Exam 3 Flashcards
(122 cards)
1
Q
Congenital heart disease can be caused by
A
Genetics
Teratogen [things that hurt the embryo]
Structural abnormality
2
Q
Which congenital disease can progress after the point of birth
A
Only aortic stenosis - common in dogs
3
Q
What is the diagnostic test for a definitive diagnosis with congenital heart disease and cyanosis congenital disease?
A
Echocardiography
For Dogs mainly its PDA and SAS
For all others it’d VSD
4
Q
Over circulation pattern that means that there is a lot of blood going through the pulmonary circulation
What are the 2 heart diseases
A
- PDA
- VSD
- ASD???
5
Q
A small hole with VSD vs
small hole with VSD and SAS ;
which is better with a smaller hold
A
VSD- small hole is good
SAS - small is bad with more velocity
Pg= 4 x (velocity)^2
6
Q
Subaortic Stenosis [SAS] increases the risk of
A
Endocarditis risk!!
Peri-dental antibiotics are good with increased risk
AV valves are commonly where there is endo carditis in small animals
7
Q
The most common acquired degenerative disease in dogs
A
Mitral valve disease
Genetic but also acquired
8
Q
ONLY 2 causes of Reverse D:
the pulmonary artery enlargement/bulge [this is the post stenotic dialation ~ aneurysm]
RV and RA enlargement
A
Pulmonic Stenosis (Heartworm too) and Pulmonary hypertension
9
Q
Tetralogy of fallot
A
this is the most common among the (more rare) cyanotic malformations
a constellation of four defects
• pulmonic stenosis
• high VSD
• overriding aorta (“dextroaorta”)
• right ventricular hypertrophy
10
Q
Because the large animals [ruminants] are under anesthesia there is:
A
Dorsal recumbancy :
- V-Q mismatch!! = hypoxemia
- Compress vena cava = lower BP and CO and VENOUS RETURN
- distended abdomen into the lung = hypercapnia
In large animals and horses= have more muscle mass
So the BP is responsible for the muscles AND organs
• the MAP > 70 mmHg [for the perfusion of the extra muscle mass]!
11
Q
Anesth: Can you determine whether the camelid blood is venous or arterial via the darkness of the blood?
A
No because they are specialized
- they venous blood is light colored
12
Q
Fasting before anesthesia in ruminants and calves and kids….
A
▪Adult cattle: 24-48 hours for feed;12-18 hours for water
▪Small ruminants, camelids: Not > 18 hours for food & 12 hours for water
▪ Calves, kids, lambs, crias: Not > 4 hours of fasting (risk for hypoglycemia)
Dont want to completely empty the GI track because dont want ketosis!!!
13
Q
Which species is the most sensitive to alpha 2 agonists
A
Ruminants —> esp Brahmin
Sheep - pulmonary edema!!!!
14
Q
What is good to sedate ruminants?
A
Benzodiazepines
15
Q
Two species that are prone to laryngospasms
A
Cats and pigs and guinea pig
- use lidocaine on the larynx
16
Q
WHATS IN THE WAY OF INTUBATION in guinea pigs and pigs
A
Guinea pigs: palatial optimum
Pig: pharyngeal diverticulum
17
Q
Biggest anesthetic problem in pigs :
A
Malignant hyperthermia :
- transport and restraint
- warm temperatures
- halothane
- succinylcholine [paralytic given in anesthesia
Generalized muscle contraction—> Ca released into sarcoplasm —> ETco2 increase and then tachypnea and high temp
Acidosis —> Hyperkalemia —> death
Treat with DANTROLENE!!!!!
18
Q
Do you fast the pet exotics??
A
NO
THEY REGURGITATION AND HAVE ILEUS AND HYPOGLYCEMIA
19
Q
Mask induction in small animals or pigs
A
DONT USE MASK INDUCTION TO IMMOBILIZE PIG OR ANY SMALL ANIMALS
• high mortality
Only with very profound sedation can we use inhalant to induce [but ideally just use propofol IV]!!!
