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23 spring: med surg > Test 1: lecture 11+ 12: congenital > Flashcards

Test 1: lecture 11+ 12: congenital Flashcards

1
Q

pressure overload in heart will cause

A

concentric hypertrophy

thick, smaller volume can fit

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2
Q

what congenital outflow tract obstruction can cause pressure overload in the heart

A

Pulmonic stenosis
sub-arotic stenosis

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3
Q

high afterload can be caused by

A

systemic HTN
pulmonary HTN

leads to increased pressure in LV→ concentric hypertropy

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4
Q

clinical signs of outflow tract obstruction in heart

A

weakness and fainting, arrhythmia and sudden death

reduced ventricular filling from concentric hypertrophy

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5
Q

what types of dogs get pulmonic stenosis

A

small to medium

beagle, bulldog, boxer, spaniel, bullmastiff

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6
Q

Pulmonic stenosis (PS) refers to a dynamic or fixed anatomic obstruction to flow from the — to the — vasculature.

A

right ventricle (RV)
pulmonary arterial

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7
Q

pulmonic stenosis is caused by

A

valve issue

can sometimes be subvalvular or supravalvular obstruction as well

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8
Q

type A pulmonic stenosis

A

fusion of the leaflets

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9
Q

type B pulmonic stenosis

A

hypoplastic valve annulus and thickened leaflets

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10
Q

english bulldogs can have — coronary malformation that leads to pulmonic stenosis

A

aberrant left coronary artery that encircles PA- causes narrowing

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11
Q

clinical signs of mild to moderate Pulmonic stenosis

A

no clinical signs

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12
Q

clinical signs of severe pulmonic stenosis

A

exercise intolerance
syncope
systolic murmur 4-6/6 loudest over left 3rd ICS

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13
Q

what kind of mumur for PS

A

systolic murmur
4-6/6 loudest over left 3rd ICS

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14
Q

physical exam of PS
murmur, pulse, membranes?

A

Systolic murmur 4-6/6 loudest over left 3rd ICS
* Arterial pulses: normal
* Mucous membranes: pink
* Ascites (rare)

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15
Q

xray of PS will show

A

bulge at pulmonic artery (post stenotic bulge)

reverse D: enlargement of the RV

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16
Q

PS will have — velocity

A

high: 6.5 m/s

measured with doppler

bernoulli equation will meaure pressure difference between right ventricle and pulmonary artery

pressure gradient: 4x velocity²
4 x (6.5^2)= 170 mmHg

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17
Q

normal velocity of blood past pulmonic valve

A

1-2 m/s

PS will cause increased velocity

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18
Q

prognosis of mild PS

A

mild (0-50 mmHg)= no intervention,

can treat with beta blocker to decrease HR during exercise and reduce RV hypertrophy

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19
Q

prognosis of moderate PS

A

moderate 50-85 mmHg
+/- valvuloplasty

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20
Q

prognosis of severe PS

A

> 85 mmHg
death in 1 year without intervention
balloon dilation valvuloplasty

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21
Q

english bulldogs and some boxers can have a anamolous — arising from a single — associated with PS

