Clin Med- Cardiac 2

untimely's version from 2015-05-14 23:55

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 and 30min before and 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 and stuff on a rad?A-B-V (artery bronchus vein)
(pulmonary artery and vein distension is caused by which dz?)(more blood to lungs than should happen) PDA (and some septal defecs) bc half of blood from aorta is going back into pulmonary circulation
In PDA, preload/afteroad are inc where?INC preload to L side and INC afterload to R side
what's a fissure line?seeing a separation between lung lobes on the radiograph, implies sthign is between 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 function which allows you to eval flow and pressure and the effect on the valves
(corrigan says) how do you ascult cat?DONT FORGET TO do L, R, AND 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. and then pools in L atrium--> clot--> saddle thrombus
what are the two modes you can do with echocardiography?there is 2-dimentional mode (B-mode) and 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 and bulky and 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 function of heart
what does ECG eval? what can it tell you? what kinda devices are associated with this kinda monitoring?Evaluation of wave forms and patterns! Can tell you about rhythem disturbances. It looks at the elec activity at that point in 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, and T of the ECG relate to?P=atrial depol. QRS= ventricular depol. T= ventricular repol.
(not 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 theraputic 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 one valve on one 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 insuffciency 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 heartINC afterload of R heart
(she said in class) which is more uncommon- systolic or diastolic murmur? which condition often causes 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 with high BP, and high BP can often be the first sign?CKD, HAC (hyperadrenocortisism), hyperthyroidism, Pheochromocytoma (neuroendocrine tumor of medullar of adrenal), DM, lvier dz, hyperaldosteronism, intracranial lesions
what are 4 ways to evaluate BP?(1) Oscillometric (2) doppler (3) Pressure plethysmography (4) High definintion oscillometry
what does doppler tell you?SYSTOLIC pressure and also in minimally invasive prcedures, you have a good way to tell you that your dogs heart is beating, or that it's a little lower.
what are the three types of hypertension that small animals tend to get? (which is most commmon?)(1) White coat syndrome-- sympathetic activation (2)**Secondary hypertension (most common)- Concurrent with clinical disease or drug administration. (3) Idiopathic hypertension (primary or essential). usually indicated with 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 with CKD, gonna change the way you treat them) Evaluate creatinine, proteinuria, GFR
Evidence of Target Organ Damage in BP--> eyes (which dz?)RETINOPATHY. high BP may cause 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 and Vessels (which dz?)Left Ventricular Hypertrophy or cardiac failure (Heart size, rhythm, murmurs, hemorrhage... check with Auscultation, radiography, ultrasound, ECG)
Pulmonary Hypertension can be cause by what 4 broad situations?(1) Increased pulmonary blood flow (2) Increased blood viscosity (3) Incresed pulmonary vascular resistance (PVR) (4) Luminal narrowing
Increased pulmonary blood flow can cause pulmonary hypertension. what are two situations where there might be inc pulmonary blood flow?Congenital L to R shunts, ↑CO
Incresed pulmonary vascular resistance (PVR) can result in pulmonay hypertension. what are some things that can cause this, and how does it affect flow in the heart?causes decreased 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), HWD, HAC(hyperadrenocortisism), IMHA, sepsis, neoplasia, nephrotic syndrome, cor pulmonale, chronic upper airway disease
Luminal narrowing can result in pulmonary hypertension. what are two different types of luminal narrowing, and a few reasons for each type?(1) ANATOMIC narrowing: Eisenmengers(congenital prob causing inc flow to pulmonary vessels, or PDA, and whatever), HWD, 1pulmonary hypertension. (2) Pulmonary vasocontriction- High Altitude, Cor pulmonale (alteration in the structure and function of the right ventricle), Hypoventilation, NMD(neuromuscular dz), obesity, chest wall deformaties
*with Pulmonary Hypertension, if you do a Echocardiography and put it in M-mode (continuous wave), and you see tricuspid regurgitation (pulmonary hypertension can cause tricuspid regurg), what speed would the regurg/insufficiency be? (she says just know if you see this number with TR, it means hypertension)>2.7 m/sec
*with Pulmonary Hypertension, if you do a Echocardiography and put it in M-mode (continuous wave), and you see pulmonic insufficiency (pulmonary hypertension can cause pulmonary insufficiency), what speed would the regurg/insufficiency be? (she says just know if you see this number with PI, it means hypertension)>2 m/sec

i hate ECGs right now

Question Answer
what are the bundle branches? (name them)left anterior and posterior, and 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 recumbancy, 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 interfearance
what are the two types of leads, and 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 postitive (aVR arm Right), and it is going to the L arm and leg which are then negative
what does aVL lead mean?it's the lead where the LEFT ARM is positive, and it is going to the R arm and leg which are then negative
what does aVF lead mean?it's the lead where the left leg is positive, and it's going to the R and 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, and how its usedgreen is the normal range of where the axis should be pointing (down and to the left) and the range is different for dogs and 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) rhythem (3) P/QRS and 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 rhythem question for an would you describe rhythemsheart beat like drum beat-- is it regular? It's either regular or irregular. IF IT IS IRREGULAR, there are two kinds: regularly irregular (there is a predictable pattern of irregularity) or irregularly irregular
explain the P/QRS and 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 with QRS morphology?does the QRS look normal? does every QRS look the same?