Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Small Animal Medicine > Diastolic Dysfunction > Flashcards

Diastolic Dysfunction Flashcards

Exam IV (51 cards)

Start Studying
1
Q

Diastolic Dysfunction

DfDx (categories)

A

Primary:
Hypertrophic Obstructive Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy

Secondary:
Pressure Overload (Hypertension, Stenosis)
Pericardial Diseases (cannot relax because so stiff)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Brief pathophysiology of aortic and pulmonic stenosis

A

Diastolic Dysfunction

Pressure in aorta too high (due to stenosis) causing pressure overload in LV

Pressure in pulmonary artery too high (pulmonic stenosis) causing pressure overload in RV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Diastolic Dysfunction?

A

Concentric Hypertrophy; increased wall thickness and decrease lumen

Usually a disease of cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Blood pressure importance

A

Blood pressure dictates perfusion (blood to vital organs; brain, kidney, heart, eyes)

Hypotension: ischemia, not enough vascular tone, perfusion is poor

Hypertension (Systolic >160 mmHg): capillary beds will rupture, too high of pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Systemic Hypertension

DfDx

A 
Hyperaldosteronism 
Pheochromocytoma (increases production of Epinephrine and norepinephrine which act directly on heart -> vasoconstriction, also causes vasoconstriction peripherally)
Acromegaly
Medications
Diabetes Mellitus
Hyper/hypo-thyroidism
Hyperadrenocorticism (Cushing's; papillary muscles will enlarged in LV)
Renal Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Systemic Hypertension

Hypertensive Encephalopathy

A

Diastolic Dysfunction

Hemorrhage into brain
Seizures
Ataxia
Stupor
Blindness (especially cats)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Systemic Hypertension

Hypertensive retinopathy

A

Vascular distension and tortuosity
Retinal hemorrhage

Cat with acute blindness? Always check blood pressure

Fundic exam: very injected vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Systemic Hypertension

Hypertensive Choroidopathy

A

Focal necrosis: hypopigmentation

Retinal detachment: fuzzy appearance because the retinal is floating towards you

Treatable!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Systemic Hypertension

Hypertensive optic neuropathy

A

Optic nerve ischemia -> edema -> atrophy

Absence of retinal blood vessels

Retina is dead; not reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Systemic Hypertension:

Cardiac damage

A

Results in secondary cardiac remodeling

Concentric hypertrophy of LV; wall gets so thickened that there is ischemic damage

Muscle growing inwards but the arterial blood supply does not grow => myocardial ischemia

NOTE: Heart disease does NOT cause systemic hypertension
Actually, heart disease decreases CO resulting in hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Systemic Hypertension:

Kidney Damage

A

Patients with kidney disease will worsen

Increased glomerular pressure
Proteinuria, glomerular ischemia
Dysregulation of autoregulatory mechanisms
Interstitial inflammation and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Systemic Hypertension relationship to Diastolic Dysfunction

A

Hypertension induces compensatory thickening of ventricular wall (LV concentric hypertrophy) => decreases LV filling

Looks similar to HCM but is not HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Systemic Hypertension

Treatment

A

Treat underlying disease (DfDx)

Decrease BP:
Beta blockers (good in hyperthyroidism cats)
Decrease preload (diuretics)
SVR:
ACE inhibitors (small BP drop)
Amlodipine (Rx of choice especially in animals with renal disease; Ca2+ channel blocker)
Phenoxybenzamine (pheochromocytoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Systemic Hypertension

Treatment Goals

A

Correct BP: 100 to 160 mmHg

Alleviate clinical signs

Prevent progression of end-organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What effect does severe acute arteriolar vasoconstriction have on the heart rate?

A

BP = CO x SVR
SVR increases therefore BP increases
BP stimulates HR to decrease (reflex bradycardia)

Brain needs perfusion!
Decrease HR means decrease CO; so brain will want to increase systemic blood pressure -> reflex bradycardia
Cushing’s Reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Hypertrophic Cardiomyopathy?

dysfunction, PE, etiology

A

Diastolic dysfunction, concentric hypertrophy of LV (wall grows inward)

Cats!
Genetic basis:
Maine Coons
Ragdolls

PE:
+/- systolic murmur
+/- gallop sound (could be due to Hyperthyroidism as well)
+/- normal

Diagnosis of exclusion; only definitively diagnosed via echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Asymptomatic HCM, Stage B

Treatment

A

B1 Mild: No treatment, monitor

B2 Moderate/Severe:
\+/- ACE inhibitor
\+/- Beta blocker
\+/- Diltiazem 
\+/- Spironolactone 
\+/- Antithrombotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptomatic HCM, Stage C

Treatment

A 
CHF:
Furosemide (pulmonary effusion) 
ACE-inhibitor
\+/- thoracocentesis 
\+/- pimobendan 
\+/- spironolactone 
\+/- antiarrhythmics

Arterial thromboembolism:
Supportive care
Antithrombotics (aspirin, clopidogrel, low molecular weight heparin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Virchow’s Triad

A

Blood stasis

Endothelial Injury -vasculitis-(release clot activating substances)

Hypercoagulability (inflammatory disease -IMHA-, hyperadrenocorticism, PLN)

Neoplasia can cause all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Feline Arterial Thromboembolism

Death due to? ECG?

