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Cardiovascular

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What is heart failure?
lack of CO
What is normal pulmonary pressure?
25/10
Why is right heart failure harder to treat?
less tissue to respond to therapy
What is pumping volume of a normal heart?
3L/min
Cats don't ______ even with considerable amounts of fluid in the alveoli.
cough
Why is there hypotension with high tachycardia?
heart hasn't had time to fill between beats = less CO
Usually, by the time animals present w/ heart failure they've had _____ ____ for a long time.
cardiac dz
What does increased T4 do to body temp?
elevates
What is the pulse?
the difference between systolic and diastolic pressures
Heart failure, stenosis, shock, and pleural effusions give what quality of pulse?
hypokinetic
Exercise, anemia, water hammer, and shunts give what quality of pulse?
hyperkinetic
What are three aarhythmias that give variable quality pulses?
A fib, VPD's, APD
What is the difference between crackles and wheezes?
crackles = fluid in alveoli; wheezes = lower airway obstruction
What is heart sound S1?
closing of mitral valve before systole
What is heart sound S2?
closing of aortic valve (pulmonic valve) after systole
What is heart sound S3?
ventricular filling (large breeds/horses/ruminants only)
What is heart sound S4?
loud filling of hypertrophied L ventricle
What is a gallop rhythm?
when the S3 and/or S4 heart sounds are heard on ascultation
T/F transient murmurs are not common in puppies.
F; they are
Which group of dogs has a big problem with mitral valve insuf.? What kind of murmur would they have?
older, small breed; systolic, a "whoosh" between S1 and S2
What is a holosystolic murmur?
a murmur heard thru all of systole with S1 and S2 still audible
What is a pansystolic murmur?
no heart sounds heard, only whoosing
A PDA will have a ________ murmur which is a washing machine sound that occurs thru systole and diastole.
continuous
Describe the sound of a mitral murmur. aortic?
mitral = plateau, no increase or decrease in volume
aortic = crescendo then decrescendo
What is the most common murmur?
3/6 holosystolic loudest over mitral valve
What is commonly the loudest murmur?
VSD
What is the sinus of velselva?
where the coronary arteries branch off of the aorta
How do you know when heart dz treatment is working?
resp. rate goes down and HR goes down
What is the best tool to diagnose cardiac enlargement?
ultrasound
Where does the neg. terminal of lead 2 go? pos?
right forelimb; left hind
What position does the animal need to be in for proper heart eval. w/ an EKG?
right lateral
What is the mnemonic for lead placement?
christmas in the rear of the year, green on the ground; news paper in hands, snow on the ground
1cm on a EKG paper usually represents?
1mV or .2 sec (1mm = .01 mV and .02 sec)
What would electrical interference usually be confused with on an EKG?
a fib.
What is the mean electrical axis norm in a dog?
+40 to +100
Which two leads do you plot to find the mean electrical axis? which is on the y-axis? x?
lead 1 = x-axis; and aVF = y-axis
A mounded P wave indicates _____ while a peaked indicates _______.
left atrial enlargement; right atrial enlargment
What does the QRS complex represent?
septal and ventricular depolarization
An increased height of the QRS complex is associated with?
left ventricular enlargement
How many BOXES wide should the QRS complex be?
2.5-3 boxes
What is the most common EKG abnormality?
increased QRS height; left vent. enlargment
Deep S waves are representative of?
right ventricular hypertrophy
What is the normal depth for an S wave?
3 boxes
Describe the findings in a right bundle branch block.
Deep S, QRS prolonged (wide), decreased R wave height
Describe the differences in the R wave on a right and left bundle branch block.
right = small R waves, left = normal R waves
A wide QRS of normal height, and normal CO indicates?
left bundle branch block
What causes the change in R wave height in low-voltage complexes?
heart moving around in chest = pericardial effusion, plerual effusion, pneumothorax
What does depression of the ST segment below 5 boxes off baseline indicate?
myocardial hypoxia
If the T wave is more than a quarter of the amplitude of the R wave it indicates?
hypoxia
Which drug specifically increases the QT segment?
digoxin
What do beta-blockers do to the QT segment?
increase it
Which arrhythmia is described as having a p for every QRS but R R intervals vary?
sinus arrhythmia
Which arrythmia is directly correlated with respiration rate?
sinus arrhythmia
What is the treatment for sinus arrhythmia?
none
Describe the EKG of a wandering pacemaker arrhythima.
P waves from outside the SA node; variable morphology of P wave, variable P-R interval,
What is the preferred treatment for wandering atrial pacemaker?
none; no hemodynamic consequences
What is one drug that can ilicit any arrhythmia?
digoxin
A HR of under 60-70 in dogs, and less than 100 in cats with normal EKG shape?
sinus bradycardia
What is the treatment for sinus bradycardia?
remove the cause; atropine, glycopyrrolate;, terbutaline; isoproterenol, isopropamide, probanthing
What is an atropine test?
atropine is given to see if HR can be increased, if it is = too much vagal tone; if no effect = problem w/ heart
T/F a pacemaker is an option for sinus bradycardia.
T
What is the failure of the SA node for 1 or more beats?
sinus arrest
When do you see junctional escape beats in cats?
when HR is 80-100 BPM (bradycardia)
T/F junctional escape beats are preceded by p-waves.
F; no p wave
What HR will the AV node keep the heart at if the SA node is out of comission?
