Small Ani. Med 2- Cardio 1

wilsbach's version from 2016-01-30 19:21

intro

*WHAT IS THE NUMBER 1 PRIORITY OF THE HEART???Maintain normal systemic arterial pressure-- EVEN TO ITS DETRIMENT
(physio review) what's the equation for CO?CO= SV x HR (stroke volume times heart rate)
what is the equation for MAP (mean arterial pressure)CO x SVR (cardiac output times systemic vascular resistance)
how should we think of preload?the volume of blood that is coming back to the heart (so inc in preload= inc in volume)
how should we think of afterload?the pressure in the body that the heart has to pump against (inc in afterload=inc pressure)
what is Starlings law? equation and explainFM= K ([Pc – Pi] – [πi – πc]) .....which means Fluid Movement= Constant of how leaky vessels are in organ you are talking about[(Capillary hydrostatic pressure - interstitial hydrostatic pressure) - (capillary oncotic pressure - interstitial oncotic pressure)]
list the #1, #2 and #3 goals of the heart(1) Maintain normal systemic arterial pressure (2) Maintain normal tissue blood flow (3) Maintain normal systemic and pulmonary capillary pressures
What is the frank-starling mechanism?The ability of the heart to change its force of contraction, and therefore stroke volume, in response to changes in venous return (inc venous return: i.e. Preload/end-diastolic
reminder- with an action potential, what stuff is going on during depol and repol?depol: massive influx of na. repol: efflux of K
review- why does cardiac action potential have a plateau between depol and repol?Ca++ involved
explain this bullshit(LV=left ventricle) Bottom red line: Filling, blood pouring into ventricle. Blue box's line going up in the middle: the valve closes, pressure starts to build. Blue box's line now moving to the left again at the top: pressure in LV overcomes aortic pressure.. so the vol is dec (hence doubling back on itself). Then pressure in aorta got high enough to overcome pressure in LV, valve closes. Once this happens, you get the far left blue line that is vertical bc pressure is going down but volume is not changing. the green part shows that in a good heart, if you pour more blood into the heart, it can handle it and pump it out
how does R heart output compare to L heart outputthey have to be the same lol otherwise won't work
***most common first sign of heart dz beginning is???exercise intolerance
know this, be able to explain what's going on.basically explaining how heart can't compensate for greater return, so first signs of heart dz are exercise intolerance, bc cant inc contractility enough to compensate for inc venous return (preload)
Inc venous return is an inc in... (preload or afterload?)preload/ end diastolic volume (inc in vol to heart)
which changes with inc venuos return-- end diastolic or end systolic volume?systolic must be maintained (for a pump to work correctly) so diastolic!
what are the three main categories of heart dz/failure?(1) volume overload (2) pressure overload (3) pump failure
of these options: [(1) volume overload (2) pressure overload (3) pump failure.] mitral valve insufficiency has what problem happen first?leads to vol overload first she said in class
clinical signs of heart dz that owners will recognize/tell youSyncope, Exercise intolerance, Cough, Dyspnea, Abdominal Distention, Cyanosis
clinical signs of heart dz that VETS detectPulse abnormalities, Murmurs, Arrhythmias, Jugular pulses (these can be incidental findings)
why do heart pts cough/get dyspnea?fluid backing up into their lungs
why do heart pts get exercise intolerance?has to do with Frank-Starling Mechanism. Heart is too weak/dzd to compensate for inc return which happens when they are exercising
why do heart pts get abdominal distension?ascites--> hearts fail backwards, so R heart failure means fluid is backing up into systemic circulation--> hydrostatic pressure drives fluid into interstitium--> ascites
why do heart pts have jug pulses?its bc blood is congested and backed up--> jug is distended--> more obvious to see beating of carotid behind jug bc of how its distended
why is there syncope in heart pts?if heart is struggling to pump blood up to the head, you can faint
things you should ask when taking history of a heart ptVaccination status? Travel history? (think texas and chagas which is transmitted by reduviid aka kissing bugs, which transmit trypanosomes, infection with these in end stage will look like DCM), Diet, recent changes in H2O intake? Indoor/outdoor? Normal activity level? Coughing? When? Vomiting/gagging? Urinary habits? Fainting/weakness? MM changes? Cyanosis? Medications?
3 diff options for hx/CS for a heart failure?(1) no CSs (occult dz- first clinical sign can be sudden death) (2) Signs of Congestive Heart Failure (CHF) (3) Signs of low cardiac output—usually late onset
explain signs for congestive heart failure versus signs of low cardiac output. Which happens first?CHF happens first, and this is where you see "backwards failure" like resp signs and ascites. Signs of low CO happen late in the dz, and are things like Exercise intolerance (can't get it out enough to compensate for, syncope (can't get the blood up there), pre-renal azotemia (blood not getting to kidney enough for good filtering), cyanosis (poor perfusion in general)
what's your ddx for POSSIBLE syncope based on what owner tells you?can be heart dz, can be seizures (know CS to tell them apart)
whats the gol standard for working up a heart?MRI

