacterial endocarditis
guarded as permanent damage could have been done, of emboli could of broken off
117
aortic regurgitation in horses is often due to
endocardiosis
118
ruptured chordae tendinae can occur (3)
- spontaneously
- secondary to inflammatory changes of chordae tendinae
- secondary to degenerative changes of chordae tendinae
119
ruptured chordae tendinae is more common in what valve (horse)
mitral valve
120
patent ductus arteriosus is normal in (horse)
7-10 day old foals
121
PDA murmur timing
continuous
122
PDA murmur point of max intensity
heart base
123
6 primary causes of arrhythmias
- infectious
- nutritional
- neoplasia
- toxins
- cardiomyopathy
- immune-mediated
124
6 secondary causes of arrhythmias
- endotoxaemia
- electrolyte disturbances
- acid-base disturbances
- hypoxia
- catecholamine induced
- vagally induced
125
nutritional myodegeneration (white muscle disease) occurs on ruminants due to
selenium deficiency
126
cardiac form of nutritional myodegeneration is seen in (cows)
young animals
127
skeletal form of nutritional myodegeneration is seen in (cows)
older animals
128
inherited cardiomyopathy is linked to what gene (cows)
red holstein gene
129
cardiac neoplasia appearance cows
right atrial lesions extending into heart and heart base area
130
cardiac isoenzymes indicating cell death
- creatine kinase
| - lactate dehydrogenase
131
lead used during ECG in large animals
base apex lead
| base is -ve. apex is +ve
132
radiotelemetry define
wireless ECG used to look at animal at work
133
ambulatory ECG define
can monitor ECG of patients at home over 24 hours
134
commonest pathological dysrhythmia large animals
atrial fibrilation
135
4 predisposing factors to atrial fibrilation
- large atrial mass
- slow SA node rate (high vagal tone)
- variable refractory period
- myocardial disease
136
re-entry in atrial fibrilation
a unidirectional block to conduction in the atrial mass, causes signal to go in a circel and so causing atrial fibrilation
137
atrial contraction contributes to % of ventricular filling
15%
138
waves seen on ECG indicating atrial fibrilation
F waves
139
treatment of atrial fibrillation horse
quinidine sulphate every 2 hours until atrial fibrillation stops or signs of toxicity show
140
treatment of horse with atrial fibrillation and heart failure
- furosemide
- digoxin
- ACE inhibitors
141
quinidine sulphate is a (class and type)
class 1a antidysrhythmic drug
142
quinidine sulphate actions
slows the Na+ fast channels and so prolongs the effective refractory period of the heart
143
4 side effects of quinidine sulphate
- tachycardia
- hypotension
- decreased cardiac output
- GIT ulceration
144
quinidine sulphate how to give
via stomach tube
145
atrial fibrillation recurrance rate if occuring for less than 3 months
15%
146
atrial fibrillation recurrance rate if occuring for more than 3 months
60%
147
normal QRS complex with abnormal P wave indicates
atrial premature complex
148
abnormal P wave with no QRS complex indicates
non conducted atrial premature complex
149
abnormal QRS with no P wave indicates
ventricular premature complex
150
ventricular premature complex with constant QRS waveform is
uniform
151
ventricular premature complex with variable QRS waveform is
multiform
152
supraventricular tachycardia define
rapid heart rate originating at AV node or above
153
most common form of pericarditis in cattle
septic pericarditis
154
2 causes of septic pericarditis
- traumatic
| - emolic
155
most common cause of pericarditis in horse
idiopathic
156
most common form of pericarditis in pigs
primary bacterial pericarditis
157
5 causes of pericarditis
- septic
- idiopathic
- primary bacterial
- neoplastic
- viral
158
cause of lymphoma in cow
bovine leukaemia virus
159
cause of pericarditis in pig
haemophilus suis
160
3 causes pericarditis horse
- e.coli
- equine viral arteritis
- equine influenza
161
treatment of pericarditis in horse
drain pericardial fluid and lavage with antibiotics
162
lab data of bacterial endocarditis cow
- hyperfibrinogenaemia
- anaemia
- leukocytosis
163
cor pulmonale define
right sided heart failure
164
exercise induced pulmonary haemorrhage where haemorrhage occur and why
- caudodorsal lung lobes
| - higher blood flow and lower intrinsic resistance, also mechanical forces are greatest here
165
3 clinical signs of exercise induced pulmonary haemorrhage
- poor performance
- swallowing after excersize
- epistaxis
166
4 diagnosis methods of exercise induced pulmonary haemorrhage
- endoscopy
- bronchoalveolar lavage
- radiography
- scintigraphy
