Clin Med - Cardiac 2

drraythe's version from 2016-03-15 13:18

Cardiac 2

Question Answer
What is Holter monitoring?24 hour monitor recording the whole time (strapped to a halter-but its NOT a HALTER its a HOLTER monitor)
What is Event monitoring?Wear for a week - NOT recording the whole time, but if there is an event owner hits button & 30min before & after event is recorded
What are some things thoracic radiographs can tell you?(1) Is there cardiomegaly? (or chamber enlargement)
(2) Vascular abnormalities
(3) CHF (how soon do you need to Tx?)
(4) Lungs
(5) Pleural space
Order of vessels & stuff on a rad?A-B-V (artery bronchus vein)
(Pulmonary artery & vein distension is czd by which dz?)(More blood to lungs than should happen) PDA (& some septal defects) bc half of blood from aorta is going back into pulmonary circulation
In PDA, preload/afterload are ↑ where?↑ preload to L side & ↑ afterload to R side
What's a fissure line?Seeing a separation btwn lung lobes on the radiograph, implies sthign is btwn them-probably fluid
Echocardiography (NOT ECG) is what?It is a non-invasive heart imaging (chambers, vessels, valves) technique that allows you to measure the heart, as WELL as a Doppler fxn which allows you to eval flow & pressure & the effect on the valves
(Corrigan says) how do you auscult cat?DONT FORGET TO do L, R & STERNAL
*Most common heart dz of dogs? What does it look like on imaging?Mitral endocardiosis  Big L atrium
*Most common heart dz in cats? What does it look like on imaging? (Common sequale?)Hypertrophic cardiomyopathy → L ventricle gets big, then pressure pushed through even a good mitral valve. & then pools in L atrium → clot → saddle thrombus
What are the 2 modes you can do w/ echocardiography?There is 2-dimentional mode (B-mode) & also M-mode, where it shows it in kinda a long graph thing
(Good to know) when does heart get blood? Which problem makes this a bad time?Heart receives blood supply when it is RELAXED. So in hypertrophic cardiomyopathy, the heart is huge & bulky & not very relaxed, so it gets less blood
(Not sure if she will ask) in echocardiography, how might a transverse versus a longitudinal cross section look?In transverse it's like cutting the top off of a strawberry-roundish spaces. if longitudinal section, chambers are long
What is Electrocardiography?THIS is ECG. Eval elec fxn of heart
What does ECG eval? What can it tell you? What kinda devices are associated w/ this kinda monitoring?Evaluation of wave forms & patterns! Can tell you about rhythm disturbances. It looks at the elec activity at that point in time. So might be problem but if it isn't happening right then, you aren't going to see it. Use holter/event monitors to look at this
What does P, QRS & T of the ECG relate to?P = Atrial depol
QRS = Ventricular depol
T = Ventricular repol
(Bot common to use) What might you use Cardiac Catheterization to diagnose?Complicated congenital abnormalities, or evaluating pressures
Huge dogs are prone to what heart dz?Dilated cardiomyopathy
Bulldogs are prone to what cardiac dz?Pulmonic stenosis
(Not common to use) What therapeutic uses might there be for cardiac catheterization?Presurgical/ballooning
Pulmonic stenosis in bulldogs
What's the caution about using pacemakers?You can pacemaker a heart to death - work faster, die faster
Explain balloon dilation of a stenotic pulmonary valve-how do you do it, who's prone, precautions?Get cath under bad valve. Shred pulmonic valve by inflating it. Only need 1 valve on 1 side of heart - if you got Tricuspid, you good. Wanna balloon dilated pulmonic stenosis pretty early in life. as long as tricuspid is ok, a little bit a pulmonic insufficiency is fine. HOWEVER look for malformation of the Coronary artery before balloon dilation of pulmonary
If there is a stenotic pulmonary valve, is it pre or after load, L or R heart↑ afterload of R heart
(She said in class) which is more uncommon-systolic or diastolic murmur? Which condition often czs this uncommon murmur?Diastolic uncommon in sm animals. Usually due to pulmonic insufficiency
Systemic Arterial Hypertension → what are some common dzs which are commonly associated w/ ↑ BP & ↑ BP can often be the 1st sign?CKD
HAC (Hyperadrenocortisism)
Pheochromocytoma (neuroendocrine tumor of medullar of adrenal)
Liver Dz
Intracranial lesions
What are 4 ways to evaluate BP?(1) Oscillometric
(2) Doppler
(3) Pressure plethysmography
(4) ↑ definition oscillometry
What does Doppler tell you?SYSTOLIC pressure & also in minimally invasive procedures, you have a good way to tell you that your dogs heart is beating, or that it's a little lower.
What are the 3 types of hypertension that small animals tend to get? (Which is most common?)(1) White coat syndrome-sympathetic activation
(2) **2⁰ hypertension (most common)-Concurrent w/ clinical dz or drug administration
(3) Idiopathic hypertension (1⁰ or essential). usually indicated w/ subclinical dz - Maybe more prevalent than expected 18-20% (we should be doing more BPs)
Evidence of Target Organ Damage in BP → kidneys (which dz, look at what?)Progression of CKD (if hypertensive w/ CKD, gonna change the way you treat them)
Evaluate creatinine, proteinuria, GFR
Evidence of Target Organ Damage in BP → eyes (which dz?)RETINOPATHY. ↑ BP may cz Acute blindness, detachment, vessel tortuosity, perivascular edema, papilledema, hyphema, glaucoma
Evidence of Target Organ Damage in BP → Brain (which dz?)Encephalopathy or stroke (Localize to CNS, neuro exam, MRI)
Evidence of Target Organ Damage in BP → Heart & Vessels (which dz?)Left Ventricular Hypertrophy or cardiac failure (Heart size, rhythm, murmurs, hemorrhage... check w/ Auscultation, radiography, ultrasound, ECG)
Pulmonary Hypertension can be cz by what 4 broad situations?(1) ↑ pulmonary blood flow
(2) ↑ blood viscosity
(3) ↑ pulmonary vascular resistance (PVR)
(4) Luminal narrowing
↑ pulmonary blood flow can cz pulmonary hypertension. What are 2 situations where there might be ↑ pulmonary blood flow?Congenital L to R shunts
↑ CO
↑ pulmonary vascular resistance (PVR) can result in pulmonary hypertension. What are some things that can cz this & how does it affect flow in the heart?Czs ↓ drainage into the left heart from the lungs (bc vessels are retaining it)
Could be from things like:
Loss vessels of vessels from PTE (pulmonary thromboembolism)
HAC (Hyperadrenocortisism)
Nephrotic syndrome
Cor pulmonale
Chronic upper airway dz
Luminal narrowing can result in pulmonary hypertension. What are 2 different types of luminal narrowing & a few reasons for each type?(1) ANATOMIC narrowing: Eisenmengers (congenital prob causing ↑ flow to pulmonary vessels, or PDA & whatever), HWD, pulmonary hypertension
(2) Pulmonary vasoconstriction - ↑ Altitude, Cor pulmonale (alteration in the structure & fxn of the right ventricle), Hypoventilation, NMD(neuromuscular dz), obesity, chest wall deformities
*W/ Pulmonary Hypertension, if you do aN Echocardiography & put it in M-mode (continuous wave) & you see tricuspid regurgitation (pulmonary hypertension can cz tricuspid regurg), what speed would the regurg/insufficiency be? (she says just know if you see this number w/ TR, it means hypertension)>2.7 m/sec
*W/ Pulmonary Hypertension, if you do aN Echocardiography & put it in M-mode (continuous wave) & you see pulmonic insufficiency (pulmonary hypertension can cz pulmonary insufficiency), what speed would the regurg/insufficiency be? (she says just know if you see this number w/ PI, it means hypertension)>2 m/sec