40-60 BPM = junctional escape beats
What is needed to diagnose junctional escape beats? treatment?
prolonged cardiac monitoring; + chronotropes, pacemaker
What kind of EKG arrhythima would aortic thromboembolism have? why?
hyperkalemia; deoxygenated tissues release potassium, when reperfused after clot is removed = hyperkalemia
Tall T waves, absent P waves and a sinusoidal appearance to the entire EKG signals?
hyperkalemia
What is the treatment for hyperkalemia?
bi-carb, insulin, Ca gluconate as a cardioprotectant
What is the failure of transmission at the AV node?
AV block
What cardiac conduction dz is seen in pugs?
AV block
What is 1st degree AV block and what is its treatment?
increased PR interval, monitor/ no treatment
What is defined as intermittent failure of the AV node to conduct? PR interval increases until QRS is dropped and then another P wave...
2nd degree AV block
Actual Dz of the AV node is the cause of this type of block.
2nd degree
What is third degree AV block?
no AV conduction what so ever
At what heart rate do you start to see junctional escape beats?
40-60
What AV block is wrought with junctional escape beats and ventricular escape beats?
3rd degree
What is the emergency treatment for AV block?
take drugs away (digoxin), treat -itis of the heart; isoproternol/dopamine
What increases survival of AV blocked animals the longest?
pacemaker
Intermittent failure of the AV system with random tachycardia and intermittent weakness can be thought to be due to?
sick sinus syndrome
What is atrial standstill?
no atrial activity and a fixed HR
Atrial myocarditis/dystrophy, DCM, electrolyte imbalances and drugs are all causes of this atrial dz.
atrial standstill
An increased HR w/ normal EKG is?
sinus tachycardia
Fear, pain, fever, anemia, and thyroid dz all cause this arrhythmia.
sinus tachycardia
What does an SPD look like?
variable P waves buried in the T wave, normal QRS, shortened RR intervals
3 SPD's =?
superventricular tachycardia
Why will an SPD have a hypokinetic pulse?
heart hasnt had time to fill
Esmolol and diltiazem are used w/ SPD's to do what?
slow the heart
How does thumping the chest help treat SPD's?
stimulates vagus = increase para. tone = decrease HR
What are the three meds. used to maintain SPD patients?
digoxin, b-blockers, Ca channel blocker
Digoxin mainly works by ______ the heart.
slowing
T/F digoxin is a negative ionotrope.
f; it is not
What is a very common arrhythmia w/ DCM?
atrial fib
A normal QRS w/ no p waves and random RR intervals = ?
atrial fib
What does a heart sound like in atrial fib?
boots in a dryer
Atrial fib can cause HR of ?
200 BPM driven by ventricular escape beats
A normal heart rate in atrial fib needs what treatment?
none; monitoring
A DCM in A fib is best treated w.?
digoxin, b-blockers
What is a good negative chronotrope to decrease HR?
aminodarone
What drug is contraindicated w/ cats in a-fib?
digoxin
What cardiomyopathy is can cause A fib in cats?
HCM
Which arrhythmia causes the sawtooth shape of the baseline?
atrial flutter
A wide bizzare QRS w/ no p wave that is premature =?
VPD
What are the only two types of premature beats?
Superventricular and Ventricular premature depolarization
A VPD originating in the right heart will deflect the QRS ? left heart?
positive/ negatve
A series of VPD's that are positive and negative means that?
ectopic foci are in both ventricles = worse prognosis
What is a fusion beat?
When a normal QRS and VPD combine and looks like you averaged the QRS and VPD shapes
What is bigeminy?
alternating normals QRS and VPD's
What arrhythmia is common in animals that suddenly die?
VPD's
What is the R-on-T?
When the heart is re-polarizing (T wave) it tries to initiate a QRS; heart is very sensitive during repolarization and the initiation of the QRS too early can take the heart into v-tach to v-fib to sudden death
German Shepherds = ?
DCM and VPD's
The VPD management is best done by treating?
the underlying cause
if over 10% of beats are VPD's, there are doublets/triplets of VPD's. R on T phenom. are all causes of increased chances of?
sudden death
What is the best drug of choice for ventricular tachy arrhythmias?
lidocaine
What is the def. of V tach?
> 3 VPD's back to back with a HR > 160-180
T/F treatment of VPD's is very successful at stopping sudden death and eliminates the VPD's.
f; there will still be VPD's and a chance of sudden death
What is the difference between accelerated idioventricular rhythms and v-tach?
the HR = v-tach> 160-189, AIR = 60-80 BPM w/ EKG like v-tach
What is the treatment for AIR?
none; monitor
What is polymorphous v-tach?
torsades de pointes
V-fib is usually?
terminal
CPR, electrical cardioversion, and epi. are emergency treatments for?
v-fib
Describe the EKG of pre-excitation syndrome
a wave after the P wave = the delta wave
What does angiotensin 2 do to the vasculature?
veno/arterioconstriction
T/F the RAAS system can cause hypertrophy of the heart.
T
T/F furosemide affects the production of aldoseterone.
f; spironolactone
What is the standard of care for LCHF? why?
ACE inhibitors; furosemide causes increases in aldosterone = increased blood volume
What are the four phases of heart dz?
1 =dz but no CS
2 = cough, dyspnea/ fatigue w/ exercise
3= cough dyspnea/ orthopnea at night or w/ any exercise
4 = cough, dyspnea, cyanosis at rest
DCM is best managed w/ this negative ionotrope.
b-blockers
What do you to to a refractory heart failure case?
max the ACE dose