20
Q
Pressure overload diseases
A
Rarely lead to congestive heart failure
21
Q
What type of cough is seen with non-productive/non-inflammatory disease
A
Goose-honk —> tracheal collapse
22
Q
Productive cough is seen with
A
Inflammation or pneumonia
23
Q
Cough receptors are mainly around
A
Prevalent around the larynx, tracheal bifurcation, and the main bronchi
24
Q
Intrathoracic or Extrathoracic airway obstruction:
Normal inspiration and prolonged expiration and increased effort
A
Intrathoracic airway obstruction - it is within the thorax —> harder to expire
Whereas with extrathoracic - it is in the upper airway so it is harder to inspire
25
Sterdor vs strider
Stertor: low frequency because of soft palate or nasal disease
Stridor: like a squeaking ; high pitch because there is a narrow passageway for air
- larynx or trachea [**Larynx EVAL W SEDAITON**]
26
Nasopharynx and nasal : Tooth root abscess, is nasal airflow preserved?
Yes it is
Airflow obstruction can be caused by nasopharyngeal stenosis [congenital or inflammation]
27
Spread through inhalation and with facial distortion and Stertor in cats
Check with cytology and serology!! -CRYPTOCOCCUS
Fluconozole
Monitor long term with titer
28
Dolicocephalic dog with nasal turbinate destruction and nasal depigmentation with facial pain
And treat
Canine nasal aspergillosis - fungal plaques on the rhinoscopy and CT
Treat with **clotrimazole** anti fungal infusion after trephination
29
Nasal neoplasia in dog and cats
Pretty common
Dog: carcinoma/adenosarcome
Cat: lymphosarcoma [localized]
Survival is worse with dogs:
Dog- palliative radiation therapy; 9-23 months
Cat: 2.5 years
30
Chronic rhinitis due to unknown origin which is in large ; young to middle aged dogs
Lypmphoplasmacytic inflammation
Hard to treat! SiMILAR to feline chronic rhinosinusitis
31
BOAS- brachycephalic obstructive airway syndrome
Increased airway resistance :
Reduced nasal bones
Stenosis nares
Elongated soft palate
Everted laryngeal saccules
Laryngeal collapse
Hypoplastic trachea
32
BOAS: Laryngeal collapse
Resect everted laryngeal saccules, expand stenotic nares, fix the elongated soft palate
33
BOAS can cause GI signs that are seen via
Regurgitation and vomit or hiatal hernia
Caused via increased negative pressure during inspiration
34
Laryngeal diseases
Laryngeal Diseases
• Laryngeal paralysis
• Laryngeal collapse
• Edema/inflammation
• Laryngeal mass
• Neoplasia
• Inflammation
• Extraluminal obstruction
35
Treat **bilateral** laryngeal paralysis with
Unilateral arytenoid lateralization [tie back surgery]
Connect circoid cartilage to the muscular process of arytenoid
Consequences : 20% risk of. **aspiration pneumonia**
36
**Fibrin**ous pericarditis vs suppurative pericarditis
Fibrinous pericarditis= sepsis
Haemophilus parasuis (Glasser’s
disease)
Streptococcus suis
Mycoplasma hyorhinus
Suppurative pericarditis:
Traumatic reticulopericarditis [ hardware disease]
37
Heart, endocardium, vessels: Dystrophic mineralization?
Heart - vitamine/selenium deficiency
Endocardium and vessels is Metastatic mineralization - vitamin D toxicosis which increases calcium, and phosphorous
38
Myxomatous mitral degenerative disease vs Endocarditis
Endocardiosis is inside the value and is smooth while endocarditis is on the valve and rough
39
Most common disease in geriatric dog
Myxogenous mitral valve disease/ endocardiosis
40
Myxogenous mitral valve disease grading
Stages:
A- predisposing breed [cavalier King Charles]
B1- can recognize disease but no cardiac enlargement
B2- no clinical signs of heart failure but heart is big
• loud murmur and the atria is big on echo
• VHS [vertebral heart score]
C- heart failure clinical signs and there is enlarged hear
D- the drugs wont work [refractory disease]
Very common
Only small percent of dogs progress to the heart failure!!!
41
What disease is good to treat with pimobendan?
Mitral valve disease [but you HAVE TO check that it is with echocardiography]
Treat with **furosemide** and pimobendan +ACEI +spironolactone
And DCM
And generally volume overload diseases
42
Does the presence of a heart murmur and cough mean that the patient is in heart failure?
No it does not!!
Have to take radiographs! And echocardiography!
Check with furosemide and see if there is the resolution of the tachypnea
43
Does vertebra heart score say right or left heart enlargement?