A

left main coronary artery
single right coronary artery

artery can rupture during valvuloplasty

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22
Q

breeding advice for PS

A

do not breed
watch siblings

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23
Q

— is the most common heart defect in dogs

A

subaortic and aortic stenosis

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24
Q

what breeds will get subaortic stenosis and aortic stenosis

A

golden, newfoundland, boxer, german shepherd, rotti, bull terrier, bloodhound

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25
breeding of SAS
mild SAS affected parents can produce severely affected pups Do not recommend breeding
26
what is subvalvular aortic stenosis
ridge below the aortic valve causes narrowing heart has to work harder to pump, which leads to permanent long term damage
27
SAS severe clinical signs
exercise intolerance, syncope, sudden death
28
Subvavlular aortic stenosis physical exam
systolic murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries murmur appears/increases until 1 year old femoral pulses can be **weak** if severe stenosis
29
murmur of SAS
**systolic** murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries ## Footnote can get worse until full grown (1 year old)
30
why will echo have bright sections with SAS
increased pressure causes increased work and increased oxygen requirement leads to ischemia→ fibrosis which is white on echo
31
how to measure pressure in LV if peak flow is 5.24m/s
4 x (5.24)² =109 mmHg 109= LV-aorta assume aortic pressure is 120 LV= 109+120=**229 mmHg**
32
prognosis of SAS mild
<50 mmHg good prognosis, no intervention needed normal life span
33
prognosis for SAS moderate
50-80 mmHg normal: 10 years+
34
prognosis of sever SAS
80-130 mmHg 3 years vs 8 years if graduent less then 133
35
severe SAS over 130 mmHg will have what prognosis
70% mortality in 3 years
36
treatment of severe SAS
can do surgery or balloon but does not actually lengthen life span, may improve quality of life
37
complications of SAS
sudden death from arrhythmias infective endocarditis on the aortic valve CHF
38
Dogs with mild and moderate SAS (--- mmHg) have a good long- term prognosis with a normal or near-normal life expectancy.
< 80
39
Dogs with severe disease (--- mmHg) have a fair prognosis, although cardiac-death remains a possible outcome.
80 – 130
40
Dogs with very severe SAS (--- mmHg) are more likely to have a poor prognosis and are most likely to benefit from the development of effective therapeutic interventions.
PG ≥ 130
41
pulses for PS vs SAS
PS: normal SAS: weak (takes longer to leave aortic valve)
42
PDA is
patent ductus arteriosis connection between PA and aorta did not close at birth allows for left to right shunt
43
what breeds get PDA
bichon, german shepherds, maltese, yorki females > males
44
clinical signs of PDA
75% no symptoms coughing, exercise intolerance (CHF) **continuous murmur** (loudest over left heart base) **bounding** femoral pulse
45
PDA will have --- murmur
continuous loudest over left heart base
46
femoral pulse for PDA
bounding higher pulse pressure gradient (120/40) from blood shunting back through PDA to Pulmonary artery
47
Xray of PDA
cardiomegaly: LA and LV pulmonary over-circulation (increased size of lobar vessels (arteries and veins) and increased vascularity ) triple bump (big aorta, PA, Left side)
48
amplatz device is used for
close PDA minimally invasive (through catheter) used for medium duct
49
how to repair PDA
small dogs: coil embolization medium: amplatz canine duct occluder (ACDO) german shepherd or toy breed: surgical ligation
50
VSD
ventricular septal defect shunt from one side of the heart to the other side
51
VSD is the --- most common congential defect in cats and dogs
cats: #1 dogs: 4th or 5th
52
what breeds get VSD
Engl. Springer Sp., WHWT, Cocker, Engl. Bulldog, Basset Hound, Akita, Shih tzu, Husky
53
what kind of murmur for VSD
systolic murmur loudest over the **RIGHT** 3rd intercostal space
54
VSD will have blood flow
from left to right high to low pressure
55
VSD can causes
pulmonary overcirculation eccentric LV hypertrophy from volume overload +/- eccentric RV hypertrophy dilated left atrium
56
Xray of VSD
left sided (LV,LA) enlargement RV enlargement pulmonary over circulation → CHF
57
echo of VSD will show
high velocity get from left to right small hole may be hard to see
58
treatment for VSD
usually no treatment can do surgery invasive or catheter(amplatzer duct occluder ADO) if severe
59
ASD
atrial septal defect left to right shunting
60
what kind of murmur for atrial septal defect
no murmur because pressure between right and left atrium are similar
61
how to treat atrial septal defects
s**mall**= no treatment **large:** can cause volume overload and CHF: Transcatheter occlusion for PFO and secundum defects with AMPLATZER® Atrial Septal Occluder open heart surgery very rare in animals
62
what is complete AV canal defect
opening to all 4 chambers very bad: need to fix with open heart rarely done: high mortality can do bubble test: will look like snow
63
what can cause right to left shunt
reverse PDA tetralogy of fallot malposition of great arteries
64
clinical signs of a right to left shunt
exercise intolerance, weakness, fainting cyanosis ## Footnote reverse PDA, tetralogy of fallot, malposition of great arteries
65
reverse PDA will cause
right to left shunt exercise intolerance, hind limb weakness, seizures, polycythemia **differential cyanosis** (mouth pink, prepuce blue)
66
how to treat reverse PDA
closure is not recommended would cause right heart failure and death phlebotomy to decrease hematocrit keep PVC > 75% chemo to try to decrease production of RBC ## Footnote low oxygen in lower half, body trys to compensate by making more RBC, can make too many and cause problems
67
reverse PDA will have what murmur
no murmur: pressure similar right to left shunting
68
echo of reverse PDA
right to left right wall will be very thick from increased pulmonary pressure bubble test: will see airbubbles in abdominal vena cava: this means blood skipped the lungs
69
tetralogy of fallot will have what 4 things
VSD pulmonic stenosis/hypoplasia overriding aorta RV hypertrophy
70
what breeds get tetralogy of fallot
keeshond and english bulldog
71
what kind of shunt for tetralogy of fallot
right to left across VSD
72
treatment of tetraology of fallot
ballon valvuloplasty for the PS beta blockers to decrease RV hypertrophy Phlebotomy to decrease hematocrit (PVC 70-75%) open heart surgery
73
tricuspid valve dysplasia is common in
labs, shepherd, great danes
74
mitral valve dysplasia is common in
bull terrier, great dane, weimaraner
75
what kind of murmur for tricuspid valve dysplasia
systolic murmur 2-6/6 loudest over right 3rd ICS
76
symptoms of tricuspid valve dysplasia
systolic murmur 2-6/6 loudest over right 3rd ICS ascites puppy usually asymptomatic
77
treatment of tricuspid valve dysplasia
will cause right heart failure leading to ascites treat with diuretics, ACE-I, pimobendan, venodilators can do open heart surgery- valve repair or replacement
78
grossly tricuspid valve dysplasia will look
thickened, short or elongated valve with wierd chordae tendineae and papillary muscles valve may be tethered to septum (unable to open or close)
79
mitral valve dysplasia symptoms
CHF cough in dogs dyspnea in cats
80
mitral valve dysplasia will cause --- murmur
systolic and diastolic murmur over left 5-6th ICS
81
mitral valve dysplasia prognosis
poor causes huge LA pressure that leads to CHF very early in life can try to manage on drugs or repair surgically ## Footnote cats and dogs

23 spring: med surg (60 decks)

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