congestive heart failure part 1

CHF is often ___ for many cardiac dzsend stage
What IS congestive heart failure?a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues.
If you see pulmonary edema with CHF...which side of the heart is the prob and which direction is the fluid going in?left sided backwards heart failure
If you see plural effusion in cats, which side of the heart is affected?could be LEFT OR RIGHT!!
what is the diff between pulmonary edema and plural effusion?pulm edema- water in alveoli in lungs. plural effusion- NOT in the lungs
If you see hepatic congestion/ascites, which side of the heart is problematic, and what direction is the fluid going in?Right Sided backwards heart failure
what's Cachexia and why do you see it in CHF?weakness and wasting of the body due to severe chronic illness (CHF is chronic)... see this often in cancer and cardiac problems. Can lose weight SUPER fast
why do you see jug vein distension in CHF?blood backing up bc heart not pumping well enough... it distends
how does an animal with CHF appear?Anxious, Open mouth breathing, Orthopnea and elbows abducted, Tachypnea (short and shallow), Hyperpnea (increased depth), Inspiration vs. expiration (Upper airway vs lower airway)
why might a CHF pt have tachypnea? (what is the nature of the breathing?)short and shallow, this is bc of pulmonary edema
why might a CHF pt have hyperpnea? (what is the nature of the breathing?)inc depth of breath-- this is bc of Hypoxia, hypercarbia
If the hyperpnea or signs are on inspiration vs expiration, what might this say about location of the problem?upper vs lower airway
When might syncope happen? how might it look/present like?can occur due to Exertion or excitement. Syncope can present as Rear limb weakness, Sudden collapse, Lateral recumbency, Stiffening of the forelimbs and opisthotonos, Micturition, vocalization, Vocalization, Hypoxia
what signs are generally NOT seen with syncope, and might make you think sthing else is going on?Tonic/clonic motion, Facial fits, defecation, aura, Post-ictal dementia, Neurologic deficits (The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms)
**coughing--> what are some reasons a patient might be coughing with CHF? (what non-cardiac dzs should you consider)coughing can be due to mainstem bronchus compression, Pneumonitis and vascular disease 2° to HWD. NON-CARDIAC dzs: airway dz, parenchymal dz, pleural space dz
wut goin' on here?alveolar pattern in L sided backwards HF-- pulmonary edema- water in alveolus- looks like trees in a snowstorm (she says: dog is drowning! give lasix, get that water out)
wut goin' on over hur?top arrow pointing to L atrium pushing up on L mainstem bronchus. (damn good reason to be coughing)
with your complete PE, Pay close attention to MM and CRT....why?Anemia or hypotension and poor perfusion, Differential cyanosis
what is something you might feel on abd palpation with CHF?fluid wave
what is precordium? it's the the region of the thorax immediately in front of the heart. Palpate that shit.
how do you detect Arterial pulse abnormalities? what is the reason for these?you MUST PALPATE THE PULSE WHILE YOU ASCULT THE HEART. (she will take points off your OSCE if you don't do this. for realz). Abnormalities are due to pulse pressure differences. DIAGRAM: Pulse pressure is Pressure of Systolic minus pressure of Diastolic. (so if diastolic drops and systolic rises, get a bounding pulse)
what thing should you palpate in the body that you wouldn't really think to palpate which might relate to heart problems?thyroid
Why would you want to do an eye exam if you suspect cardiac dz?look for retinal hge and detachment
Jugular pulses happen because of increased venous pressures. What are 4 main situations where there is inc venous pressure?(1) r sided heart failure (backs up the cr vena cava) (2) pericardial dz (3) volume overload (4) cranial mediastinal mass
3 main reasons you'd have R sided heart failure, leading to jugular pulses?tricuspid dz, pulmonary hypertension, caval syndrome
What is caval syndrome?Caval syndrome is an acute manifestation of heartworm disease that occurs in association with a large number of heartworms in the right heart that entwine around and pass through the tricuspid valve apparatus.
When doing cardiac auscultation, you listening to both heart ___ and heart ___ . (of these two categories, what are you paying attention for?)(1) Heart sounds (normal? abnormal? extra sounds? murmurs?) (2) Heart Rate and Rhythm (normal, tachycardias, bradycardias, gallops, arrhythmias)
examples of some abnormal lung sounds?Crackles, wheezes, rales, or general dec sounds