No just says its enlarged
- look for interstitial pattern for left chf
44
Cyanosis that has history of seizures canbe tested by
PCV
There is more RBC produced —> there is blood moving like sludge and there is trouble perfusing the muscles
**Polycythemia reflects severity of RtoL shunt/hypoxemia**
45
Ventricular tachyarrhythmias can be caused by
Pressure overload diseases like PS and SAS
Or cyanotic heart diseases
Or DCM [clinical or Doberman preclinically]
46
Most common non-congenital heart disease in cat
Is cough in cat a sign of this/any heart disease
With a murmur is the cat having having heart disease?
HCM
Cough is not representative of any heart disease; its just respiratory
A murmur is not enough ; must do echocardiogram
47
Most common heart disease in dog
MMVD
48
T/F: Dogs and cats with big heart are at risk of clot formation? PTE vs FATE (SATE)
- artery syndrome
False
ONLY CATS associate thromboemboli with heart disease!!
PTE:
Dog and cat = PLE/PLN, immunomediated disease, neoplasticism disease, hyperadrenocorticism, HWD
**Cat = R-heart enlargement due to ARVC and RCM**
—> also cause PHT
SATE: **cats mainly**
FATE- main reason that a cat throws a clot because it of the cardiomyopathy with LA/LV enlargement =HCM
— **5 P’s. Pallor, Pain, Paresis, Pulselessness, Poikilothermia**
Dog = PLN/PLE, Immunomediated diseases Hyperadrenocortism, **endocarditis and hypothyroidism**
Equine : Aortic iliac thrombus due to strongylids vulgaris —> exercise to maintain collateral circulation
49
Tracheal collapse
Dorsoventral flattening of the tracheal rings with lax dorsal tracheal membrane
- softening of the cartilage ring
- chronic inflammation and alterations of elastic fibers in the dorsal tracheal membrane
Hard to see on radiograph: due to collapse being dynamic
Chronic progressive problem : manage with weight and antitussives
50
What is best for looking at intrathoracic collapse
Fluoroscopy because you incite the cough then see
Tracheobronchoscopy in all cases of tracheal collapse
51
The biggest concern with feline asthma and bronchitis is
The inflammation causing airway smooth muscle constriction which will make the lumen of the airway smaller
- acute respiratory distress? Then alleviate the bronchoconstriction [Albuterol and terbutaline]
52
Dog vs Cat what is the respiratory disease with predominance of non-degenerative neutrophils and some eosinophils?
What if there is a predominance of eosinophils?
Predominant non-degenerative - neutrophils
Dog- Canine chronic brochitis
Cat: Feline asthma/bronchitis
Predominant eosinophils
Dog- Eosinophillic bronchopneumopathy
53
Aspiration pneumonia mainly affects __ lung lobes
Aspiration pneumonia mainly affects **cranioventral or middle lung lobes**
- alveolar infiltrate
54
If there is laryngeal paralysis : unilateral vs bilateral
Unilateral = no surgery
Bilateral = **unilateral arytenoid lateralization** [move the arytenoid laterally]
Or **vocal fold resection** [remove vocal folds to make opening]
55
The cervical trachea will collapse during
The cervical trachea will collapse during inspiration
Thoracic trachea collapses during expiration
56
Dynamic tracheal collapse happens in
Middle aged to older miniature, toy, and small dogs
- Yorkshire terrier
- Pomeranian
- Pug
57
Dirofilaria Immitis causes what to the heart
Right heart enlargement —> resulting in the potential of pulmonary thromboembolism
58
Dog vs cats heartworm disease
#worms
Antihelminth tx
Cats can be affected by just a small number of worms
No approved antihelminth tx for cats
59
Dirofilaria immitis: Caval syndrome
More than 40 worms in the RV and the RA and the caudal vena cava
- fatal outcome even with surgery
The worms are cumulative so as more come in they move to the muscle —> then pulmonary artery causing endothelial damage, vessel thickening, stasis—> then heart
60
Pathology of MMVD
The preload is increased [volume overload disease]—> lower cardiac output—> compensatory mechanism —> **afterload is decreased** ‘
Compensatory mechanism keeps the contractility up **increases fractional shortening to 45%** in the LV and makes this a LONG dz process
Normal FS =30%
WITH MMVD= 45%
61
Loud or soft _ a cardiac cough
Soft cardiac cough
62
What direction does the thrombus build?