I Hate ECGs Right Now

Question Answer
What are the bundle branches? (Name them)Left anterior & posterior & right bundle
To do an ECG, what side do you lay them on? What surface should you have them on? If you are having a problem seeing whats going on, what might you consider?R lateral recumbency, put them on a towel or a mat (not the bare metal table). Some problems might be that they need more lube/alcohol on the probes, or there is electrical interference
What are the 2 types of leads & which ones is she talking about?(1) External limb leads are the wires
(2) The other leads are the things the machine calculates on the ECG → THIS will be the lead she refers to when she says "leads"
What is Einthoven’s triangle? DRAW IT.Fack
What does aVR lead mean?It's the lead where the RIGHT ARM is positive (aVR arm Right) & it is going to the L arm & leg which are then negative
What does aVL lead mean?It's the lead where the LEFT ARM is positive & it is going to the R arm & leg which are then negative
What does aVF lead mean?It's the lead where the left leg is positive & it's going to the R & L arm which are neg
Normal axis area points to where on the electrical axis?L ventricle (bc electricity is traveling towards L vent every beat)
Explain the green area in the electrical axis & how its usedGreen is the normal range of where the axis should be pointing (down & to the left) & the range is different for dogs & cats. When the axis starts to point out of this range, there is an abnormality in the heart. For instance, if it starts pointing more purely left, there is L vent. enlargement!
What are the 5 questions you should ask, IN ORDER, about the ECG?(1) RATE
(2) Rhythm
(3) P/QRS & QRS/P
(4) QRS morphology
(5) Measurements
How would you determine the rate on an ecg? (25mm/sec or 50mm/sec)(1) 25 mm/sec: count how many QRSs in about 30 boxes. Multiple # of QRSs by 10 → this is the HR
(2) 50 mm/sec: count number of QRSs in 30 boxes. Mult that number by 20. That's your heart rate
Explain the rhythm question for an would you describe rhythmsHeart beat like drum beat-is it regular? It's either regular or irregular. IF IT IS IRREGULAR, there are 2 kinds: regularly irregular (there is a predictable pattern of irregularity) or irregularly irregular
Explain the P/QRS & QRS/P question you're asking yourself for an ECGIs there a P before every QRS? Is there a QRS after every P?
What should you be looking for w/ QRS morphology?Does the QRS look normal? Does every QRS look the same?