A

Reperfusion injury (hyperkalemia) -> cardiac arrest

ECG changes:
Tented T waves
Decreased amplitude P waves to no P waves
Increased PR interval
Wide QRS complexes
Potentially atrial standstill (no P waves, ventricular escape complexes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Feline Arterial Thromboembolism

Treatment

Study These Flashcards
A

Dextrose +/- insulin
Bicarbonate
Calcium
Furosemide
IV fluids; may have to decrease if the cat has heart disease
Pain will most likely resolve within 3 days; treat pain while hospitalized (monitor potassium)

Guarded to poor prognosis (<40% survive)

22
Q

Feline Arterial Thromboembolism

Regaining function

Study These Flashcards
A

3-6 months to regain function

Complications (self mutilation, necrosis, need for amputation)

Recurrence Rate: 25-50%
Keep on Clopidigral

23
Q

Hypertrophic Obstructive Cardiomyopathy
What is it?
Diagnosis

Study These Flashcards
A

Diastolic Dysfunction

Idiopathic

Cat disease

Diagnosis; echocardiogram
Systolic anterior motion of mitral valve:
transient with stress -> no hypertrophy
obstruction -> concentric hypertrophy

24
Q

Asymptomatic Hypertrophic Obstructive Cardiomyopathy, Stage B
Treatment

Study These Flashcards
A

B1 and B2:
Slow heart rate to reduce systolic anterior motion
Beta blocker (go to)
Dilitiazem