• OPPOSITE THE DIRECTION OF BLOOD FLOW
• in veins it builds away from the heart [away from the heart because flow coming to heart]
• In arteries it builds toward the heart [ closer to heart]
63
Thrombus can happen due to
Blood statis
Hypercoagulability : hyperadrenocortism and glomerular disease - lose AT-3
Endothelial injury : ie vasculitis
64
Arteritis parasites that cause endothelial injury
Dirofilaria - pulmonary arteries
Strongylids vulgaris - in cranial messenteric artery
65
Arterial medial calcification where there is accumulation of mineral in artery wall happens with
Endocardia’s mineralization which is Metastatic due to Vitamin d TOXICITY OR jOHNES disease
66
Lymphangiectasis vs lymphangitis
Lymphangiectasis : dialation of the lymph vessels and is
- congenital
- obstruction of lymph drainage
Lymphangitis - inflammation of the lymphatic vessels
- ie. CORYBACTERIUM
67
Can a dog be MF+ 3 month after treatment with within the AHS protocol?
Killed MF with macrocyclic lactones, and adulticide melarsomide for the adults
Resistance to macrocyclic lactones
MF can live up to 2 years in the blood; the adults killed with melarsomide
- between the 42 days and the adult stage
There could be larvae in muscles or SQ tissue
Reinfection
False positive test: MF that is not heartworm
Melarsomide will leave mainly just female adults ; males are more susceptible
- but if large infection then there may be some males left
- MF+ / Antigen -
Treat with MF-cide and retest!
68
How often after last administration will the dog have to be tested?
6 months after the last dose then have to do the MF/larvae test [knotts test] and antigen test [SNAP]
If <6 months then can restart macrocyclic lactones
69
Why no clot in normal condition?
Fibrinolysis : break apart clots
Antithrombin 3! —> hypercoagulability in PLE/ with glomerular filtration losing AT3
70
Cat HCM radiography
**think what is different for L-heart enlargement**
LA enlargement. = wide base of heart on DV
LVH= the ventricle apex touches the diaphragm [not too tall like dog]
L-CHF= pulmonary edema AND **pleural effusion**
71
Thrombi therapy options
Thrombolysis - nahhh because of reperfusion injury
Primary thromboprophylaxis
Secondary tromboprohylaxis- keep from reoccurring!!!!
Heparin
Aspirin- 11days not ideal
***Clopidergol - best from secondary thromboprophylaxis ***
72
Eosinophillic Broncopneumopathy
↑ eosinophils with moist cough
No know cause
**Siberianhusky**
Prophylatically treat for parasites and responds to life long steroid
73
Lung lobe torsion in small vs large
More common in deep chested African hound
Large= right middle
Small = left middle
Will see pleural effusion because of the swelling and lobar opacity
TX - lobectomy
74
Non-cardiogenic pulmonary edema
In the pulmonary parenchyma
Increase fluid because of decreased interstitial hydrostatic [pull water into interstitum], decreased capillary oncotic, increased permeability
Endothelial damage => **Increased permeability IS WORST —> Acute respiratory distress**
- furosemide wont work!!
**Caudodorsal lung field infiltrates in lung =opacity bilateral in rads**
O2 supplementation + mechanical ventilation
75
In camelids is the jugular vein blood darker than the carotid artery?
No camelid color is same
76
Eyelid reflex in anesthesia
CAMILID UNIQUE: The dorsal eyelid reflex remains in surgical anesthesia and then the ventral will only move when touched
Hard to see small ruminant too
Stable ruminant ventromedial
77
Anesthesia of large animal in
Lateral and recovery in sternal
78
Thoracocentesis
7th-8th intercostal space at level of or just above costochondral junction
At cranial border of rib
79
Chylous effusion medical management
Rutin
• Benzopyrone
• Enhances protein removal and phagocytosis of chyle
• Efficacy unproven
80
How to determine the chronicity of the pleural effusion? With rads
The rounded nature of the lung margins —> chronic effusion
Dont remove all the fluid that was present because there can be fibrosing pleuritis
81
DCM path
Less contractility in LV —> Dialation —> mitral valve regurg due to dialaiton
No clinical signs; possible S3 gallop -lub duh ah
**ventricular arrhythmia in Dobermans with DCM**
- Screening for Dobermans HAS to have **Holter**
82
Pathoneumonic for cardiac tamponade
Becks triad:
Muffled heart sounds
Weak femoral pulses because when inspiring the LV does **not** fill because of the pericardial fluid being so bad
**Pulsus paradoxus: the LV only fills in expiration so there is bounding femoral pulses**
Jugular pulse
83
WITH pericardial effusion never give
Furosemide!!!! Because decreasing the preload and the ventricles are already not filling right !!!
Do perform pericardial centesis
84
Anesthetic depth monitoring in horse:
Sedation means…
Sedation = 5 point stance, head droop, minimal response to external stimuli, lip dropped
Induction Ketamine + guafenesin, diazepam, propofol OR telazol
Monitor: accumulation with IV and analgesia + CV depression with Inhalant anesthesia
**Eyes =slow palpebral stong corneal, tearing and slow nystagmus**
Muscle relaxation
**MAP >60** if low then lower anesthetic, add fluids and give vasopressin’s/positive ionotropes
85
Factors that affect horses recovery from anesthesia
Temperament
Personnel
Anesthetic drugs
Surgical procedure
Sedatives given for recovery
Size, weight, age, health, duration of surgery, padding and position
86
Common anesthesia related complication in horses
Cardiovascular Collapse
Hypoxia
Myopathy
Neuropathy
Fractures
Airway obstruction
Corneal ulcer
Injury to people
87
Is dental disease a predisposing factor for endocarditis?
**No it isn’t**, so no need to give antibiotics prophylatically
Just give if there is Subaortic stenosis [SAS], immunosuppressive therapy, long term catherthers, UTI, pyoderma!!! predisposing factors for vegetative valvular endocarditis
88
Diagnosis of the valvular vegetative endocarditis
Usually aortic or mitral
Via echocardiography
GOLD STANDARD : blood culture every 15 minutes 3x
PRESUMPTIVE DIAGNOSIS IS BASED ON THE PRESENCE OF A PREDISPOSING CONDITION AND ECHOCARDIOGRAPHIC EVIDENCE OF VEGETATIVE LESIONS ON THE AORTIC OF MITRAL VALVE
Teat with antibiotic and long term tx
89
Why is preclinical identification of systolic dysfunction with DCM important?
**serial echocardiography**
It avoids worsening with anesthesia
It can be treated with pimobendan
+/-ACE inhibitor (which work for Dobermans) - not with MMVD
It can not be bred
90
When to stop with the furosemide for heart failure
DO NOT exceed the 8mg/kg in 8 hours
Do 2-4 mg/kg IV every 1-8 hours
91
T/F: All antiarrythmic drugs can be also cause arrhythmia
True
Also wont work the same in all species
92
Digoxin -and positive ionotropes mainly for atrial fibrillation
Everytime time you deplete intracytoplasmic calcium then they contract less
Digoxin blocks Sodium potassium ATPase —> traps the Sodium within cell —> exchange Sodium with calcium with a exchange channel—> calcium into cell—> stronger contraction
Slows the AV node conduction—> slows the rate
93
Treat wide complex QRS tachycardia
Wide complex =lidocaine IV only afffects the ventricular tachycardia
94
Bradyarrythmia treatment
Pacemaker for sick sinus syndrome and 3rd degree av block
95
Pacemaker knowledge
• !!NO jugular blood draws!!
• NO MRI (unless specified)
• NO collars
• **Heart rate should never be lower than what was set at implantation**
96
How to tell if premature complex is ventricular or supraventricular
If the sinus node is firing consistently over the premature complex = ventricular premature complex
97
Does cardiac disease cause systemic hypertension?
NO!
Bc if you have cardiac disease and lower CO—> Lower Systemic Bp
Then there will be baroreceptor reflex —> vasoconstrict to increase BP
The body will increase vascular resistance to maintain BP
SYSTEMIC hypertension will cause cardiac disease
- **High BP= increase afterload and pressure overload over left ventricle = Concentric hypertrophy**
- NOT the sole cause of heart failure
- thickened ventricle is caused leading to cardiac disease
98
Organ damage with SBP >160/180 happens with
Eye
—acute blindness in cats
Kidney -
—decrease in renal funcation and renal death —> PLN and high renal values (ABILITY TO RETAIN SALT AND WATER IMPAIRS)
— **CKD can cause SH or SH cause CKD**
Brain
—seizure
Heart +vessels
—pressure overload
—LV concentric hypertrophy
99
Fetal hemoglobin has more or less 2,3DPG to alter the affinity to oxygen
Has low 2,3 DPG to increase O2 affinity
100
Heart is made
Of splanchnic mesoderm
The endocardial cushions/tubes fuse to make the blood vessels and the heart chambers
By the cephalocaudal folding which brings the heart dorsal to the pericardium
**Bulbus cord is =roundest part**
Blood comes in via the sinus venosus = vena cavas
AV and semilunar valves from the neural crest cells
101
Which part of the interventricular septum is most of it
The muscular part -lower on septum
- no apoptosis happens here just myocardial growth and thats why there is trabecule carnage in the ventricles but not in the IV septum
102
Explain what causes the Atrial septal defect
Also known as the patent foramen ovale.
Septum primmun is made with a hole dorsally and then the septum secondum is made in the right atrium side
Completion of the division: when the pressures on the left side get higher than the right [postnatally when lungs are functioning] the foramen will close but is not in the defect
103
When the blood skips the liver
Patent ductus venosus - the liver doesn’t detoxify so there is toxic blued up in blood
104
When there is a circle of depolarization that happens many times
Re-entry arrhythmias: Atrial flutter or atrial fibrillation
Atrial flutter= macrorentry : there is a circle of depolarization that happens over and over again
Atrial fib= microentry: very many small circles with cells
• mainly in the LA
105
Treat :
RV tachycardia
Rapid supraventricular tachycardia
Atrial fibrillation
106
Pacemaker rules about test, blood draws, HR
No jugular blood draws
No neck leads
No MRI
Never have HR below the set number
107
A plexiform lesion
When remodeling is done and there is occlusion of the pulmonary capillary
108
Most common cause of pulmonary hypertension
Category2 due to the left sided heart disease
109
How to diagnose pulmonary hypertension
Arterial BP in pulmonary artery
Clinical signs and echocardiography
Clinical:
—Syncope
—Right heart failure
—respiratory distress
Echo: RAE, RVH [RV thicker then LV], enlarged pulmonary artery
Pericardial effusion mild due to the R-Side heart failure
110
Common cause of cardiac murmur in large animals
Systolic : MVR, TVR
Diastolic: Aortic valve regurgitation [ left side- dive bomber]
111
Acquired valvular disease in large animals
Degenerative
Endocarditis
Ruptured cordae tendinae.
— Horses = mitral valve degeneration of the chordate tendinae = goose honk
• Very bad heart failure
— Cattle = tricuspid valve cordae tendinae ruptured because of the bacteria endocarditis
112
Clinically significant murmurs with congenital heart disease in large animals
VSD -right sided murmor
PDA
113
Cor pulmonale
Pulmonary hypertension and **lung disease** leads to RV dialation or right sided heart failure
— cattle commonly
— not as common with horses
114
Most common cause of cancer in ruminant
Bovine leukemia virus causes lymphoma which will be in the **right atrium, mediastinum, pericardium**- transmit uteri or secretions
115
Atrial fibrillation in horses
**most common pathological arrhythmia in horse**
Result of genetic predisposition or primary cardiac disease [atrial enlargement] or electrolyte abnormality or sepsis
No p wave just normal irregular QRS
Tx. Ryhthym control — quinidine (Sodium channel block) and electrocardioversion
116
What will arrhythmia do to systemic bp
It will lower the arterial pressure bc not enough fills
117
How to diagnose ARVC
MRI to see the fatty O
Fibrous tissue in rv
118
Can cycnotic heart diseases cause syncope
No they don't → they cause hypoxia mediated collapse, polycythemia associated seizures and Lind limb weakness
The heart diseases that cause syncope are: ** anything that reduces cardiac output**
Bradyarrhythmia tachyarrhythmia, pericardial effusion, pulmonary hypertension, congestive heart failure, stenosis
119
Seizure vs syncope
Seizure: **Teeth chattering or salivation with seizure and post-ictal signs**
Syncope : possible arrhythmia , rapid recovery
—quick!
—+/- exercise associated
120
Three categories of stuff that causes syncope
All cause less cardiac output
Cardiovascular, reflex mediated (vasovagal), orthostatic hypotension (dehydration, or fluid loss)
121
Heart failure is not synonymous for Myocardial failure
Myocardial failure is the decrease in systolic function/lower myocardial contraction
Heart failure mainly happens with MMVD where the systolic function is still good
HF =MMVD , HCM
Heart failure won’t benefit from any positive inotropes (no Pimobendan or digoxin)
122
Probnp
HCM TEST -cardiac biomarker
NT- proBNP [brain naturitic peptide which is secreted by the ventricle everytime the ventricle is stretched; N terminal of this peptide]
• if the SNAP test is + then there is probably heart disease
• Good sensitivity/specific
Genetic
• not good sensitivity