25
Symptomatic Hypertrophic Obstructive Cardiomyopathy, Stage C | Treatment
``` CHF: Furosemide (pulmonary effusion) ACE-inhibitor +/- slow HR +/- thoracocentesis +/- pimobendan +/- spironolactone +/- antiarrhythmics ``` Arterial thromboembolism Supportive care Slow heart rate (beta blocker) Antithrombotics (aspirin, clopidogrel, low molecular weight heparin)
26
Restrictive Cardiomyopathy What is it? Diagnosis
Diastolic Dysfunction Idiopathic: amyloidosis, fibrosis Cat disease Diagnosis: Echocardiogram; Normal wall thickness (not HCM) Normal to reduced systolic dysfunction Diagnosis of exclusion
27
What is pulmonary hypertension?
A secondary disease process! (left heart disease or pulmonary disease) Increased pressure in the lungs Normal pressures: Systolic: 30 mmHg Diastolic: 10 mmHg
28
What increases pulmonary venous/LA pressure?
Decreased pulmonary venous drainage Left-sided heart failure (any left heart disease) - LA pressure increase can cause increase in pulmonary venous pressure (back up) Pulmonary venous obstruction (hilar lymph nodes at bifurcation or trachea and mainstem bronchi)
29
CO and Pulmonary Hypertension
Increased CO can increase pulmonary hypertension Increase volume going through lungs during exercise Lungs reach capacity and will end up in pulmonary hypertension
30
What can increase pulmonary venous return?
Increase right-sided CO Anemia, fever, exercise Large L -> R shunts: PDA VSD Atrial septal defect (ASD)
31
What can increase pulmonary vascular resistance?
Loss of pulmonary vessels (obstruction) Pulmonary thromboembolism (Virchow's Triad) Pulmonary vasoconstriction (Hypoxemia; which will want to cause vasodilation); will vasoconstrict to shunt blood to areas that are in need of oxygen rich blood
32
Causes of Hypoxemia
Primary lung disease: Chronic obstructive pulmonary disease (chronic bronchitis) Pulmonary fibrosis Collapsing trachea (lungs hypoventilated; pulmonary hypertension due to vasoconstriction) High altitude Pulmonary vasoconstriction resulting in pulmonary hypertension
33
How do you diagnose pulmonary hypertension
Cardiac catheterization; measures direct pressures of the PA, pulmonary capillaries, and pulmonary veins Jugular vein --> cranial vena cava --> RA --> RV --> pulmonary artery --> lungs --> pulmonary vein Echocardiogram; indirect measures of pulmonary pressures Only definitive if pulmonic regurgitation is present
34
Pulmonary Hypertension | Treatment
Treat underlying disease (usually respiratory) Cardiac protectants Viagra (sildenafil) Phosphodiesterase type V Specifically vasodilates, pulmonary vasculature; pulmonary vasodilation
35
What is Cardiac tamponade?
Presence of pericardial effusion pressure is greater than RA pressure (5 mmHg). RA will collapse on itself; cannot open and fill Reduction of CO Will see clinical signs!
36
Physical Exam findings of pericardial effusion and cardiac tamponade
Muffled heart sounds (lung sounds should be normal) Tachycardia (less blood getting to heart less getting pumped out) Reduced/absent/shifted precordium (cannot feel heart beat when hand placed on chest) Jugular venous distension/pulses Weak femoral pulses (hypotension, pulsdes paradoxus) Right sided CHF (ascites) Exercise intolerance, lethargy
37
What is Pulsus Parodoxus?
Pulse change during inspiration and expiration due to the movement of the ventricular septum Pulses are weak during inspiration (right ventricle fills better and left fills poorly; septum moves left) Pulses are stronger during expiration (right ventricle fills poorly while left fills better; septum moves right)
38
Pericardial Effusion | Radiographic findings
Enlargement of cardiac silhouette (+/- globoid; not pathopneumonic) Sharp well demarcated edges of heart Distension of caudal vena cava (RA squished so blood is stuck in the vena cava; high pressure) Small pulmonary vessels Mass effects Abdominal effusion
39
Pericardial Effusion | ECG Findings
Decreased QRS amplitude (short) -> heart surrounded by fluid and electricity cannot travel well through fluid to the leads Electrical alternans; QRS short then tall then short then tall Sinus rhythm Irritation can be noted; ventricular arrhythmias (VPCs, supraventricular tachycardia)
40
Emergency treatment of Pericardial effusion | Short term
Goal: increase preload to force blood into the heart Fluids! = treatment of choice This will increase blood volume therefore increasing BP More fluid going to heart which will increase RA pressure Be aggressive with administration (take weight in pounds and add a zero; that is how much fluids should be given -over an hour?-) Monitor with ECG Want to expand the heart so you can perform a pericardiocentesis
41
Pericardial effusion | Diuretics?
NO do NOT use Will decrease volume and decrease BP Less blood going to CO Will cause RA to collapse more -> kills patient
42
Emergency Treatment Pericardial Effusion Long term
Goal: relieve tamponade and determine etiology Pericardiocentesis Collect samples for culture and cytology (2 red tops and 2 purple top)
43
Pericardial Effusion | Transudate DfDx
``` Hernias Cysts CHF Hypoporteinemia Heart based mass (chemodectoma) ```
44
Pericardial Effusion | Exudates DfDx
``` Foregin body (TRP, porcupine quills, grass awn) Nocardia Fungal FIP Idiopathic inflammation ```
45
Pericardial Effusion | Hemorrhagic
Most common type Neoplasia: HAS (#1; mass on right auricle tip), Chemodectoma (base of heart, around aortic base), Ectopic thyroid, lymphoma Coagulopathy: Rodenticide Idiopathic
46
Pericardocentesis | Risks
VPCs Coronary artery laceration Lung laceration and resultant pneumothorax, hemorrhage Dissemination of infection/neoplastic cells to pleural space NOTE: tamponade will kill them first therefore this must be done
47
Pericardocentesis | Procedure
Sterile with long (equine) catheter, 3 way stop cock, 2 red top tubes, 1 purple top tube, IV extension set Sternal or right lateral approach, cranial to rib (intercostal space 3 to 6) Attach ECG; if VPCs noted during procedure pull needle back Have lidocaine ready for any arrhythmias that may occur Sample should not clot; otherwise might have sampled from vessel or heart Should resolve tachycardia (heart will fill better)
48
Peritoneal-Pericardial Diaphragmatic Hernia (PPDH)
Congenital pericardial disease in animals Retention of abdominal contents in the pericardium (failure of embryologic separation); diaphragm and pericardium communicate Cats can present at older ages
49
Peritoneal-Pericardial Diaphragmatic Hernia (PPDH) | Findings
Signalment: Young, no trauma history, common in cats Clinical Signs: Variable, respiratory, GI (if intestines get impacted) Omentum is most common organ PE: Muffled heart sounds
50
PPDH | Treatment
If symptomatic than surgery No symptoms? Leave be.
51
PPDH | Diagnosis
Radiographs Wide base connection between heart and diaphragm Pericardium and diaphragm connected Ultrasound See abdominal organs near/around heart

Small Animal Medicine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions